How to treat chronic hemorrhoids with sudden severe pain and itchiness in the anus?

Hello doctor,

I am 52 years of age. I have a history of piles or hemorrhoids from my late teens onward. The condition was on and off. I have never had surgery. In the past, I was treated with Daflon 500 and Anovate cream. With a change of diet (less meat), the problem used to get solved. The above medicines were suggested and treated by a doctor. I used to have some bleeding occasionally also during that time.

It was nine years ago I had the same problem, and at that time, the doctor had given me Oxerute CD tablets and Oxerute cream. That medicine worked wonders, and I have been fine since then.

I was fine for many years. But, lately, one month before, I am noticing some growth in the external part of my anus, which is very painful and itchy this time. I am sharing the photos here. I am taking homeopathic R13 (Reckeweg) medicine and applying Oxerute cream. But unfortunately, the problem remains with pain and itchiness.

I am also under medications like,

• Prodep - 20 mg daily.
• Udiliv - 300mg twice daily.
• Storvas -10 mg daily at night.

The pain is only present when I pass stool. But there is no bleeding this time. So please suggest some medicines to me.

How many times a day should I take Oxerute CD or Daflon-500 (whichever is better)? I also want to know if it is piles or fissures. I am not comfortable with surgery. So please do not suggest surgery.