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Anal abscess and hemorrhoids are among the most painful and embarrassing of all health conditions. People are so hesitant to talk about these embarrassing health conditions with their doctors, and doctors often avoid training in anorectal diseases, so many misconceptions exist.

This article explains anal fistula, anal abscess, and hemorrhoids, and offers ten home remedies for these common yet seldom discussed conditions. Here are the basic definitions:

• An anal abscess is an infection of the tissues lining the anal canal, forming an indentation in the anal wall. The most common kind of bacteria in anal abscesses is E. coli. Once the infection has breached the anal sphincter, the ring of tissue that holds the anus shut when bowel movements are not passed, an anal fistula often develops.
• An anal fistula is a second passage from the bowel to the outside of the body, usually formed by an anal abscess. Anal fistulas may also result from trauma to the anus, radiation treatment, Crohn's disease, cancer, fungal infections, and chlamydia. Glands lining the anus form an easy route for infection to spread from the access to the outside of the body.
• A common complication of chronic constipation, a hemorrhoid is an area of swelling into the rectal canal. Unlike an anal abscess, which is an indentation of the canal, a hemorrhoid swells into and blocks the canal. Hemorrhoids consist of a swollen vein plus unusual accumulations of connective tissue and smooth muscle. They are not, as often described, a kind of varicose vein.

The symptoms caused by hemorrhoids differ by their placement. Internal hemorrhoids, inside the anus, do not have nerves that can sense pain. These hemorrhoids, however, can emit a kind of mucus that can cause intense itching around the anus as the fluid leaks out. When internal hemorrhoids prolapse, pushing out the anus, they can cause intensely painful spasms of the anal sphincter.

External hemorrhoids have the same kinds of pain receptors as any kind of skin. The vein beneath an external hemorrhoid can clot after straining, whether straining at stool or strenuous physical activity, and also cause intense pain.

Medical treatment of anal abscess and hemorrhoids, as well as anal fistula, is usually surgical.

• The early stages of an anal abscess are treated by draining pus out of the anus with a syringe. If the condition is not recognized in time, the surgeon may make a temporary fistula to open all the layers of tissue surrounding the anus so they can heal.
• Surgery for anal fistula, called fistulotomy, opens an anal abscess so that the inner layers can heal. Infected tissue has to be removed, and the operation temporarily makes the opening to the outside of the body up to 2 cm (about 1") wider.
• Surgery for external hemorrhoids focuses on removing the entire vein, not just the clot. Surgery for internal hemorrhoids focuses on preventing the strangulation of the vein as it plops through the anus, an event that inevitably results in tissue death.

Complete relief of anal fistula, anal abscess, and hemorrhoids without medical intervention is rare. The question of home remedies or surgery for anal fistula, anal abscess, and hemorrhoids does not require choosing one approach to the exclusion of the other. Home remedies can greatly reduce symptoms. Here are 10 tips for easing the pain of these troubling anorectal conditions.

1. Try a sitz bath. Often recommended by doctors, a sitz bath, as its name suggests, a sitz bath is a warm bath in which the buttocks are immersed in warm (104° F/40° C) water for up to 30 minutes at a time. Certain essential oils added to the bathwater may help relieve symptoms. Valerian relieves spasms, and calendula, chamomile, or yarrow relieve inflammation. If sitting in the tub is impractical, a warm water spray also works.
2. Try omitting dairy products. Especially when anal fistulas occur in young children, the problem can be a sensitivity to cow's milk. Just be sure that other sources of protein and calcium are included in the diet. Replacing cow's milk with almond milk or rice milk also lowers the frequency of allergies, eczema, and bronchitis.
3. Drink up to 1/4 cup (60 ml) of raw cabbage juice once or twice a day. Cabbage juice contains a highly bioavailable form of glutamine that the bowel uses to make a "glue" that maintains the integrity of the lining of the rectal canal. It is also food for the healthy bacteria that line the colon and make up about 1/3 of the mass of soft stools.
4. Take up to 1,000 mg of vitamin C a day. Vitamin C seems to prevent formation of fistula when there is anal abscess. Don't take more than 1,000 mg of C, since higher doses can cause diarrhea, which can cause injuries to the anus similar to those caused by constipation.
5. Avoid excessive cleansing, which may cause anal itch. Whenever possible, cleanse with water rather than paper. Use only white toilet paper. The dyes used to make colored toilet paper can cause itch and inflammation.
6. Avoid heating hot peppers. The burning capsaicin in hot peppers survives digestion and can cause itching in places where you cannot scratch.
7. In small children, treat contributing conditions such as pinworms. Parasites may also contribute to
8. Sit down less, or use a ring-shaped cushion that takes weight off the anus. This reduces pressure on the blood vessels in the anal canal.
9. Drink slippery elm tea. Slippery elm causes the stomach to form mucus that coats the entire lower digestive tract. And, finally, and most importantly,
10. Treat constipation. Relieving constipation is probably the single most useful home remedy for anal abscess, fistula, and hemorrhoids.

How do you treat constipation? Avoid laxatives. Harsh chemical or herbal laxatives can cause painful bowel movements that make anal abscess, anal fistula, or hemorrhoids worse. Instead, focus on healthy diet:

• Drink at least six to eight glasses of water every day.
• Gradually increase your consumption of fruits and vegetables to 5 to 9 servings a day.
• Take fiber supplements (always with water), but only if you also take Lactobacillus capsules or a probiotic yogurt. Bacteria break down fiber into a form that makes bowel movements easier.
• Avoid large meals. Eat less food so your colon has less food to process at any one time.
• Beware of bran if you get heartburn or have gastroesophageal reflux disease (GERD). Bran speeds up the passage of food through the colon, but it slows down the passage of food through the stomach. The bran you eat for breakfast may still be in the stomach at noon, leading to heartburn in the afternoon.
• Especially if you are diabetic, avoid sugar. The central nervous system slows down the passage of food through the intestines when blood sugars are high. Slow passage of food always aggravates anal fistula, anal abscess, and hemorrhoids.