Hello doctor, I am 25 years old. I am suffering from fissure for the past one year but it is not healing properly. I am using Lox-2%, Osil and stool softener Softovac now regularly. Last time when I consulted a doctor he told me that I am having piles too with warts. Warts are now disappearing as I used Imiquimod for more than a month but it caused the skin around my anus red, little itchy, and inflamed. Please help. I am an HIV positive person. Can I use Candid around the anus?
Hello, Welcome to cliniq.com. I see you have taken all the necessary medications for the fissure in anus. What I would like to tell you is you need to do two more important things. Firstly, since you have fissure and piles I can guess you might have constipation quite commonly hence you must be straining to pass the stools so I suggest you stop straining while passing stools. Next, add fiber to your diet. Consuming one cucumber and carrot a day will help you a lot to avoid constipation. Also, drink plenty of water throughout the day. Secondly, how you use the medication is also important. I advise you to do a sitz bath twice a day (add Betadine 5 ml in lukewarm water in a tub and sit on it for 5 to 10 minutes). Next apply the Lox-2% (Lignocaine hydrochloride) cream (opaque) and not gel, as gel does not get absorbed and the cream crosses the skin. Apply it before passing stools and immediately after cleaning yourself after passing the stools. You can apply it whenever you have severe pain also. You can also take syrup Lactulose 15 ml at night time after food for 10 days. For the piles, if you have third or fourth-degree piles then surgery is the only choice. For first and second degrees you can treat by tablet Daflon 500 mg one tablet a day for 14 days. Apply Pilex ointment or Hemoproct ointment before sleep in the anal region. Avoid anal sex if any until the fissure heals. Lastly, all acute fissure can be treated by the methods I have mentioned here and more than any medication follow the dietary advice and you can keep the fissure occurrence under control. However, if the fissure is persistent for more than two to three months it is better to get operated. Suggested operations are lateral internal sphincterotomy for the fissure and hemorrhoidectomy for piles. Also, keep a check on your viral load and Cd4 counts. I hope this helps.