I am a 19 year old female with a 4 year history of piles. I have pain, a small lump, burning after passing stool, and occasional slight bleeding (few drops of bright red blood). I also have chronic constipation. Without laxatives, I pass stool about twice a week with hard stool and moderate straining. With laxatives, it becomes soft and occurs every alternate day. However, recently laxatives are not working as effectively. I have tried Isabgol (initially helpful but later ineffective). A doctor previously prescribed Movicol, Looz (PEG), and Pruwel 2, which work only while I continue them, constipation returns if I stop. Currently, I am not taking any medication. My questions: 1. Do I need long-term medication or any further tests? 2. Is this still manageable with lifestyle/diet or do I need a procedure/surgery? 3. What is the safest long-term solution for constipation so that piles don’t keep recurring?