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

### input:
need assistanceI am experiencing hemorrhoidal pain Xs 2 days.  I took a warm bath last night in Epsom Salt. I am also using Preparation H PRN. I have had this problem in the past where the hemmrhoid became thrombosed and had to be lanced by my MD. I would like to know at what point should I make an appointment to see my physician and if there is anything else I could do to relieve the symptoms.  age 26, 506, 165 NKDA

### output:

Hello, Welcome to Chat Doctor, Hemorrhoid is unlikely to cause pain unless complicated by thrombosis(clotting of blood). The cause of your symptom is likely to be anal fissure, which is a small ulceration at anal opening. Exact diagnosis will depend on clinical examination. In the meanwhile I would suggest you the following 1.  Chat Doctor.  2. High Fiber diet-Vegetable salad and Fruits especially citrus fruits. 3. Avoid Diet causing constipation- Especially those food stuffs containing refined flour like cakes, bread, biscuits, cookies 4. Hot Sat bath: Add a handful of common table salt in a tub of lukewarm water and immerse the bottom by sitting in it. Every such session should last for 15 to 20 minutes. Two such sessions a day, one in the morning and one before retiring to bed at night. 5. Local application of local anesthetic ointment like Xylocaine will help in relief of pain. Apply it 15- 20 minutes prior to every bowel movements and also before retiring to bed. 6. Nifedipine Ointment: Local application of it will relieve the spasm of internal sphincter and help accelerate fissure healing. Most of the patients have benefited from this by following it and making it the part of their lifestyle especially water intake and high fiber diet. Thank you.