Anal fissures can cause severe pain, burning, and throbbing after bowel movements because the small tear in the anal lining keeps getting irritated when hard stools pass through it. Even though your haemorrhoids are improving, the persistent fissure pain suggests that the area is still not healing completely, most likely due to ongoing constipation or passage of hard stools. Along with continuing the medicines prescribed by your doctor, the most important part of treatment is keeping the stools consistently soft and avoiding strain during bowel movements. Drink plenty of water throughout the day and increase fibre intake through fruits, vegetables, oats, salads, and whole grains. Warm sitz baths, where you sit in warm water for 10-15 minutes several times a day and especially after passing stool, can significantly reduce pain, improve blood flow, and help healing. Avoid sitting for long periods and do not delay the urge to defecate. Since even higher doses of Cremaffin are not giving adequate relief, you should revisit your doctor because the dose or type of stool softener may need adjustment, and sometimes additional medicines are required. Diltigesic gel usually helps by relaxing the anal muscles, but fissures may take several weeks to heal completely. Frequent use of painkillers should be avoided without medical supervision because they may cause stomach or other side effects. If severe pain continues despite treatment, or if there is bleeding, swelling, fever, pus discharge, or difficulty passing stools, a surgical consultation may be needed because some chronic fissures may require procedures such as Botox injection or minor surgery for proper healing. Early follow-up with a colorectal surgeon or experienced general surgeon can help prevent the problem from becoming long-term.

To treat anal fissures, therapy focuses on softening stools and relaxing the anal sphincter muscle. Key medications include: 1. Stool Softeners/Laxatives: Over-the-counter options like docusate sodium or polyethylene glycol, combined with fiber supplements, prevent straining. 2. Topical Pain Relief: Lidocaine ointment can numb the area before bowel movements. 3. Prescription Ointments: Nitroglycerin (0.2%) or calcium channel blockers (like diltiazem cream) relax the sphincter muscle, which improves blood flow and promotes healing.Additionally, taking warm sitz baths for 15 minutes daily helps soothe the area. Please consult a healthcare provider for a proper prescription.