There have been a few posts recently from people who find it really painful going to the loo 'cos of hemorrhoids or anal fissures. I thought I'd post some advice my GP gave me which has really helped me. My problems probably began when I was not drinking enough water. I did not feel thirsty so did not realise i was dehydrated but it was causing hard painful stools and after some months every time I went to the loo it was like passing glass it was so painful and there was a lot of bright red blood. So I hauled myself to the GP and was told to make sure I drank plenty of water, eat fruit and veg, exercised (all the usual stuff).
However, my GP also mentioned that toilets are really badly designed in that they put a lot of pressure on internal blood vessels in the anal canal. She advised that I invest in a squatty potty or squatty stool. They cost about £10 from Amazon or ebay etc and are available in lots of countries. It is basically a stool that you rest your feet on so your knees are above your thighs when sitting on the loo (I am sure you can try this with a stack of books too). This changes the pressure on your anal canal from pushing and makes it a LOT easier to go. It took me weeks to get used to it as it is uncomfortable on the thighs at first - a bit like correcting back posture is uncomfortable at first - and I tended to use just for a few minutes. But now I have got used to it and it is so much better. My piles are too large to vanish but it is now rarely painful or bloody when i visit the loo and of course since it is not a medication there are no side effects.
I'd definitely recommend that people with this problem look into this as a possible way of relieving symptoms and perhaps trying out a homemade system such as books before paying for a toilet stool just to see if it helps you too.