Hello.
Thank you for your query at DoctorSpring.com.

I understand what you are going through and will do my best to help you,
You seem to have Grade 3 Hemorrhoids (Piles) from your description. The hemorrhoids prolapse upon defecation and must be reduced manually in this stage.
Hemorrhoids are quite common and a cause of great discomfort. However, with proper management, good relief can be obtained.

I suggest you take the following measures:
1. Please take a diet rich in fibre like wholewheat cereals, fruits and vegetables. Also drink plenty of water, minimum 2 litres per day.
2. You need to start on a fibre supplement like Psyllium husk (Brand names: Isabgol/ Metamucil etc). Please take about 10 grams dissolved in a glass of water, three times daily. Adding fibre to the diet is beneficial for bleeding from hemorrhoids.
3. Please do not use Smuth cream for longer than a week because it contains steroids which cause thinning of the lining mucosa and other side effects. Instead of this, you can use Xylocaine jelly 2% prior to passing stools.
4. Please take Sitz bath after passing stools. Here you have to sit in a tub of warm water for 15-20 minutes. This will relieve pain and discomfort. You can add an anti-septic liquid to the water too.
5. In case of severe pain, you can take Ibuprofen 400 mg, once after food.
Please follow these measures for a week. If the symptoms persist, you need to consult a general surgeon for examination and further treatment.

I hope this was helpful. Feel free to ask queries.

Thank you.