A 37-year-old man presented to you with intermittent hemorrhoid bleeding and irritation. He reported a long history of constipation and straining with bowel movements. He has embraced a high fiber diet and increased water intake. Bowel movements are passing well without straining. He still notes large anal tags and intermittent irritation though much less bleeding. His symptoms have not completely resolved. He is interested in additional treatment to reduce symptoms. The best option for him at this time is
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