Grade 2/3 piles and severe constipation.

1. I have externo-Internal piles and severe constipation 2. Initially I get type1 stool or hard lumps then I get soft stools 3. I tried many laxatives but they couldn't stop my initial Hard lumps. 4. pegalup was working before but now its not working. Can I take it twice a day (25ml in morning and 25ml at night) ? 5. I consulted 4 doctors, 1 doctor said I have enlarged rectum which makes stool to wait for longer time at rectum causing stool dry and hard. 6. Doctor said I need to go for surgery but if I go for surgery does my rectum issue gets resolved? 7. If I get hard lumps even after surgery then I can't bear that pain at anus. 8. Should I take any scan to confirm my rectum issue? 9. Can I go for surgery or need to fix my rectum problem? 10. I do follow strict diet with 3-4 liters water intake, fiber rich foods and excercise daily. 11. Please advise why I am getting constipated even after taking laxatives and good amount of fiber and water? 12. I have sphincter muscle stiffness also.