Hello,
From the picture, there seems to possibility of anal fissure secondary to constipation.
However, you’ll need to meet with a pediatric surgeon for proper assessment.
Next Steps
Continue Mu-out powder.
If she’s experiencing significant difficulty, she can be given a Dulcoflex 5 mg anal suppository or neotomic enema - they help in providing some immediate relief.
Please apply Lignox gel around her anal region after she passes stools - it will help to reduce pain.
Give her sitz bath daily - take a tub of mildly warm water and let her sit within for 10-15 minutes, twice a day for at least 7 days - will provide local relief.
Health Tips
Please ensure she eats a healthy diet - no junk food, green vegetables and fruits to be included and increase water intake.