Sitz bath Maintain hydration Maintain hygiene Avoid oily and spicy food

Your symptoms are suggestive of a chronic anal fissure that is healing and recurring due to intermittent hard stools. Since this has been ongoing for more than 6 months despite conservative treatment, further evaluation is warranted. My recommendations: * Continue stool softeners such as Lactifibre (or polyethylene glycol if advised) to ensure consistently soft stools. The goal is to prevent even occasional hard bowel movements. * Continue a high-fiber diet, adequate hydration, and avoid straining during defecation. * Warm sitz baths 2-3 times daily can help reduce sphincter spasm and improve healing. Further evaluation: I would recommend consultation with a Surgeon. An examination is needed to assess for: * Persistent chronic fissure * Sentinel pile (skin tag) * Associated hemorrhoids * Anal sphincter spasm * Less common causes such as inflammatory bowel disease Treatment options if symptoms persist: * Topical medications such as diltiazem or nitroglycerin ointment (if not already tried) * Botulinum toxin injection for persistent sphincter spasm * Lateral Internal Sphincterotomy (LIS), which is considered the gold-standard treatment for chronic fissures that fail medical management and has a high success rate