Since they are caused by squeezing out something too big(go figure!), the repeated actions will irritate the area. Afterwards, hardened stools will aggravate and enlarge them, or cause bleeding. The key is to avoid large hardened stools, which is a dietary issue, not to be confused with DIET(or as Garfield the cat says, Die with a T). Increasing your fiber intake, be it with fiber supplements or fibrous foods, and a healthy balance and portion of the other foods will help. I've had bad flare ups prior to that time of the month hitting, so I adjust my intake to help by eating leafy green iron rich foods and lighter proteins like chicken and fish, and easing up on the hard iron rich proteins like beef, as this type of iron also seems to aggravate them by making the stools harder. I also take a shot of chlorophyll in my juice every morning(for some reason, it helps build blood volume, which is good due to me having an issue with anemia. I don't question it too much, I take it because it works), which also seems to help process my foods better, and the stools are less like ejecting .50 cal bullets out me bum!.
WitchHazel wipes cleanse and ease pain, loads of extra fibrous foods, fiber supplements, and as a last resort, Dulcolax to soften the stools and make the issue lessened. Oh, and warm baths with epsom salt(it'll sting, but it will also clean the area, which is very important).
Surgery is for the very large ones that are untreatable with normal methods. I know some have gotten the surgery because they think they needed to(most doctors will tell you to do the surgery), or for cosmetic reasons(yeah, no really?), and have had a less than stellar reaction to it.
Hope you feel better.