Hemorrhoids are like exaggerated varicose veins in rectum and can protrude out the anus. If outward, they can become so engorged with blood, because of the pressure, the blood can actually clot and they are very painful, at this point they are "thrombosed" and must be treated by a physician. When they are like this, they will not retract in or shrink, so they can be "lanced" by the Dr. INSTANT relief and will heal up in a few days. You can use "Tucks" over counter thin pads that cleanse and relieve discomfort. They are an astringent with witch hazel.
If your Dr. doesn't do the procedure, call and get in to a GI doc or proctologist or be referred. I have had thrombosed hemorrhoids three different times and they were lanced, a very quick procedure and went on about my life the same day, even taking a car trip without any problems.
To have a hemorrhoidectomy, is much more involved and has a longer recovery. Sounds like you are putting up with a lot more than you should, if you are having them every month in four years. Get them taken care of so you don't develop other problems.
Proper fiber and nutrition, avoid constipation or diarrhea, avoid heavy lifting, and avoid long periods of standing, is conservative treatment.