40 years male painful NODULAR ulcerative lesion on anal area since 4 months oozing present Diagnosis and treatment

A 65 yrs old female pt has suffering multiple fistula since 5 yrs.. symptom.. massive burning sensation and pain during defecations of stool. some time itching pus discharge all.reports r normal...respected drs plz share ur valuable opinion on dis case.

This patient was presented with history of anal fistula since 6 years followed by multiple drained abscesses over the time and huge enlargement of scrotum . Rectal mucosa normal and biopsy from Perianal skin didn’t prove crohn's disease or other pathology..what is provisional diagnosis and any other suggestions regarding this patient??

Anal Fistula An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus . They're usually the result of an infection near the anus causing a collection of pus (abscess) in the nearby tissue. When the pus drains away, it can leave a small channel behind. Anal fistulascan cause unpleasant symptoms, such as discomfort and skin irritation, and won't usually get better on their own. Surgery is recommended in most cases. Causes of anal fistulas: Most anal fistulas develop after an anal abscess. They can occur if the abscess doesn't heal properly after the pus has drained away. It's estimated that between one in every two to four people with an anal abscess will develop a fistula. Less common causes of anal fistulas include: 1.Crohn's disease – a long-term condition in which the digestive system becomes inflamed 2.diverticulitis – infection of the small pouches that can stick out of the side of the large intestine (colon) 3.hidradenitis suppurativa – a long-term skin condition that causes abscesses and scarring 4.infection with tuberculosis (TB) or HIV 5.complication of surgery near the anus Common Symptoms of Anal Fistula: The abscess or opening of fistula near anus secretes pus almost all the type. Sometimes the abscess is closed for a day or two and then bursts releasing lots of pus and traces of blood. Sometimes mixture of blood and pus is drained from abscess. The fistula abscess does not heal and will continue discharging pus for many years until it is treated. Itching and pain in the anal abscess is common. Constipation or diarrhea may also be seen in some patients. The symptoms and signs are examined. If fistula is very old or complex then tests for tuberculosis or Crohn’s disease are done. In Homeopathic treatment medicines are given to help in healing the wound and controlling the infection. In this treatment fistula tract is closed and from within first. Once all internal fistula tract is healed and dried, the outer fistula opening is healed and closed. Once fistula is healed by homeopathy medicines, there are almost zero chances of recurrence. Fistula patients are advised to show patience while treatment because it may take 3-6 months to heal completely. Common Medicines For Fistula Treatment: Common medicines used to treat anal fistula in homeopathy are Collinsonia, Silicea, Calendula Q, Acid Nit, Sulphur and Thuja Dr.Sangeeta kumari

43M left with persistent perianal foul discharge since 3 yrs following I&D for perianal abscess. L/E bilateral bad scars in perineum with external opening on left side about 2cm from anal verge. MR fistulogram film and report enclosed. Rx plan?