A female 47 yrs suffering from excruciating pain in lower back and ano rectal region,with fever

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Excruciating pain anorectal region suggestive of fissure ano Adv local examination Rx inj diclofenac im Broadspectrum antibiotics like amoxyclav625mg 1bd Antispasmodics NSAIDs Seat bath in lukewarm water Locally apply anometerogyl oint twice daily Xylocaine gelly 2%frequently Review after one week

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Adviced USG...Abdomen & Pelvic Urine routine & Micro./ C.& S / CBC. If required proceed for Proctoscopy Till than MAFTAL SPAS DS..1 BD.

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DD Anal fissure Ca cervix Multiple myeloma affecting Lumbosacral nerve Rectal growth