Hello I want to tell you that these are two separate problems . 1 Piles or hemorrhoids , when such patient visit I advise them to use a cream ( nifedipine & lidocaine cream ) in anus three times in day as this will provide complete relief in pain as well decrease the size of piles . 2 Anal fissure ( commonly known as fistula in anus ) use dilator of different size . Start from less diameter to large diameter and use same cream as mentioned for piles before use of dilator. The most important step is don t go for DEFECATION or toilet till there is complete desire of defecation i.e don t strain over anus just for passing for stool . If you have constipation take high fiber diet as well you can take some laxative . If you are from India you can take some Ayurvedic capsule for piles and they are very much effective particularly in piles. Hope these information will be helpful for you.