I'm sorry to hear that you're experiencing painful rectal bleeding again. Since this symptom has recurred despite previous treatment with Amikacin (an antibiotic), Pause (tranexamic acid, an anti-fibrinolytic), and Metrogyl (metronidazole, an antibiotic), it is important to have a thorough evaluation by a specialist.

• You should promptly consult a colorectal surgeon or a gastroenterologist to identify the underlying cause of the bleeding and pain.
• Avoid self-medicating further without medical advice, as persistent rectal bleeding can indicate conditions needing targeted treatment.
• If you experience severe bleeding, dizziness, weakness, or worsening pain, seek emergency care immediately.

Please arrange an appointment with a specialist doctor as soon as possible to get appropriate investigations and treatment tailored to your condition. If you want, I can explain what might cause recurrent rectal bleeding and what tests are usually done.To narrow down potential causes, we will need some more information.I understand you're concerned about the painful rectal bleeding you're experiencing, especially after previous treatment. To give you the best advice, could you please share your age and gender?