Hi, The most probable causes are: - Fissure in ano with sentinel piles - Boils I would advise him the following: * High fibre diet * Avoid all the foods and beverages and stress-like conditions which gives constipation * Laxative for softening the stool - never allow the dose too much to cause liquid stools * Sitz bath - very important - just before passing a stool and after passing stool * Clean the area very clear of the faecal soiling that remains after cleaning; use cotton soaked in the same water to clean You can apply liquid Povidone iodine locally. Apply nothing else. Five day course of an antibiotic on prescription of a local doctor. Add probiotics and multivitamins. Avoid stress and mental tensions at any cost; this is a very important factor. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. T. Chandrakant, General Surgeon