Since your current options aren't providing relief, you may benefit from targeted medical treatments. For pain relief and healing, ask a doctor for a prescription topical ointment containing lidocaine (to numb the pain) combined with diltiazem or glyceryl trinitrate (to relax the muscles and promote healing). Additionally, taking a daily stool softener like lactulose or psyllium husk will prevent straining. Warm sitz baths (sitting in warm water) for 15 minutes after bowel movements also help significantly. Please consult a healthcare professional to get the correct prescription and ensure proper healing.