hi welcome to the healthcare majic my name is Dr Ehsan have been through your concerns and worries regarding this haemorrhoids there are two key aspects in dealing with these I will try my level best to make your understanding of dealing this issue as easier as possible A) Life style modifications : hard stools are one of the key factors leading to pain , discomfort and bleeding from the haemorrhoids ... you will have to deal this issue by Diet modifications like you must take -diet rich in high fibers - diet with Low processed food -drinking plenty of water ( like 6-8 , eight ounce water glasses a day or even more ) - you can use stool softner drugs in case of constipation - ispaghul husk and use of plenty of fruits and vegetables keeps your bowels soft and relieves discomfort and you have mentioned that you do sitz baths in hot water , you should do sitz baths in warm water for about 15 -20 minutes 3-4 times a day and that water should be about 3 inch high at least . B) -you can use pain relieving drugs like Tylenol - some other over the counter haemorrhoid drugs are available in the forms of creams , lotions , foams, pads and suppositories which give relief to this condition and you can buy those without prescription C) procedures like -injection sclerosis in which a chemical is injected into haemorrhoids and that makes it a scar and relieves this condition - banding - cauterisation - coagulation - and off course Surgery is an other option (haemorrhoidectomy) I will recommend that you should start with life style modifications and if need then use Tylenol and haemorrhoid over the counter available medications hope this will improve your condition much in case of still having problem then you will have to consult your physician for further work up and management hope this answer helps you in dealing with this issue and if anything not clear then kindly just let me know . do write a review regarding this answer. wish you quick recovery and get well soon. Regadrs Dr Ehsan