Antiinflammatories v. S surgery. Only two options. Response or lack thereof will dictate next move.
External hemorrhoid. External hemorrhoids usually swell and cause discomfort. Squatting and straining at any endeavor is a common denominator. Sometimes they clot (thrombose). Acutely, i usually advise alternating ice packs and warm tub soaks. Creams rarely help. If an episode is focal and really bad, then local excision may be required. If more extensive involvement and happening over and over, then hemorrhoidectomy.