Hi. Thanks for your query. Thanks for a good history and it suggests that this may be one of the following: -Sentinel pile is a small skin tag in the center, this occurs as a reaction to fissure-in-ano. -can be small fistula-in-ano. An examination by a general Surgeon can get you the most proper diagnosis. You may or may not seed a surgery. I would advise you the following. If your fissure is just for 3 months and if there are less than 3 attacks till now and there are no associated problems , you can try the following method of treatment and you may NOT need surgery. High fiber diet. Avoid all the foods and beverages and stress-like conditions which gives constipation. Laxative for softening the stool- never allow the dose too much to cause liquid stools. Sitz bath- very important- just before passing a stool and after passing a stool. Clean the area very clear of the fecal soiling that remains after cleaning; use cotton soaked in the same water to clean. You can apply liquid povidone iodine locally. Apply nothing else. 5 day course of an antibiotic on prescription of a local Doctor. Add probiotics and multivitamins. Avoid stress and mental tensions at any cost; this is a very important factor.