Olyad Erba URGESSA
Journal of International Health Sciences and Management - 2026;12(2):1-8
Recurrent fistula-in-ano presents a significant clinical challenge due to high patient morbidity and the risks associated with repeated surgical interventions. This report details an N-of-1 case 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 the frequency titrated between two and three 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.
