Brief Answer: Possibly it is a fissure and not a hemorroid . Detailed Answer: Hi XXXXXX ! Good evening. I am Dr Shareef answering your query. Usually uncomplicated hemorrhoids do not cause much pain excepting for bleeding in drops or in a spurt. What I feel from the description of your symptoms, is that you might have rather got a fissure in ano ( a cut in the skin around the anus), which occurs due to constipation/hard stool resulting in the tear of the peri anal skin mostly on the posterior aspect. This gives rise to severe pain with burning, and also blood which comes as a streaking in the stool. This condition is often interpreted as a hemorrhoid in common population. The treatment of fissure in ano is usually conservative to start with. 1) First in the list of treatment is a dietary modification towards more of roughage including fresh vegetables, salads,fruits, and enough of liquids so that the stool bulk is formed and it does not become hard. 2) Next is you can go for some anti inflammatory drug for a pain relief, a proton pump inhibitor, a stool softer like Loose or the like so that you pass stool comfortably without any fear of pain. 3) Add to this a local anesthetic like Xylocaine gel 2% especially before going for the toilet. 4) You can continue using Diltiazem cream as this relaxes the spasm of anal sphincter caused due to pain and helps in the passage of stool and healing of the ulcer. 5) One more addition will be an antibiotic covering both aerobic and anaerobic organism to help healing of the ulcer. 6) One of the most important addition to the conservative management programme is a sitz bath (sitting on XXXXXXX warm water with betadine lotion in it) at least three times a day, which helps in healing of the fissure and relief of the pain as well. With the above regimen, the fissure might heal up completely with good symptomatic relief. However, you have to follow the dietary modifications as noted above permanently to avoid its recurrence due to constipating diets like high protein diet (meat etc) and less of water intake. In case it goes on recurring, then you have to get your self examined by a general surgeon who will first confirm by physical examination that you have got a chronic fissure, and will decide that you need a surgery for a long lasting cure. The surgery is usually not a very major surgery (lateral sphincterotomy), but has to be done under general anaesthesia/spinal anaesthesia depending on the decision of the aneasthetist. I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts. Thanks for choosing health care magic to clear doubts on your health problems. Wishing you an early recovery. Dr Shareef.

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Brief Answer: Try for medicines of good international brand. Detailed Answer: Hi XXXXX! Nice to hear from you so soon. This shows your concern on your health. If I were your doctor, I would advise an oral antibiotic containing ciprofloxacin and tinidazole from a good reputed brand available in the market twice a day for 5-7 days after meals. I would also advise along with it a proton pump inhibitor like pantoprazole 40 mg once a day, and a probiotic containing lactobacillus twice a day. There are many good international brands available with good chemists, and please do not go for local brands. You might need a prescription for these drugs from your local practitioner. There may not be any necessity for an anti biotic cream as such. Thanks and take care. Dr Shareef.

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Brief Answer: You are welcomed. Detailed Answer: You are welcomed. Hope an early relief for you. Dr Shareef.

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