Hello, The extreme pain caused by hemorrhoids can be due to internal stretching of anal tissue by constipation. Primary guidelines at present: - Sitz bath (sitting in a tub filled with lukewarm water, 5 minutes each 3-4 times a day, particularly after passing stool) - Local application of xylocaine (5%) jelly over anal region after passing stool and taking sitz bath - High fiber diet with bulk forming laxatives as Ispaghula husk or Psyllium husk to get rid of constipation - Plenty of liquids, diet rich in green leafy veg, cereals, pulses, organic fresh fruits - Analgesic as diclofenac or tramadol hydrochloride gives best pain relief Excess sleepiness can be due to low hemoglobin or malaise and absolutely not a normal sign of hemorrhoid, which can t be neglected. Consult your general surgeon for further care in terms of hemorrhoids are concerned. As many cases do require laser therapy or band ligation procedure. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Bhagyesh V. Patel, General Surgeon