Brief Answer: A delailed assessment is required. Detailed Answer: Hi XXXX! Good morning. I am Dr Shareef answering your qurery. You have not mentioned any history of bleeding per rectum, but only pain which is not very much a characteristic of hemorrhoids. Normally simple hemorrhoids without any complication does not give rise to this kind of pain excepting for bleeding per rectum, but complicated hemorrhoids like a prolapsed or thrombosed hemorrhoids do give rise to severe pain with a usual history of bleeding per rectum prior to this. I am not aware whether a per rectal along with a proctoscopy was performed in your case before diagnosing it as hemorrhoids or not. If diagnosed after doing this test, then ok, otherwise simply from your history I would diagnose it more towards a fissure in ano ( a tear in the anorectal region) due to constipation and passage of hard stool than as a hemorrhoid. This would give rise to the pain like you described in your history, along with a possible streaking of blood in the stool at times. Whatever might be the diagnosis, for the present status of your perianal problem with pain and discomfort, you should continue your high roughage diet with enough liquids to avoid constipation, avoid spicy diet, regular sitz bath (sitting for five minutes on a container having lulke warm water ) which would reduce your discomfort and help healing a fissure or reduce edema of a prolapsed/thrombosed hemorrhoid at least two to three times a day, a stool softner, and possibly a short course of antibiotics and an anti inflammtory drug by your treating doctor. A regular morning walk and a active life style also helps in reducing chances of having constipation. In case these conservative means do not work or your symptoms increase preventing you to lead a normal life style, then I would advise you to take appointment with a general surgeon in your area and get yourself re assessed for further opinion and management. Pain in your back and leg might not be related to the hemorrhoids and could be a separate entitiy. For this I would advise you not to bend forwards, maintain your posture right while working on computers or otherwise, and take a muscle relaxant with an anti inflammatory to be prescribed by your doctor, which should relieve your symptoms. In case of the pain persisting, you might have to go for an ultrasound of abdomen to rule out any renal stones, and also might have to consult a orthopaedician for your back pain. 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.

---

Brief Answer: Insist on a re assessment by a general surgeon. Detailed Answer: Hi XXXX! Nice to have so fast a response from you. Yes, both the fissure and hemorrhoids could occur during the child birth due to pressure on the intestines giving rise to constipation, and also due to stretching and pressure on the surrounding tissues. Usually peri-partum hemorrhoids subside of their own post delivery excepting for a few cases where surgery might be required. Your doctor might be correct at that stage in saying after having a per rectal examination that it was hemorrhoids. But this could be the external skin tags (frequently known as external hemorrhoids) which grows as a natural protective covering over a fissure in ano. To diagnose actual internal hemorrhoids, one has to go for a protoscopy, which no doctor would venture in the acute stage when one has got pain in the area. Also the history of streaking of blood in your stool with pain goes more in favour of a fissure in ano than a hemorrhoid. As I already mentioned, at the present stage with acute pain, the management would remain the same in both cases. For a definitive treatment however in case of persistence of the symptoms, you have to consult a general surgeon in your area to get it reassessed and managed properly immaterial of whether it is a hemorrhoid or a fissure in ano. I hope I have answered your doubts. In case of any further clarification, please do so at your pleasure, and I would be glad to answer. Otherwise you are at your XXXXXXX to close the discussion after rating it. Thanks and good luck. Dr Shareef.

---