Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management

Olyad Erba

doi:10.48121/jihsam.1923118

EN

Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management

Abstract

Recurrent fistula-in-ano presents a significant clinical challenge due to high morbidity and the risks associated with repeated surgical interventions. This report details an N-of-1 observation of a patient with a Grade 3 fistula-in-ano who experienced a symptomatic recurrence one year post-fistulotomy. In a resource-constrained setting, management was achieved through a multimodal Supported Self-Management (SSM) framework, integrating topical phytotherapy via Neem (Azadirachta indica) sitz baths with systemic interventions, including mechanical offloading, optimized hydration, and dietary fiber intake. The protocol involved 15-minute immersions in a Neem-leaf decoction, with frequency titrated between three and two times daily based on pain, edema, and scar integrity. Following the intervention, all clinical manifestations—including persistent pruritus, abscess formation, and hemopurulent discharge—completely resolved. These findings suggest that Neem-based bioactive compounds may function as a biological tissue conditioner, enhancing scar elasticity and mitigating mechanical triggers in ways traditional saline baths do not. While this case offers a viable, low-cost model for enhancing health equity in developing economies, structured clinical trials are necessary to quantify the efficacy and long-term safety of this integrative approach.

Keywords

Ethical Statement

As the investigator acted as the subject of this study, formal ethics committee approval is not required for this single case report in accordance with institutional guidelines. However, in strict adherence to ethical standards, the author-patient provided written informed consent for the documentation and publication of this case report.

Thanks

The author wish to express his sincere gratitude to the members of School of Biological Sciences and Biotechnology, Haramaya University and Adama Science and Technology University PhD student friends for their generous financial and moral support during the medical treatment related to this case

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Details

Primary Language

English

Subjects

Primary Health Care

Journal Section

Other

Authors

Olyad Erba ^*
0000-0001-5552-6884
Ethiopia

Publication Date

May 22, 2026

Submission Date

April 4, 2026

Acceptance Date

May 17, 2026

Published in Issue

Year 2026 Volume: 12

DOI

https://doi.org/10.48121/jihsam.1923118

IZ

https://izlik.org/JA52YT64TB

Cite

RIS / Bibtex

APA

Erba, O. (2026). Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management. Journal of International Health Sciences and Management, 12. https://doi.org/10.48121/jihsam.1923118

AMA

1.Erba O. Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management. Journal of International Health Sciences and Management. 2026;12. doi:10.48121/jihsam.1923118

Chicago

Erba, Olyad. 2026. “Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management”. Journal of International Health Sciences and Management 12 (May). https://doi.org/10.48121/jihsam.1923118.

EndNote

Erba O (May 1, 2026) Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management. Journal of International Health Sciences and Management 12

IEEE

[1]O. Erba, “Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management”, Journal of International Health Sciences and Management, vol. 12, May 2026, doi: 10.48121/jihsam.1923118.

ISNAD

Erba, Olyad. “Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management”. Journal of International Health Sciences and Management 12 (May 1, 2026). https://doi.org/10.48121/jihsam.1923118.

JAMA

1.Erba O. Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management. Journal of International Health Sciences and Management. 2026;12. doi:10.48121/jihsam.1923118.

MLA

Erba, Olyad. “Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management”. Journal of International Health Sciences and Management, vol. 12, May 2026, doi:10.48121/jihsam.1923118.

Vancouver

1.Olyad Erba. Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management. Journal of International Health Sciences and Management. 2026 May 1;12. doi:10.48121/jihsam.1923118

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