Hi. Thanks for your query. Noted the history and understood the concerns. First of all you have to see that your Blood Sugar levels and Blood Pressure are well maintained over a time within normal range by regular checkup, followup and so on; I advise all my patients to keep the records so that a good Doctor can easily modulate your management as needed. I would also advise you to consult a General Surgeon for proper per-rectal digital examination and ano-proctoscopy to know whether you have piles and/or fissure-in-ano and to see that stage so that an appropriate management can be done under his guidance. Take Sitz bath in a tub with warm water. Laxatives and stool softeners to suit you the most. Avoid foods and beverages that cause constipation . Exercise daily and change the lifestyle to avoid stress and anxiety. If there is a fissure in ano as you have pain in anal area, anal dilatation under general anesthesia give best results.