I found suppositories were...crap
What worked best for me was a steroid foam but it's prescription only. You insert the tip and give it a squirt. You get some leakage but it's nothing much and it was the only thing (medication wise) that seemed to do the trick for me when they were bad. The only downside is that now the Pope says I'm going to hell!!!
I used to get the seeping into underwear too. It feels like your bum is sweating.
When mine got really bad I would get soreness, itching, some blood, the "sweating" issue, etc and I would bath in warm salt water. This really did help calm down the symptoms.
I think swgrl mentioned ice packs.
If you sit for a long time, that may not help. I was in offices at the time and found the naff chairs just made the pressure on that area made the sweating & soreness worse.
Maybe loose underwear might help too. Less rubbing.
I don't know in your case, Matt, because you've got some real issues going on and I think it needs a doctor to be sure there is no connection, whether it can just be the added strain on the body, but purely in terms of piles these things might be worth a try.