How do you treat piles fissure fistula? The Grade I and Grade II piles don't need any surgery if they are asymptomatic. But, for Fistula, there is no other medication possible for treating it. People with Fistula must and should undergo surgical treatment as there is no medical management for it. Piles are mainly the swollen blood vessels while fissures are kind of cracks and fistulas are an opening of a cavity. Piles are mostly painless and unnoticeable. Fissures cause a lot of pain. In the case of fistulas, pus is discharged out of the anal area.