This treatise serves as an exhaustive exploration into the multifaceted realm of anal fissures and fistulas, offering an in-depth analysis of their epidemiology, etiology, clinical presentation, and structural intricacies. The comprehensive journey through the anatomical and bio-chemical aspects includes a detailed examination of the anal canal's structural overview, blood supply, innervation, and anatomical variations, providing clinicians and researchers with a holistic understanding. Delving into the pathophysiology, the treatise elucidates the microtrauma, sphincter tone's role, inflammatory processes, and the chronicity of anal fissures. The molecular intricacies unfold in subsequent chapters, unraveling cellular responses to tissue injury, the role of inflammatory mediators, and the impact of cytokines, growth factors, and matrix metalloproteinases in tissue remodeling. Navigating beyond the medical intricacies, the treatise embarks on clinical history, physical examination, and a meticulous exploration of differential diagnoses. Diagnostic modalities, stool examination, and diet assessment are scrutinized to equip healthcare professionals with a comprehensive diagnostic toolkit. The treatise doesn't merely stop at diagnosis and treatment; it extends into conservative and pharmacological interventions, topical therapies, and surgical options. Chronic anal fissures, fistula formation, and implications for quality of life are thoroughly addressed, demonstrating a commitment to holistic patient care.