Thanks your your query.
She has developed anal fissure
secondary to constipation
& after enema
simply the pain has returned because anal fiisure takes few weeks to heal provided the stools are kept soft during that period . Do not think of "anything else" at this stage.
An anal fissure is a small tear in the thin, inner lining of the anus. an anal fissure may occur when you pass hard or large stools during a bowel movement. anal fissures typically cause pain and bleeding with bowel movement. Anal fissures are painful and may cause your child to resist going to the toilet (or holding on). A vicious cycle can then set up with holding on making constipation worse and subsequent bowel movements more painful to pass.
Increase her fluid & fibre intake. ask your GP for stool softeners which need to be continued for 4-6 weeks as a minimum . By then anal fissure will get healed & her eating & toileting habits can be changed positively.
Hope you find the information useful.