Has he tried Preparation H suppositories? They shrink plus they soothe. If he can't get the suppository inserted there is Prep H tooth paste like tubes so it can be applied on the outside. Also plain old Witch Hazel with a cotton ball applied on the outside is an astringent that doesn't burn but is actually soothing.

Also he should be taking Metamucil &/or stool softeners. This is a must to get his stool softened up so that it doesn't continually upset the inflamed hemorrhoids. Sitz baths also help with the pain

It has been a long time but I had them bad during and after my first pregnancy and this is all I remember doing. I hope he's feeling better soon. Very painful plus he doesn't want the surgery as it's awful too. We all know about how many nerve endings there are in that area!

Metamucil or oatmeal works wonders for me. Almost instant relief. My gastro doc calls Metamucil a stool regulator. If you have diarrhea, it thickens things. If you're constipated, it loosens things. Wonderful stuff, for me anyway!