Brief Answer:
As discussed in details below.

Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
Read the history carefully, noted the findings and understood your concerns.
My opinion and suggestions with explanations as required:
- Itching and stinging still persists, painful bowel movements in spite there is no anal fissure, stretch marks around anus, applying coconut oil locally.
This history is suggestive that you still have a problem. The possible causes are as follows:
- Thinned out skin due to long term Anovate locally.
- Fissure in ano still persists but may not be visible.
- You might have colitis/intestinal infection: the stool in contact and the bacteria therein does not allow proper haling or causing excoriation of the anal/peri-anal skin; the daily process not allowing healing an keeping the skin healthy.
- Possible deficiency of multivitamins, particularly Vitamin A and D, you may please get Vitamin D estimates and take supplements as per the findings.

I would advise you the following in such a situation:
- First of all send the stool samples for lab tests for 3 consecutive days. This is very important investigations which may give a great clinical evidence.
- Tests of blood: CBC, sugar, thyroid functions
- A course of an antibiotic and metronidazole, these being a prescription medicines, you need a valid prescription of these.
- Probiotics, activated charcoal tables like gasex, yogurt/curds, banana do help.
- Therapeutic dosages of Vitamin A and D as per the tests; also may need Iron, folic acid and other supplements in the form of multivitamins.
- stop applying anything to the peri-anal area, not even the soap. Clean the area with plain water 2-3 times, make the area dry with a cotton clothe or hair dryer.
You may please apply Liquid povidone iodine (Betadine twice daily to keep the area sterile.
- Sitz bathe before and after passing motion.
All these efforts will help to recover from whatever problems you have and thus help recover the anal and peri-anal area.
Thus the skin may recover to the original condition.
It will take 3 - 6 weeks for a good recovery. The healing continues on for about 9 months as it applies to any part of the body.
Start on the suggested course of treatment and please give me the feedback about the progress.

I hope this answers your queries, please feel free to ask for further relevant queries if you feel that there is a gap of communication.

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Brief Answer:
As detailed.

Detailed Answer:
Thanks for your feedback.
I have mentioned the full line of treatment above that will help to recover the skin to normalcy.
I have also mentioned not to apply anything to the skin there, not even the soap.
Please follow and you will be fine.
Have started with the medications.
If required, discuss the issue with your family Doctor and get a valid prescription and start treatment asap.
Let you wait and see the results, do not apply any barrier creams at the moment.
Additionally:
Use loose underwear and pants.
Allow well aeration when at home.

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Brief Answer:
Thanks for your appreciation.

Detailed Answer:
You are most welcome.
Awaiting for your feedback.

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