Hi. Thanks for your query. Noted the history and understood the concerns. Your question relates to whether these are piles or anal fissure means you have to follow the routine things: Get an opinion of a General Surgeon for per-rectal digital examination, anoproctoscopy to first know whether you have anal fissure or pile or both or any other problems. This will help to know the exact diagnosis and hence give a proper plan of management. If there there piles, grade I and II needs medical management. If grade III or IV then you need a surgery. If the Fissure-in-ano is chronic and recurrent you need a dilatation under general anesthesia. In addition you have to follow the general principles of management. Sitz bath in a tub with warm water. Stool softeners and laxatives to keep the stools soft and easily passable. High fiber diet. Avoid outside foods and beverages.