Brief Answer:
as explained in details.

Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Female/69 - constipation - pulsing beats in anus like hard - since the beginning of this week - started in single episode - now its like three or four times - bled last time - Using preparation H with cortisone ....

The commonest cause I can think of after reading your history is
Anal fissure with infection causing pulsing beats.
Thrombosed prolapsed piles/hemorrhoids.

I would advise you the following:

We have to find the root cause, its secondary effects and treat them together.
I would advise you the following in such a situation:

- First of all, consult a General Surgeon to get a clinical evaluation, per-rectal digital examination and ano-proctoscopy if possible/if pain allows to get the exact diagnosis. Without knowing the exact diagnosis and the severity/grade it is difficult to predict the best possible treatment for you.
- Sit'z bath in a tub with plain warm water. Please do not add anything to water and to be done 3-4 times in a day.

- Laxatives and the dosages to be adjusted as per your requirements.
- Please make a list of the foods and beverages that cause constipation or enhance your problems in any way and to stop them altogether strictly.

- Make another list of the foods and beverages that suit you the best and continue those alone. Do not try anything out of ordinary.
- Control of stress and anxiety if you have.
- Keep the area clean with plenty of water after passing motion.
- Stool analysis, blood and urine and get a course of an antibiotic (eg. Quinolone groups) and Metronidazole if there is any evidence of infection.
- Probiotics and multivitamins help in faster recovery.

These measures help a lot in complete recovery and avoiding the recurrence.

I hope this answer helps you, please feel free to ask for further relevant queries if you feel that there is a gap of communication.

Regards

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