Hello, If various lifestyle modifications and medications do not work then depending on the status and type of the piles and fissures one may have to go for surgery to get those fixed. Seeing a general surgeon in that case may be a good idea. Some of the lifestyle modifications that may help in piles are: 1. Trying to make the stool softer so that it pass out through the anal canal easily without straining. This can be done by including more green/leafy vegetables and fruits (high fiber diet) and drinking enough water up to 2.5-3L per day. The measure will also help with constipation and will help maintain regular bowel habit. 2. Laxatives may be helpful in making the stool softer and thus prevent any injury to the blood vessels in the anal canal and bleeding. 3. Regular exercise or physical activity also helps improve bowel habits and constipation, facilitating in easier evacuation of bowel. 4. Avoid straining while passing stool. Prefer Asian toilets than western ones if possible. Fistula should be examined by general surgeon and get treated with surgery if required. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Md Eftekhar