1) Please stop planning a 5th local surgery until the cause is found — more cutting on an undiagnosed Crohn's/TB perianal disease makes things worse, not better. 2) Get these done: CBC with ESR/CRP, serum ferritin and iron studies, vitamin B12, albumin/total protein, stool for occult blood and faecal calprotectin, Mantoux/IGRA and chest X-ray, and a CECT enterography or MR enterography of the abdomen and pelvis. 3) An MRI of the pelvis/perianal region specifically will show any residual fistula track, abscess or scarring far better than clinical examination. 4) See a gastroenterologist for a colonoscopy with ileal biopsies — this single test is what usually settles whether it is Crohn's, TB or simple fissure disease. 5) In parallel, ask for a referral to a pelvic floor physiotherapist: for the pulling/burning pain going into the legs, pelvic floor relaxation exercises, warm sitz baths and a short course of a nerve-pain medicine (pregabalin/amitriptyline, prescription only) usually help far more than painkillers. 6) Correct the anaemia properly — most likely you will need IV iron rather than syrups, and treat the pica by treating the iron deficiency. 7) Please do not quit your job in a hurry; once the underlying diagnosis is treated, the pain and energy usually improve. You are welcome to consult me on Practo with your operative notes and all reports uploaded so I can go through the whole 6-year picture in one place, or meet me in person at Synergy Multispeciality Hospital, Miraj, if travel is feasible for you — this needs a proper joint surgical and medical review, not another quick fix.

Word of caution: go to hospital the same day if you develop fever with chills, a painful swelling near the anus, pus discharge, severe abdominal pain with vomiting and no passage of stool or gas, heavy fresh bleeding, fainting or breathlessness. Also please do not take repeated painkiller tablets on your own — NSAIDs can worsen gut inflammation and bleeding. If your periods are heavy, mention that too, as it adds to the anaemia.

Continue sitz bath 2-3times/day