Up until about 10 years ago I suffered with anal fistulas with constant referrals to the hospital for treatment. My regular GP had no solution. Then luckily on this one occasion my GP was not available, and I saw a Locum of Egyptian heritage he said in Egypt they traditionally used a Shatafa a kind of Bidet for anal hygiene, but with increased westernisation and affluence people were switching to toilet paper with a corresponding increase, he had observed, in the incidence of anal fistulas. So, he suggested to me that I refrain from the use of toilet paper. I took his advice and now douche my anal area. I have been free of the problem ever since.