Hi,Dear,Thanks for your query to HCM. Dear I read facts of your query and reviewed it in context to your health issues submitted in your query. I understood your health concerns and feel Concerned about them. Based on the facts of your query the reply of your query is- Your current health issues seem to be due to -Accompanied and hidden but Now Grad II internal Piles with existing external pile. The solid mass protruding in anus is tender, because it s Inteo-External Variant-of the Internal Piles, which other wise is the painful structure. Or it could be from Granulomatous mass from Crohn s disease with perianal pain and inflamation/ or it could be from Rectal malignant Growth with Secondary Anal piles-which is usually a painless. This is therefore more alarming condition and situation needs to be dealt by urgent Consultation with Surgeon . Therefore Cause of these complaints in your case needs to be investigated by physical Examination and proctoscopic examinatoin by Surgeon. Other causes-like Rectal Malignancy with secondary Anal piles / LGV and others, need to be verified,as discussed above.For this you need to consult Surgeon . Do s in your case- Check With Doctors as suggested above,who would fix the cause- which is mostly external painful small hemorrhoids with protruding Intero-External piles.Possibility of the Crohn s Granuloma with External piles needs to be ruled out. Rest in head low position to reduce the Congested obstructed Piles You need to Urgently plan Corrective Surgery -of High ligation of Intero-External piles ,as your case is bit neglected. Get physical check with Surgeon who would do needful physical and other investigations. There are many causes which need to be verified amongst the causes discussed above before planning specific investigations and remedies. Thus You should consult Surgeon. This would resolve the complaints of your s. Constant follow-up with local family or specialist Surgeon and Physician for long term would give you long remissions of such complaints in time to come,which would depend on meticulous follow-up treatment of your health concerns. Just don t worry and be patient and co-operate with your doctors,till you verify with your attending doctors. For early recovery-please follow above do s which would resolve your complex health issues. Hope this would help you to treat your health issues in the best way possible. Welcome for any further query in this regard to following link- http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229 Wishing Good Healthy Life!! Dr.Savaskar M.N. Senior Surgical Specialist M.S.Genl-CVTS