This is the exact treatment surgeons prescribe. Follow it for at least 4–6 weeks, not just a few days. A. Stool Softening – The MOST important part Your fissure will not heal unless your stool becomes soft daily. Start one of these: • Lactulose syrup 15–20 ml at night • Cremaffin Plus 1–2 teaspoon at night • Softovac pouch at bedtime • Isabgol 2 teaspoons in warm water nightly Do this every night for 4 weeks. B. Warm Sitz Bath (Twice a day) Sit in warm water for 10 minutes: • Relaxes the anal muscle • Reduces pain • Allows ointment to work better Do this morning and night. C. Fissure-healing ointment (Essential) Use ONE of the following twice daily: • Diltiazem 2% ointment • Nitroglycerin 0.2% ointment • Nifedipine 0.3% ointment How to use: Apply a pea-sized amount just inside the anal opening using your finger. This relaxes the tight muscle and allows healing. Use for minimum 4 weeks. If you only used local anesthetic gel previously (like lignocaine), it won’t heal the fissure — you need Diltiazem or Nifedipine. D. Pain relief (if burning is too much) Use Lignocaine gel before passing stool. This numbs the area temporarily. E. Diet changes For next 4–6 weeks: • Eat papaya daily • 1–2 bananas at night • Oats, dal, sabzi, whole fruits • Drink 2.5–3 litres water • Avoid spicy food for 2 weeks • Avoid tea/coffee on empty stomach • Avoid sitting long on toilet

When to see a doctor urgently • Severe bleeding • Pain lasting many hours • Fever • Pus • Lump becoming bigger • New swelling These may indicate infection or abscess.