From my research thus far I think I have a sentinel pile and have had for years. However, it has never swollen up like it is now. I get lots of itching at night. Lots and Lots of itching. The scratching has thinned out the skin and i have several open sores...I don't know if I actually have a fissure or not. The skin on my right cheek looks like i've got poison ivy or maybe a chemical burn. I've washed the area with denorex, use Tucks, and eat a ton of fiber. However, I have been drinking more coffee lately (which i'll stop) and haven't heard of a sitz bath till now (which I'll start). Should I be using something like neosporin? I've tried so many things I'm now experimenting with just trying to keep the area clean with no additives so to say. I may need to bump up my water intake and will do that. I've not experienced the sphincter tightness I've read several describe, nor any crazy constipation. Lately, the bowel movements aren't real comfortable, but they are expelled easily enough. Any ideas on the skin issue (looking like a chemical burn or poison ivy)? Or the itching? If I could stop scratching I think I could start healing.