An anal fissure is a tear in the lining of the lower rectum that is caused by injury to the anal canal while hemorrhoids are swollen veins in the anal canal. Sometimes anal fissures and hemorrhoids develop at the same time, as you have stated in your case. Those hemorrhoids and anal fissures that have not healed after 6 weeks are a long-term problem (chronic). If your chronic hemorrhoids and anal fissure does not heal with medicine, you may need to see a gastroenterologist
or preferably a general or a colorectal surgeon
. During an exam, the doctor
can help you figure out if another condition may be causing your condition. In general these hemorrhoids and anal fissures occur when you strain to move stool (i.e, constipation or diarrhea) and cause the veins in tissue inside the anus to swell and tear. However, there are also some other causes. They include anal cancer, colon cancer, and inherent bowel diseases, such as irritable bowel syndrome, Crohn's disease, and ulcerative colitis, etc. Once these conditions are ruled out, there are a number of conditions that can cause resistant constipation. I recommend that you see a colorectal surgeon for an evaluation. Some people can have terrible constipation that will eventually require surgery to remove part or all of the colon. Likewise, both hemorrhoids and anal fissures should be examined by a surgeon and possibly treat.