Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Initially it can be treated with dietary changes by having high fiber diet with lot of fluids and make your stool soft. There are few procedures which can be used but surgery should be avoided unless there is no improvement on conservative measures. In early phase this is initially treated with dietary changes by having high fibre diet with lot of fluids and make your stool soft. Also take fruit, vegetables, avoid chocolate, refined meat, overeating and food that causes There are supplements such as Psilium and Detralex which may help as well. Also, you should use sitz baths and have hemorrhoid cream such as Procten ointment. Also, you should use sitz baths by sitting in warm water for 20 minutes daily. Second, it can be treated with rubber ligation or sclerosation and in severe stages and this can be done in ambulatory settings. On the other hand, open the surgery is recommended onl y in resistant cases but for this you should consult proctologist about these options. Other causes include abscess and anal polyps but for this differentiation you should do proctological examination. Till that , try to follow my recommendations and see if this will be helpful. Hope I have answered your query. Let me know if I can assist you further.