Hi, Sorry to hear about your problems. Hemorrhoids especially external hemorrhoids are generally non-painful. Painful defecation with blood in stools is very much suggestive of anal fissure for which we usually advise topical creams like nitrates and lignocaine for pain relief. Furthermore, it is advised to take plenty of fluids and avoid constipation by taking ispaghul and some laxatives like castor oil and lactulose. Including more fibres in your diet like vegetables and green leafy salads is also found to be very effective in preventing constipation and hence reducing pain. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Muhammad Zahir Shah, Internal Medicine Specialist