Anal fissures, fistulas, abscesses, and hemorrhoids in a tropical population

Anal fissures, fistulas, abscesses, and hemorrhoids over a seven-year period in a tropical environment are reviewed. It is suggested that these diseases may be commoner in urban and city dwellers than in villagers. Increasing sophistication and changing food habits in the cities and towns and the attendant limitations on defecating at will are suggested as responsible etiologic factors. If diet, transversal gut time, and bowel habits contribute to large-bowel oncogenesis, cancer of the large bowel should increase in cities and towns faster than in villages. The marked male predominance in the diseases under discussion here is not explained, except that the incidence of perianal abscesses in females could have been higher if “pelvic inflammatory disease” had been taken into consideration. In an area where tuberculosis is very common, it is not considered an important cause of fistulas and abscesses. In an area where amebic ulcers of the rectum are common (third commones side in the large bowel), one would expect perianal abscess and fistula formation to benmuch more prevalent than these findings seem to indicate.