Please help!

You can try OTC treatments for hemmroids, but I think you need to speak to a doctor first about the anal fissures. One, you may not can use hemmroid creams and suppositories when you have them. Two, there may be something else you can apply to help them heal. Three, your fissures may be healed and it may be hemmies only that's causing your problems.

Yes, you can have all three at once. Is the bleeding bright red? If so, it's almost certainly hemmies or fissures (or both together). Make sure you go the doctor quickly, though, if the blood becomes darker or black.

Unfortunately it's very hard to treat Alternating C and D because treating one tends to give you the other. In most cases it's better on the fissures and the hemmies if your stools are soft or watery than if they are hard, but if you have a lot of D and have to stay sitting on the toilet a lot, just sitting down can put pressure on both the hemmies and fissures and make them worse. It's a very fine balancing act. One thing I have found, though, is that if I take Immodium for D, it constipates me. You may be making yourself swing back and forth with just medicine. If you take medicine for D, take less of it and see what happens. I cut Immodiums in half and only take one half at a time (if I still have D 30 minutes later, I take another half, and so on), or I take Pepto Bismol pills because they've never constipated me (warning: they will turn your stools black/dark but this is harmless--don't take if you have aspirin allergies, though).

I'm sure you wouldn't want to do it at work, but you can get a hemmroid doughnut to sit on at home. That might help make things better by spending less time sitting on them.

Are you on a multi-vitamin? I've started taking one of those and am feeling much better lately. D and other bowel issues can interfere with your absorption of vitamins, so that may be why you are feeling lethargic and groggy.