Third degree Hemorrhoids and anal fissure

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Hi, I am facing Hemorrhoids for last any years and on/off fissure too. But its terrible since last 5 weeks. My HM are third degree i.e. i have to manually reduce them i pass stool. I am done with Twice Antibiotic course, Steroidal creams, Pain ointments and now even GTN (which i am using around 7-8 times per day). Is there anyone else with similar i.e. 3rd degree HM and fissure problem?

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    Just to add that till date no benefit from these. My surgeon has asked for examination under anesthesia and surgery, but I am little fearful however it seems that i may take a second opinion and then might be surgery

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