### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
i have noticed a small lump in there crack of my butt around the upper cleft or 2-3 cm below the coccyx. its not visible to the eye but can feel it and is slightly uncomfortable. It appeared about 6 months ago but went away and now its back again. Could you give me a clue what this could be. Im offshore and will have to book myself into a surgery for when I m home if its anything serious.thanks.

### output:

Hi. Thanks for your query. Thanks for a good history, and it suggests that this may be one of the following:-Sentinel pile is a small skin tag in the center, this occurs as a reaction to fissure-in-ano. -can be small fistula-in-ano. An examination by a general Surgeon can get you the most proper diagnosis. You may or may not seed a surgery. I would advise you the following. If your fissure is just for 3 months and if there are less than 3 attacks till now and there are no associated problems, you can try the following method of treatment, and you may NOT need surgery. High fiber diet. Avoid all the foods and beverages and stress-like conditions which gives constipation. Laxative for softening the stool-never allow the dose too much to cause liquid stools. Sitz bath-very important-just before passing a stool and after passing a stool. Clean the area very clear of the fecal soiling that remains after cleaning; use cotton soaked in the same water to clean. You can apply liquid provide iodine locally. Apply nothing else.5-day course of an antibiotic on prescription of a local Doctor. Add probiotics and multivitamins. Avoid stress and mental tensions at any cost; this is a very important factor.