First I would make an appointment to see a colon-rectal surgeon in your area and ask him for advice. If you have severe prolapsed internal hemorrhoid in a flower shape mixed with external hemorrhoid, then you will need a surgery to fix the problem. I had hemorrhoids since I was 5-6 years old and the prolapse begin when I was 12 years old. Back then the hemorrhoids will automatic go back in by itself. As I grow older to about 15-16 years old, I have to change my toilet habit to before I go to bed so I can bed rest and let the hemorrhoid go back in by itself without causing me much pain. When I get to about 20 years old, the hemorrhoids will no longer go back in by itself and I have to manually push it back in after bowel movement. Finally in January 17th 2011, when I am 26 years old the hemorrhoids no longer can be push back in and it stays outside. I tried all the natural treatment like eating more fiber, drink more water, keep the area clean after bowel movement, sitz bath, all the natural treatment you can name but it just doesn't work. So I was refer to a specialist on January 31st 2011 and my surgery was on February 1st 2011. When you see a colon-rectal surgeon, ask him how many operation has he done in the past and what are the early and late complication of having a surgery. Looking back I was so stupid not to have this operation done earlier because I was afraid to have a surgery and I read many horror stories online. You really have to ask yourself this question, can you live with the prolapsed hemorrhoids? If you can, then try out the less invasive treatment such as natural with fiber and water, spend less than 3 minutes on defecation, wash it with warm salt water after bowel movement and pat dry, gently push the hemorrhoids back inside if needed. If they are mostly internal prolapsed hemorrhoids, then maybe you should try rubber band ligation as they are less painful than surgery. If you have to have the surgery, then you need to make sure someone can take care of you for one week. My first week was a complete nightmare, I was in constant pain, and I lost about 15lb plus I have a lot of drainage coming out. My first bowel movement was a nightmare, I used up all my strength and strain really hard and a dime size stool came out finally. My head was sweating and my body was shaking, nearly passed out. I was return back to work on 2nd week laying on the floor with a pad since I can't sit down or stand for more than 5 minute or I feel like I need to use the bathroom again. My advice when you do the surgery is buy a sitz bath, put little bit salt and warm water on it and then you can sit and relax for 10-15 minutes to ease the pain. After 2-3 weeks when you heal better, stop with the sitz bath, but still use warm water and salt to clean your rectum so the area heal faster. You don't need to apply any cream, medication on the area except wash it 2-3 times a day. Right now I am 2 months after surgery and I felt great. No more prolapsed hemorrhoids and now I can have a complete bowel movement within 2-3 minutes. I suffered a minor anal stenosis, so I use my finger to stretch it every time I shower and now I am back to normal. I start doing this on the 6th week when I can touch the area without causing too much pain. The pain killers are not much useful at all, I stop taking it after 4th day. All it does is make me sleepy and the pain is still there. The only problem I have after surgery now is skin tags. I have couple of them hanging outside of the rectum and the surgeon told me it can be removed if I wanted. But as long as it does not bother me, then I will just keep it there as I don't want to have another operation done. The only bad part is I can't use toilet paper to keep it clean, so I just rinse it with warm salt water every morning after bowel movement and wash it again at night to keep it clean. I hope this helps.