Dear Dr. Gott: I am a 58-year-old post-menopausal female. I have four grown children between the ages of 28 and 38, all of whom were delivered vaginally. I am a small person – four feet, 9-½ inches tall – and I normally weigh between 95 and 100 pounds.

Over the past few years, I have put on about 50 pounds and have had several surgeries, including an umbilical hernia repair, torn-meniscus repair, cataract lens implants, a partial thyroidectomy, two cervical fusions and a lumbar discectomy.

I also have gastro-oesophageal reflux disease and irritable bowel syndrome.

I would have thought all of this was more than enough to go through, but this chronic problem (which started after the breech birth of my second child) has now gotten worse. This problem is haemorrhoids and a fissure.

My doctor and my gastroenterologist keep giving me prescriptions for suppositories and creams. I soak in very warm water and try to remember to eat fibre and take a stool softener every day.

I keep myself very clean and use special wet wipes. I use only non-perfumed soaps, toilet tissue and pantiliners. I also make sure that the area is always dry.

My dermatologist says not to use the wet wipes because the area gets so irritated, but I have to stay clean.

It was so sore for more than a year that he finally gave me an ointment to rub on. It helped, but it continues to get sore, painful and itchy. I can't keep living like this. Please help!

Dea reader: I don't believe a dermatologist is the best person for the treatment of your haemorrhoids and anal fissure. You should be under the care of your gastroenterologist, who is better equipped to handle the situation.

You also may be better served by seeking out a second opinion from another gastroenterologist, because your current specialist clearly isn't taking more aggressive steps to help you despite the failure of more conservative approaches.

Haemorrhoids are swollen, inflamed veins in the lower rectum and anus.

They may be caused by chronic diarrhoea, constipation, straining, pregnancy and more.

An anal fissure is a small tear or split of the mucosal lining of the anus. It can be caused by chronic diarrhoea; constipation; passing large, hard stools; and decreased blood flow to the area.

For both conditions, it is important to ensure that the affected area is kept clean and dry. Using special wet wipes or pads to cleanse the area is often beneficial, because they reduce irritation from wiping and the pads contain anaesthetic and antiseptic components, which reduce pain and lower the chance of infection. Both may also improve with the use of stool softeners and sitz baths.

Haemorrhoids that do not respond to these measures may require surgical repair. There are several minimally invasive procedures, including rubber-band ligation, coagulation and sclerotherapy.

Each uses a different method that results in the size reduction of the haemorrhoid. The more invasive techniques include removal of the offending tissue or stapling to block blood flow to the area of bleeding.

Anal fissures usually heal with time and modest home care. For those that don't, Botox injections or minor surgery may be recommended to relax the anal muscle. These procedures are usually reserved for the rare instances when the fissure becomes chronic, resisting healing.

Speak to your gastroenterologist or seek out a second opinion with a colorectal surgeon as to why you are continuing to suffer, and ask what steps can be taken to improve your quality of life. Clearly, more aggressive steps need to be considered.

Dr. Peter Gott is a retired physician and the author of the book "Dr. Gott's No Flour, No Sugar Diet," available at most chain and independent bookstores, and the recently published "Dr. Gott's No Flour, No Sugar Cookbook." Write directly to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.