Hi. Thanks for your query. Noted the history and understood your concerns. Piles and fistula together is rare to occur. Piles can be treated as per the grades and has many amenities like: Banding, injection therapy, excision ligation and so on... Fistula in ano is of 2 types. One is superficial fistula and can be cured by simple fistulotomy or fistulectomy. But the other type is deep one and needs specialized treatment as per the MRI or fistulogram picture. West Bengal has many good centers for treatment of both the conditions and hence can be treated and operated well. Till then have Sitz bath, take antibiotics and metronidazole along with probiotics and multivitamins. Consult a General Surgeon or a Proctologist and get the investigations to know the exact grading and types to get an appropriate management.