I'm sorry to hear about your nephew's symptoms. It's important for him to see a healthcare provider for a proper diagnosis and treatment. Anal fistulas and internal hemorrhoids are two different conditions that can have similar symptoms, so it's crucial to have an examination to determine the exact cause.

In the meantime, your nephew can try some home remedies to help with the symptoms:
1. Soaking in a warm bath several times a day to help reduce pain and swelling.
2. Using over-the-counter topical creams or ointments to help relieve discomfort.
3. Eating a high-fiber diet and staying well-hydrated to prevent constipation and promote regular bowel movements.
4. Avoiding straining during bowel movements.
5. Keeping the anal area clean and dry to prevent infection.

Again, it's important for your nephew to see a healthcare provider for a proper evaluation and treatment plan. Anal fistulas and internal hemorrhoids may require medical intervention, such as antibiotics, surgical procedures, or other treatments based on the specific diagnosis. You may look for colorectal surgeon or general surgeon.

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