age 45,male, since six months , constipation, burning sensation on defication,pain, How to manage this case, please advise And suggest medicines,

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Chronic Fissure in ano + hemorrhoids Stool softener, Tinidazole, antibiotics, DAFLON, PILON, Sitz bath, Proctosigmoidoscopy, to establish diagnosis, and to rule out malignancy Once acute stage is over, Hemorroidectomy and Fissurectomy Rule out DM and ulcerative colitis .

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Prolapse piles Sitz bath Anal stretching after local xylocaine gel Tab Venusmin 300mg tds Tab Brufen 400mg sos Lactulose 6tsf at bedtime sos for constipation Plan for haemoroidectomy

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It may be a case of anal fissure with prolapsed piles bunch Reposition of the prolapse mass Sietz bath Stool softener Lignocaine gel to apply Surgical excision of piles may be planned later on.

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Sentinel piles Surgical removal

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Anal fissure with haemorrhoids

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Piles Anal stretching Or surgery

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Prolapse piles Anal strectching Advise surgical removal

Brain storm... should have healthy marital life... needs counselling calmness symphony music lime juice... yellow banana cauliflower sweet potato beetroot coriander juice pineapple with black pepper sprouts kalijeeri alkaline diet figs dates raisins apricots dates ginger carrots pomegranates muskmelon walnuts blue berries sunshine walk prayers..under strict supervision of Doctor

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