Welcome to H.C.M. I am Dr Krishna Dubey. No need to be frustated because this is curable. Hemorrhoids are swollen blood vessels that may occur inside the rectum (internal) or outside the rectum (external). Internal hemorrhoids cause bleeding and leading to anemia( low hemoglobin) and if not controlled as you told about your brother that nearly two years of diet control and creams have not helped In such conditions surgery is only option. Till then start - Tablet- Dapson 500 mg thrice a day -very helpful drug for hemorrhoids. eating a high-fiber diet, staying hydrated by drinking eight to ten glasses of water each day, using a stool softener so you won’t have to strain during bowel movements. Thanx for query.