Hello, Welcome to icliniq.com. After reviewing your history and pictures (attachments removed to protect the patient's identity), you got an acute on chronic anal fissure with sentinel piles. Your external piles are somewhat prolapsed, also most likely due to strain while passing stools. These two factors are the primary cause of pain right now. I suggest, Lidocaine gel - 2 % before and after defecation.
Hello, Welcome to icliniq.com. Thanks for writing in, and I understand your concern. You got a pilonidal cyst associated with the formation of the pilonidal sinus. It seems like it is not infected, but ultimately, it gets complicated with time. Hence, it needs a surgical intervention that is the excision of the cyst, preferably, and open healing with secondary intention.
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