Aiyo, stage 4 hemorrhoid during pregnancy is really tough, I can feel your pain through your message! Since you're 21 weeks and the doctor already assessed you, definitely stick with what your doc prescribed (Daflon, the topical cream, paracetamol) as your main treatment, but I think your combo approach is actually smart, a few of us pregnant mums swear by sitzbath with Epsom salt for immediate relief, and the probiotic + prune juice thing really does help keep things soft so you're not straining and making it worse. Your update sounds encouraging already! That said, if the swelling or pain gets worse or you notice more bleeding, don't wait, just ring your doctor or go back to the hospital, because stage 4 needs proper monitoring even if surgery isn't the first option right now. Wishing you a smooth recovery and an easier second and third trimester, mama, you're doing great!