External hemorrhoid surgery

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Hi, im wondering if anyone can help me,

im having to pay privately to have an external hemorrhoid removed as NHS are classing it as 'cosmetic'

its not there permanently but comes back daily and causes me great discomfort, it swells up to a bulge outside my bum with a hard lump inside if i exercise, stand up for too long or after a bowel movement, sometimes when it goes down im just left with a little excess skin where its stretched.

i have recently had a private cons and the only option is surgery which im having to pay a lot of money for,

i am worried as in the letter the doctor has sent me he has written that the op will be to remove the skin tag, does this mean he will not remove the haemorrhoid as well? i am not bothered about the skin tag/excess skin it causes, i want the blood vessels removed that cause the uncomfortable swelling! but as mine is not permanently swollen does that mean if its not swollen he cant see what needs to be removed?

just wondered if anyone could help that had an external pile that goes up and down, are they able to remove it when its not flared up?

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