Brief Answer:
A physical examination needed to confirm managemen

Detailed Answer:
Hi XXXX! Good morning. I am Dr Shareef answering your query.

Although it requires a local examination of the peri anal area before opining finally on your problem, I intend to let you know the possibilities based on the history only.

Starting from the common one, if you are constipated, you might have developed a fissure in ano ( a cut in the perianal skin) due to passage of hard stool resulting in pain over there.

Sometimes, though less frequently seen,the rectal muscle specially the levator ani muscles might go into spasm without any pre disposing factor giving rise to severe pain (proctalgia fugax) which might get relieved of its own or by some kind of anti inflammatory or muscle relaxant drugs. This condition might be associated with anxiety or depression.

I were your doctor, in this age group I would definitely go for a per rectal examination including a proctoscopy to rule out any intra rectal pathology.

Even though further management would depend on the examination findings, till then I would advise you for the following:

1) An anti inflammatory drug along with a proton pump inhibitor,
2) A stool softener like lactulose liquid at bed time if you are constipated.
3) Add sitz bath to it (sitting on a XXXXXXX warm water filled tub) three to four time a day for five minutes each.
4) Application of a local cream/ointment containing a smooth muscle relaxant like Diltiazem also helps and you might have to apply this locally for a long time like 6-8 weeks for a satisfactory outcome.
5) In case fissure in ano is confirmed on clinical examiantion, options for a broad spectrum antibiotic and other options of management are to be considered.

I am hopeful that you would get relief with this strategy, but to prevent the constipation, please avoid high protein diet, add to your diet a lot of roughage and fresh fruits along with sufficient liquids. Go for a regular exercise programme depending on your medical fitness.

I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts.

Thanks for choosing health care magic to clear doubts on your health problems. I wish you an early recovery. Dr Shareef.

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Brief Answer:
Use of diltiazem cream might help you out.

Detailed Answer:
Hi XXXX! Good evening. Good to listen from you.

In this case, possibly there would not be any fissure. However, you could still use creams containing diltiazem as this would relax the muscle tone in any case and thus relieve the pain of spasm due to any cause (except in an organic problem which could be known by a physical examination only). Also if there is any anxiety factor, please try to remove it.

Thanks and good luck. If you have any other doubt, please feel free to ask.

Dr Shareef.

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