Brief Answer:
Unlikely to be hemorrhoids

Detailed Answer:
Welcome to Healthcare-Magic
Greetings of the day
Namasthe
Dear Mr XXXXXXX

Hemorrhoids usually presents with painless bleeding. The stools are streaked with bright red blood. Hemorrhoids are basically dilated veins present in anal canal and lower rectum. Pain is not a presenting symptom unless it is thrombosed (blood inside the vein gets clotted).
Presence of pain along with little blood coming out , I would consider diagnosis of anal fissure more likely. Fissure is a small ulcer which occurs at the anal opening usually due to tear at the junction of anus with surrounding skin usually caused by passage of hard stools. This small ulcer causes spasm of anal sphincter producing pain.
Before we plan for definite management it is important to make a correct diagnosis. Diagnosis of fissure is simple , visual inspection by separating the buttocks and seeing the anal opening is all that is required. If the hemorrhoid are external (situated outside the anus) diagnosis can be made by visual examination. Internal Hemorrhoids will require Proctoscope for diagnosis.

I would require further additional information
1. Has the diagnosis been made my good clinical examination by Surgeon?
2. How long has it been since her delivery?
3. Is her water intake adequate?
4. Does it pain after every bowel movements?
5. How frequent is the bleeding?

Do get back to me with the details. Assuring you of definitive and long lasting cure.

Take care

Best Regards
Dr Deepak Kishore
MBBS, MS, MCH
Consultant Surgeon

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Brief Answer:
Detailed treatment given

Detailed Answer:
Namasthe
Dear Mr XXXXXXX

I would suggest the following for treatment of fissure
1. Good water intake
2. Hot seitz bath; to a tub of lukewarm water add handful of common table salt. Make her sit in it for 15 to 20 minutes each session twice a day. After that she can take regular bath. It will decrease the congestion and pain
3. Tablet Dolonex DT 20 mg twice a day for pain. For 7 days
4. Syrup Lactulose 5 ml twice a day. The dose requires adjustment so that the stools are soft
5. Nitrogesic Ointment for applications; After bath apply ointment at anal opening. It will decrease the spasm and help in healing. Apply it twice a day
6. Xylocaine Ointment: 15 minutes before passing stools will relieve pain.

Do keep me updated with progress.

Take care

Best Regards
Dr Deepak

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Brief Answer:
Pulmocef not required in my opinion

Detailed Answer:
Namasthe
Dear Mr XXXXXXX

As its been documented her complaints are due to Fissure in anus.

Fissure in anus is a small ulcer present at anal opening. The ulcer causes bleeding when it is stretched by stools. It also causes spasm(contraction ) of anal sphincter muscle complex(smooth muscle). Spasm in turn causes pain and presence of spasm delays wound healing.
Aim of treatment should be
1. To provide adequate rest to ulcer
2. To soften the stools: Hard stools will cause further trauma
3. To relieve muscle spasm
4. Pain relief: Can be achived by Hot seitz bath, xylocaine, and relief of spasm

Pulmocef is an antibiotic, in my opinion antibiotics have no role in management of fissure.

Micronized purified flavonoid fraction (MPFF, 450 mg diosmin plus 50 mg hesperidin-Daflon 500 mg) is a potent venotropic drug used in the treatment of venous insufficiency. As the etiology(cause) of issure is not venous insufficiency, daflon also has no role in management Daflon may be beneficial in Hemorrhoids/piles but not in fissure.
It would also be helpful if you could provide clinical photograph for confirmation of diagnosis.

I hope I have clearified your doubts and cleared your dilemma .

Take Care
Best Regards
Dr Deepak

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