Hello, Fissure with Sentinel pile is a very common problem. Fissures usually cause pain while passing stools and occasionally some bleeding also occurs. Most of the fissures gets cured by ayurvedic medicines only. No therapy or surgery is required in most of the cases. Kshar Sutra Therapy is required only in those patients in which medicines are not able to give desirable results. Sentinel pile cannot be cured by medicines, it needs Kshar Sutra Therapy for permanent cure. All d best