Long-standing external piles (hemorrhoids) are best managed with a combination of lifestyle changes and, if severe, minor procedures. Increase fiber intake, drink plenty of water, avoid straining during stools, and use warm sitz baths to reduce pain and swelling; topical ointments can give temporary relief. However, since it has been present for 10 years, it?s best to consult a general surgeon or proctologist to decide the most suitable treatment based on severity.

Pilorute cream may help relieve pain and irritation from anal fissures, but it's often insufficient for large or chronic cases. For effective healing, persistent fissures typically require comprehensive treatment under the guidance of a medical professional. Consult a doctor to determine the best course of treatment for your condition.