External Hemorrhoids. External hemorrhoids can be treated medically or by surgical excision. Surgery can be done under general or local anesthesia and is painful. I recommend it only when medical management fails. In most cases, topical barrier cream, fiber, and fluids and careful hygience suffice. If you consider surgery, try to identify what symptom is bothering you and if is your hemorrhoids or something els.
Consistent Treatment. Most external hemorrhoids can be managed with home treatment. The key is consistent treatment. This includes adding fiber to your meals, drinking more water, and using over-the-counter ointments for a limited time to stop itching. You also may use stool softeners to treat associated constipation. If there is a sudden increase in pain, this may indicate a clot inside the hemorrhoid and in this case incision and evacuation of the clot or excision of the hemorrhoid may be needed.
Seek surgery consult. Long term hemorrhoids can be caused by lifestyle activities such as prolonged sitting (truck driver), straining on defecation (chronic constipation), prolonged sitting on the toilet, or from having children. There are internal and external hemorrhoids which can have different causes. It depends on how bothersome they are such as recurrent bleeding, chronic pain, that determines when to see a md.
Exanmination. You will need professional examination and history to determine your best outcome.