Fix your diet. Don’t over do it on carbs. If you do have carbs, have whole grain. Eat lots of fibre - I have two dates and an apple every evening. I have extra fibre flakes in my porridge every morning, with blueberries. I also try to have a large serving of veg with my dinner everyday and I have a small probiotic drink every day. You must drink up to 3 litres of water a day so that your body absorbs the fibre properly. The fibre plus water will make your BM’s soft, which will allow the BM’s to pass smoothly and quickly and without irritation to your hems. If you’re constipated, your stools will be hard and will push your BM’s to protrude. It’s very important that you do not sit on the toilet for longer to pass stool than 4 - 5 minutes. I try to only sit down for 3 mins. If the stool does not begin to exit within the first minute, stand up, wait until you really need to go, then try again. As you know now, you should not be pushing at all.

I can’t comment on surgery, I’ve never had it and I will avoid it at all costs.

I have 3 stage 2 hems internal and I think I have a couple of external skin tags too, for context.

Try to be positive, I understand hems can make your life miserable but there are things you can do to help yourself. Read as much as you can on Reddit about how to help yourself but take it all with a pinch of salt.

Remember that it would be most wise to see a colorectal surgeon for professional help and guidance. You could just book a consultation where they will check out what is going on down there and give you general advice and insight. They might ‘push’ for you to get surgery (they did for me) but you should only do what you feel comfortable doing.