Hi. Thanks for your query. Noted the history of constipation with straining at passing stool, got pain at the anal area, hurts on coughing and can not do any heavy lifting, also hurts to sit down and feel like pulled muscle or sense cramp... As per the history you have provided, this looks to be a fissure-in-ano wherein there develops a small cut in the anterior and/or posterior part of the anal verge. I would advise you the following in such a situation: Sitz bath in a tub with warm water. Take laxatives to have soft stool. Avoid foods and beverages that cause constipation/hard stool. Anti-inflammatory like Ibuprofen at 8 hourly duration to reduce pain and inflammation.. Antibiotic and metronidazole may be needed as the fissure in ano is usually infected as suggested by the pain and so. Pulled muscles or dense cramps do not occur this way, usually associated with stress and anxiety. I hope this answer helps you as it helps all my patients.