3rd May 2024

A 35-year-old man presents with a 2-month history of severe anal pain during and following bowel movements.

A 35-year-old man presents with a 2-month history of severe anal pain during and following bowel movements. He also reports occasional spotting of bright red blood on toilet paper. He has no significant past medical history and takes no regular medications. On examination, a posterior midline anal fissure is noted. His diet is low in fibre, and he drinks minimal fluids.

Which is the most appropriate initial management for this patient?