From your history, it is encouraging that the bleeding has stopped and the pain has reduced, which suggests that the fissure is healing. The hard skin with a small lump at the outer end is most likely a sentinel skin tag, which commonly develops in chronic or healing anal fissures. At this stage (around 4 weeks), it is still early in the healing process. The skin tag may become softer and less tender over the next few weeks to months as inflammation settles. However, it may not disappear completely, as it is a form of scar tissue. This does not usually interfere with normal bowel movements once the fissure has healed completely. Continue with sitz baths, apply the prescribed ointment regularly, maintain a high-fiber diet, drink adequate fluids, and avoid constipation or straining during stool passage. If pain or bleeding persists beyond 6–8 weeks, or if the lump increases in size or becomes very painful, you should consult a general surgeon or colorectal surgeon for examination.

Based on your history it is suggestive of Chronic fissure with a sentinel pile; But there is no need to worry as of now, and continue the same conservative management which you are doing as of now.

Conservative treatment Diet modification High fiber Plenty of liquids Soft softener Sits bath Lox anesthetic medications for pain

Based on your history, this is most likely a healing anal fissure with a sentinel skin tag (sentinel pile). As the fissure heals, pain usually continues to improve over the next few weeks. The hard skin/skin tag may soften slightly, but it often does not disappear completely and can persist even after the fissure has healed. Continue warm sitz baths, maintain soft stools with a high-fiber diet, adequate fluids, and stool softeners if needed, and continue the prescribed medication. Avoid straining during bowel movements. If pain persists beyond 6–8 weeks, bleeding recurs, or the lump increases in size, consult a general surgeon/proctologist for examination, as persistent fissures may require additional treatment.

You have an acute anal fissure.Please avoid constipation. Take high fibre foods including vegetables and fruits. Please continue sitting bath, apply cremagel.  It should gradually resolve and you should be fine. In case of chronic pain and discharge  please consult general surgeon.

Do sitz bath and take good fibre diet with 4-5 litres of water For fibres you can take chia seeds

Sitz bath Maintain hydration High fibre diet Avoid oily and spicy food