Hello.
Thank you for your query at Doctorspring.com.
I understand what you are going through and will do my best to help you.
The intense pain, discomfort and spasm of the anus all indicate that you may have developed an anal fissure(a small tear in the anus) along with hemorrhoids. The bleeding on passage of stools could be from the hemorrhoids. This can be controlled by additional measures like a local anesthetic jelly applied before bowel movements to relieve spasm and decrease pain. I really appreciate all the healthy measures you have taken such as a high fiber healthy diet and increased fluid intake.
I have the following suggestions.
- An OTC containing Lidocaine like L-M-X® 5 rectal cream should be applied to the affected area up to 6 times/day for anorectal pain relief. There is no need for laxatives or any other cream.
- An OTC like Ibufprofen 400 mg, twice daily with food for 5 days will also give you good pain relief.
- Please do continue your healthy diet and plenty of fluids.
- Continue the 100% Psyllium husk, 10 g in a glass of water or juice, three times daily.
- Also continue the taking sitz baths for 15-20 minutes, after every bowel movement.
- Follow the above measures for 5 days. If symptoms persist, then you will have to see your PCP or a General surgeon for a per rectal examination which will give us an exact picture of your condition.
- I have seen your reports. You need to correlate your thyroid results with your treating doctor.
- I would strongly advise you not to take the Adderall as research shows no good evidence of performance enhancement and the harms definitely outweigh any benefit.
I hope this was helpful.
Feel free to ask queries.
Thank you.

Hello.

Yes, the 2% Lidocaine hydrochloride jelly will work. If you have a applicator cone in the package, you can use it to apply rectally about 10-15 mins prior to a bowel movement. Not more than 3 applications daily. Follow the instructions on the package insert carefully. This along with the Ibuprofen should provide relief.

You can continue using the "squatty potty", it is a good practice, and you can provide support to the anal region with your finger. 

You would have to get a physical evaluation done if symptoms persist after 5 days.

Let me know if I can assist you any further.

Thank you.

Hello.

If symptoms persist after 4 days, you can see a colo-rectal surgeon. 

For the pain, if Ibuprofen is not helping, you can take Celebrex 400 mg instead, once during the acute pain and 200 mg after 8-12 hours, on the same day. You can continue taking 200 mg, twice daily subsequently for the next 3 -4 days.

Norflex will not be of much help. So you do not have to take it.

If in case, your symptoms do not improve with this and measures mentioned earlier such as the Lidocaine jelly and sitz bath, you do not have to wait and can see the surgeon at the earliest.

Thank you.

Hello. Good to hear that your symptoms have improved. The pain might take a little more time to resolve. Please do continue the Analpram. Also, the tablet Celebrex, twice daily and the other treatment measures. You will get relief soon. Take care.