instruction: 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 oil and stool softener softovac now regularly last time when I consulted a doctor he told me that I am having piles too with 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
output: 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 cumber 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 sit bath twice a day add betadine my in lukewarm water in a tub and sit on it for to 10 minutes next apply the lox 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 syearup lactulose 15 my 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 my one tablet a day for 14 days apply pile 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