Do connect and consult with me for better treatment plan and advice

Drink 3L water per day..try to have papaya daily..increase fibre in your diet..during your episode of constipation you can try sitz bath with turmeric and salt which I will be able to explain you if you consult me

If you want to discuss your problem in more detail, feel free to message me on WhatsApp at nine one one nine two five five six nine nine for a detailed discussion

First cure your constipation Grade 1 piles can revert to normal,  if constipation is corrected. Take high fiber diet, light meals in evening which are taken early. Pappaya consumption will help you. Drink more water. Take syp lactulose 5m.l every morning and evening for 2 weeks. Regular hot Seitz bath will help in curing haemorrhoids.

One medicine is suiting you. Please stick to it. Why do you want to change your medicine?

More history clinical examination n lab inv needed to comment anything ... Better have a consultation with surgeon

Better consult a surgeon

You can use duphalac 30 ml once a day

How phylthy

Hello. I have reviewed your concerns regarding Grade 1 internal piles and the return of bleeding. ​Managing Grade 1 piles focuses on keeping the stool consistency soft to avoid any trauma to the anal canal during defecation. You noted that bulky stools from certain supplements are triggering the bleeding again. ​Here is a breakdown of management options and next steps: ​1. Laxative Selection ​Osmotic Laxatives: Instead of "bulking" agents (like Isabgol or Softovac), which can sometimes create larger stools, you may find better relief with osmotic laxatives. These work by drawing water into the colon to make the stool liquid or very soft without increasing bulk. ​Options: Syrups containing Lactulose or Polyethylene Glycol (PEG) are often prescribed for long-term daily use in patients with piles to ensure easy passage. ​2. Immediate Care (Sitz Bath) ​To reduce local inflammation and soothe the area, I highly recommend a warm sitz bath for 10–15 minutes, 2 to 3 times a day, especially after a bowel movement. This helps relax the anal sphincter and can reduce bleeding. ​3. Dietary Adjustments ​Hydration: You must significantly increase your water intake (at least 3 liters a day) for any stool softener to work effectively. ​Fiber Balance: While fiber is important, ensure you are getting enough "soluble" fiber that softens the stool rather than just adding volume. ​4. When to Seek Further Evaluation ​Since you have been bleeding daily for 4 months, a Proctoscopy or Sigmoidoscopy is necessary if you haven't had one recently. This is to confirm the grade of the piles and rule out any other source of bleeding in the lower GI tract. ​Blood Work: A Complete Blood Count (CBC) should be done to ensure the daily bleeding hasn't led to anemia (low hemoglobin). ​Next Steps: I recommend switching to a Lactulose-based syrup at night and starting daily sitz baths. If the bleeding does not stop within 3–5 days of achieving soft stools, you may require a local application of a hemorrhoidal cream or a minor procedure like "rubber band ligation."

Internal piles + hard stool causing bleeding. Better use stool softener (like lactulose syrup) daily. Psyllium makes stool bulky → can worsen bleeding. Take more water, fiber, avoid straining. Consult if bleeding continues.

I understand this has been a frustrating journey for you, especially when you find something that works (like the Constihenz) only to have the bleeding return when the stool consistency changes. Dealing with Grade 1 internal hemorrhoids is all about management of "shear force." In your case, even "bulky" stools—which are usually considered healthy—can act like sandpaper against those sensitive internal vessels. When the stool is too solid or large, it stretches the anal canal and causes the hemorrhoid to bleed. The image you provided shows a stool that is roughly a Bristol Type 4 to 5, leaning toward a soft, semi-formed consistency. For a patient with active bleeding from piles, this "mushy" consistency is actually the goal because it passes with zero strain and minimal friction. Softovac contains bulk-forming laxatives (like Isabgol/Psyllium) along with stimulant herbs like Sana (Senna). While it adds volume, that "bulk" can sometimes be too abrasive for Grade 1 piles. My Recommendations for Daily Management will be Instead of bulk-formers, you should look into Osmotic Laxatives like DUPHALAC syrup. These work by drawing water into the colon to liquefy the stool rather than just adding fiber bulk. Lactulose Syrup: (Duphalac) This is a very common and safe long-term option. It is a synthetic sugar that isn't absorbed by your body but keeps the stool very soft and "liquid-adjacent." Polyethylene Glycol (PEG) 3350This is often the gold standard for your situation. It is tasteless, can be mixed into any drink, and allows you to titrate the dose until you achieve the exact "soft-serve" consistency shown in your photo. Liquid Paraffin (Stool Softener): This acts as a lubricant. It makes the stool "slippery," which significantly reduces the chance of the stool catching on the internal piles and causing a bleed.

The goal is to keep stools soft, not bulky or hard, to avoid bleeding. Psyllium husk can sometimes make stools bulky, whereas stool softeners like lactulose based may suit you better. Along with this, ensure good hydration and fiber intake. If bleeding is recurring, it’s better to plan treatment properly. I can guide you on the right regimen feel free to book a consultation with me.

Plz do consult a General surgeon, get reassessed for piles.. if it is recurring.

Cremaffin plus

Cremaffin during night Drink plenty of water

Avoid fried and spicy food Water intake more Do connect and consult

Need a few more details please consult for further evaluation and treatment

Can help you, kindly consult and provide detailed history for proper diagnosis and further management

Duphalac

Do consult

Both medications just help in piles. They are not permanent solutions. You cant be taking stool softeners for very long periods. Dietary modifications need to be practiced. And you need to periodically evaluate the piles.