HOMOEOPATHIC REMEDIES FOR ANAL FISTULA

Anal fistula is the medical term for an infected tunnel that develops between the skin and the muscular opening at the end of the digestive tract (anus).

Most anal fistulas are the result of an infection that starts in an anal gland. This infection results in an abscess that drains spontaneously or is drained surgically through the skin next to the anus. The fistula then forms a tunnel under the skin and connects with the infected gland.

Causes--Most fistulas result from an anal abscess. A small number of fistulas may less frequently be caused by other processes such as Chron’s disease, sexually transmitted diseases,trauma, tuberculosis, cancer, or diverticulitis

Symptoms-- The following may be symptoms or signs of an anal fistula

·         Recurrent anal abscess

·         Pain and swelling around abscess

·         Pain with bowel movements

·         Bleeding

·     Bloody or foul-smelling pus from an opening around the anus. The pain may decrease after the fistula drains.

·         Irritation of the skin around the anus due to persistent drainage.

·         Fever, chills, and a general feeling of fatigue.

HOMEOPATHIC REMEDIES

In Allopathy surgery is the only option for Anal fistula. But well selected  Homoeopathic medicines cure this condition without surgery. Some of the important remedies are given below.

BELLADONNA 30- Belladonna is effective in the initial stage of fistula , when pus formation takes place. There is fever, throbbing pain and redness of anus occurs.

HEPARSULPH 30- Hepar sulph is advised when the first stage is over. There is intense pain, the part is very sensitive and tender and abscess turns into pus. There is raw smarting in rectum during stools, remaining long afterwards.

SILICEA 1000- Silicea is one of the effective remedy for fistula in anus in the ulcerative stage. Here the passage of fistula converts into sinus. There is a watery discharge oozing from the fistula.

MYRISTICA SEBIFERA Q- Myristica is considered to be a specific remedy for fistula in anus. Myristica is best suited in the early stages of pus formation, Myristica aborts the pus formation. The stool is passing with great difficult because of pain in the anal region. Stool mixed with yellow mucus.

LACHESIS 200-Lahesis is one of the top remedies for fistula in anus. There is pain in fistula as if beaten with hammers. There is chronic constipation and the stool is offensive. The patient experiences a tight feeling around anus.

PAEONIA OFF.Q—Paeonia is excellent for fistula in anus with excruciating pain in anus continued long after stools, must rise and walk about accompanied by pus discharge.The person has intense biting and itching in the swollen anal orifice. There is ulceration of the anus and perineum, which is purple covered with crusts. There is a burning sensation and internal chilliness after passing stools. Painful ulcer , from which oozing a offensive moisture on perineum. There is sudden pasty diarrhea with faintness in abdomen.

CAUSTICUM 200- Causticum is excellent for anal fistula with large piles. The patient feels great difficulty for passing stools.The patient passes stool easily only when standing. There is soreness and burning pain  in the anal and rectal region. The stools are very hard, covered with mucus , shines like grease .There is pulsation, pain and itching around the anus and perineum.

HYDRASTIS CANADENSIS 3X- Hydrastis is also excellent for anal fistula with obstinate constipation. Another feature is prolapsed of anus associated with fistula and fissures. There is raw smarting pain in the rectum during stools, remaining long afterwards. Constipation with sinking feeling in stomach.

NITRIC ACID 1000- Nitric acid is prescribed for anal fistula with soreness and burning pain in anus and rectum.Bowels constipated with fissures in anus.  There is great straining  for stool, but little passes. Violent cutting pain in anus which last for hours .There itching in around anus. From the fistula oozes a thin greenish discharge.

BERBERIS VULGARIS Q- Berberis vulgaris is best for anal fistula with burning pain in anus. Fistula in anus associated with bilious symptoms and itching around anus. There is tearing or smarting pain in anus and perineum.

FLUORIC ACID 30- Fluoric acid is best for fistula in anus accompanied with lachrymal and dental discharges. There is itching and burning around anus.

CALCAREA SULPH 30- Calcarea sulph is best for anal fistula with shooting pain. There painful abscess about the anus in cases of fistula.another feature is discharge of thick yellow colored pus from the fistula.

BACILLINUM 1000- Bacillium is considered an intercurrent remedy, especially in tubercular patients who are susceptible to cold.

SULPHUR 1000- Sulphur is another intercurrent remedy for blind fistula. Sometimes yellowish, greenish, painless discharge from the fistula 

Anal complaints – Seat of disease

Anal complaints

DIGESTIVE DISORDERS – Anal complaints – Seat (of) disease

People often suffer from anal complaints when they suffer from digestive disorders. It can also happen vice versa. To understand all about anal complaints, everyone should know about the anus and its functions. Any complaint of the anus makes everyone restless and won’t let them take their seat. Also, most of the anal complaints are left untreated or maltreated due to shyness or shamefulness to discuss/show the thing. For example, people may complain of pile mass in anus, but it may actually be a residual of fissure (sentinel pile – skin tag of linear crack). Likewise, some others may complain of pus discharging boil near the anus, but actually it may be an opening of fistula (tunnel passage from anal canal).

For normal good defecation, a good digestion is ultimately necessary i.e. all the way starting from the mastication of food in the mouth. Our digestive tract starts from the mouth (entry door of food) and ends in the anus (exit door). Any food which enters the stomach needs to pass through the coiled small intestines, where most of the nutrients get absorbed. For getting the nutrients and water absorbed, food passes slowly through this long route by swaying motion of the intestines. After reaching the caecum (first part of the large intestine), food has to ascend with ascending colon and arches left with transverse colon and descend with descending colon of large intestines. Finally it will enter the rectum and anal canal to get expelled.

Anus – is the external opening of the anal canal through which faeces (waste product of digestion) are evacuated. It is guarded and controlled by the anal sphincters.

Anal canal architecture – The anal canal is about 3.5 cms long and it starts from the lower end of the rectum and ends in the anus’ opening. The walls of the anus are well guarded with sphincter muscles which always keep it closed, except during defecation. It is also designed in such a manner to control the release of air (flatus) and watery stools i.e. airtight and leak proof.

The anal canal is anatomically divided into two parts (namely upper part and lower part) by pectinate line (bluish pink ring). These two parts are different from embryonic origin, i.e. the upper part is originated from endoderm and it is covered with mucous membranes like covering of the oral cavity. It will be pink or reddish in colour. This upper anal part is supplied by autonomic nervous system and doesn’t have pain sensitive nerve fibres. So, it responds only to fullness and tightness of intestines. The lower part of the anal canal originates from the ectoderm and is covered by skin. It is usually brown or pale white in colour. Unlike the upper part, it contains sebaceous glands, sweat glands and cutaneous pain sensitive spinal nerves like normal skin.

Defecation – The act of passing stool is called defecation. Defecation is aided by the rectum and anal canal. Defecation can be initiated by increasing abdominal pressure, straining at rectum and anal canal, mind, habits, etc. Anus with brain control controls the defecation process accordingly by time, place and circumstances. The waste products, called faeces, which are excrement discharge of the bowels, are expelled through the anus. The intestines usually secrete, excrete and absorb. But the rectum and anal canal have less work in dealing with this digested food. The absorption of water and minerals are low or very little in the rectum and anal canal.

Normal faeces usually have a water content of 60-70 per cent, fat 15-20 per cent, nitrogen 4-5 per cent, inorganic materials 10-20 per cent. The bile pigments colour the stool as brown or yellow. If the content of fat in the stool is more, it makes it pale and to float. The bile pigments and other wastages are usually excreted through faeces. So even during fasting, a small quantity of faeces will be passed on.

Importance of defecation – Defecation is discharge or evacuation of bacteria-rich faeces from the body. It is very much important in letting out the waste and unwanted toxic substances from the digestive tract to avoid toxicity. Everyone would have heard of headache, abdominal discomfort, poor appetite, sensation of vomiting, etc., when there is defective defecation. For getting energy, continuous support or intake of food is necessary, but if the stool is impacted or stagnated due to defective digestion and assimilation, then the process will make any one to reduce/avoid intake of food.

Dysfunctions causing anal complaints

Constipation is infrequent and inadequate defecation without satisfaction. It may be due to

• Failure in developing habits
• Controlling the urge for a prolonged period
• Low fibre foods with more spices and chillies
• Liver disorders with defective digestion
• Drugs impairing digestion
• Defective expulsion due to nervous disorders or nerve damages

Diarrhoea is commonly called increased motility of the bowels resulting in frequent evacuation of watery stools with uncontrollable purging. While caring for loss of minerals, the strain of the anus should also be considered. Forcible expulsion of diarrhoea from laxatives or enemas can cause anal complaints like piles and prolapse.

Incidences – One who deviates more from nature in diet, living and sitting habits will usually suffer with anal complaints. Anal problems are rare in children due to their bland diet, unless pathological. The incidence of anal complaints increases with age factor and occurs more commonly in the 20 to 30 age group. Females suffer more commonly than males. Sufferers are mostly

• Travellers who sit for long
• Sedentary workers
• Lovers of chillies and spices
• One who have is prone to constipation
• One who has or is prone to diarrhoea
• Sufferers of liver disorders

Other suspected reasons for development of anal complaints

• Erect posture of man – The evolution of man from an animal on four feet to a human being on two feet is considered one of the main causes for anal complaints, when compared to other animals
• Hereditary – development of piles is often noted to run in families
• Physiological – Pregnancy and delivery can cause increased venous pressure and weakness of the anal canal, so piles or constipation can occur
• Physical strain – exerting while passing stool, coughing, weight lifting, etc., can cause piles, prolapsed anus, etc.
• Pathological – pelvic and rectal tumours, liver and portal vein disorders can cause piles
• Infections in skin and mucous membranes of the anal canal can cause boils and proceed to fistulas
• Blood vessels – due to valvular damage or back flow or resistance pressure exerted by obstruction or disease can cause dilatation of blood vessels
• Ligaments – defective support of anal canal can cause prolapsed anus
• Worries and mental strain can also cause havoc to intestines and anus

Diagnosis & investigations – Diagnosis of anal complaints can be easily made on examination of the anus with finger palpation / proctoscope / sigmoidoscope / endoscopy / barium meal X-ray / biopsy / stool examination, etc. Other than anal complaints, anal examination is also done to detect prostate enlargement in males and to detect the changes in consistency of the uterus, ovaries, cervix, etc., in females.

Complications – if any complaint is left untreated or maltreated, then danger begins to unfold. Infection, bleeding, extreme painfulness, prolapse and strangulation may occur, complicating in their own way.

Cautions and precautions:

• Move more towards greens and nature
• Don’t be sedentary and sit idle for a long time
• Keep good diet for good digestion
• Take plenty of water
• Take plenty of fruits/fruit juices
• Follow regular bowel habits to avoid constipation and strain

Follow hygienic measures in cleaning and caring

Avoid cycling

Common complaints often faced in the anus are:

• Piles or haemorrhoids – dilatation of veins of the anal canal (upper or lower part)
• Fissures – tear in lower sensitive part of anus, which is very painful
• Fistula – tunnel passage developed from boil which gets opened internally into anal canal
• Anal stricture – constriction of the part with the feeling of tightness or compression
• Itchy skin lesions including recurrent boils, since the anus is more prone to bacteria
• Incontinence – defect in controlling or with holding or postponing the defecation process
• Congenital deformities – like miniature anus, imperforate anus

To avoid discomfort, pain, bleeding and unwanted progress of the disease, treatment should be taken at the earliest to heal with all precautionary measures in food, restriction of work/bed rest and juice fasting. Best results are often shown when one reverts to nature in food and habits rather than treatment.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)

Anal abscess and fistula

Anal abscess and fistula

Infection and abscess mostly arise in glands or hair roots of the skin. The infected spot initially erupts and then forms an abscess. The abscess gets opened and discharges its contents (pus) and then heals. Depending upon the load of infection, septic conditions like fever and toxic symptoms can result in the course of anabscess. Abscess will be usually red hot with throbbing pain. The abscess, after getting fully blown up with pus, usually opens near the surface and lets out the pus naturally. To save time and live comfortably without pain, abscess is now dealt with surgically with incision and drainage (I&D). If it is deep, persistent, not properly drained or becomes chronic in nature, then it gets reformed as a small cavity or sinus with a single opening. Sometimes, it opens at both sides/ends and thus becomes a tunnel or tract – namely fistula.

Anus, the exit route of faeces and it surroundings are more vulnerable to bacterial or fungal infection due to moisture and folded skins. Germs/micro organisms will also be more concentrated in that area in spite of cleanliness. Usually, infection occurs and causes boils or abscess due to lack of hygienic condition, but sometimes the causes remain unknown.

Anal abscess – Abscess is a mere collection of pus which is supposed to drain either inside or outside where the points are weak and easily prone for an outlet. Anal abscess mostly presents itself as a tender swelling in or around the anus with throbbing pain. Even though perianal abscesses are more common after piles, fissure and gland infection, ischiorectal abscess and submucous abscess can also be seen. Common bacterias which usually cause infections are staphy, E.coli, strepto and proteus. Sometimes abscess arises spontaneously without any cause. Mostly abscess opens externally and drains to cure. But sometimes it can lead to a tract of deep location to open in and out, giving rise to fistula. Either way i.e. natural drain or surgical drainage, if it lacks care in healing, the chances of fistula formations are there.

Fistula – Fistula in general, means abnormal passage/tunnel/tract which connects gland and skin or mucous membrane and skin. It occurs as a complication while the abscess gets resolved. It is either lined with mucosal membrane or may be lined with granulation epithelial tissue. There are different types of fistula, i.e. anal, umbilical, urethral, perineal, thyroglossal, salivary, arterio-venous, etc. Usually, the fistula opening will be indrawn and covered with the crescentic fold of skin.

Anal fistula – Among fistula, anal fistula is the commonest and most bothersome. Most commonly it arises from perianal abscess. This anal fistula mostly connects anus / rectum to the outer skin. Sometimes, it may connect anus and vagina or anus and urethra. The fistula usually traces the drainage pathway of the abscess. It may have a single or multiple opening(s) in inner/outer aspect, depending upon the position and direction of the drainage of the abscess. The fistula having multiple opening should be seriously investigated for tuberculosis or Crohn’s disease.

Incidence – Males have higher incidences than females. It usually follows in at least 40-50 per cent of anal abscess cases. Unhygienic conditions also favour higher incidences.

Pathophysiology – Usually, every abscess opens one day or the other and lets out the pus. Sometimes it needs surgical intervention to drain, especially when it is deep. In any case, if it doesn’t heal up properly or if it is not properly drained after letting out the pus then it will usually remain as infecting foci and suppurates. Also this will constantly or intermittently discharge pus or fluid through the outlet/tract. In due course, this tract gets lined with granulation tissue which resists healing (joining the other surface). Fistula’s length and openings (internal and external) usually vary in size and number according to the location of the abscess and care taken over it. Usually, the fistula tract will be a curved one. Untreated fistula or clogged outlet of fistula (due to infection or draining debris obstruction) will usually promote multiple internal/external openings with recurrent anal abscess and re-formation of tract or tunnel.

Causes – Ill-treated or maltreated infection and abscess are the main causes for fistula formation, the other causes include negligence/lack in treatment of piles, anal fissures, Crohn’s disease, cancer, constipation, etc. Fistula formation is mainly due to improper and inadequate drainage of pus from abscess with narrow opening or block or high opening or presence of infective foci or foreign bodies or unhygienic conditions. Another important cause to be ruled out is nylon underwear which does not absorb moisture. The major aggravating factor is pressure exerted by physical strain while passing stool since it will propel the faecal matter into the fistula tract.

Symptoms – Anal fistula is mostly present with the following symptoms, when there is infection or strain or block.
Feeling of lump near the anus with stabbing/throbbing pain

• Pain will shut off immediately after letting out the pus
• Continuous or intermittent (on and off) leakage of foul pus/mucous/faecal matter from the fistula’s external opening, soiling the inner garments
• Discomfort and skin infections due to constant wetness caused by leaked fluids
• Constipation or diarrhoea
• If fistula gets blocked, again there will be abscess formation with the symptoms of swelling, fever, malaise and septicaemia.

Diagnosis – Anal fistula can be diagnosed easily by physical examination of the anus and its surroundings. Rectal examination, sigmoidoscopy and fistulography give more details about the abscess, its tracts and openings.

Management

• Take plenty of water and fruit juices to avoid constipation
• Follow hygienic measures in cleaning and caring
• Pass stool twice a day to avoid strain to rectum and anus
• Don’t strain while defecating. It is better to have semisolid stool for easy defecation
• Sitz bath – After passing stool, sit in a shallow bath tub filled with antiseptic lotions or warm salted water for 10 minutes, to make the condition hygienic
• Hot compress can help anal abscess by enhancing blood circulation for diluting the infective toxins over there and healing faster with supply of nutrients

General treatment Fistula is usually very difficult to cure with medicines. So, allopaths mostly opt for surgical excision of fistula namely Fistulectomy. But, even after surgery, the chances of recurrence are more, which may be due to leftovers of fistula tract or abscess residuals or suppuration after surgery. Caution should be exercised during post-operative care for otherwise the tendency to form abscess will post another innings with a new tract formation. Other than delayed healing, abscess formation and recurrence of fistula, surgical removal can also cause incontinence of anus related to urge. These make the sufferers dejected and shameful.

Preventive measures

• Follow regular bowel habits without any strain
• Follow hygeinic measures to keep anal area clean and dry
• Treat any infections or boils immediately
• Avoid nylon underwear and use cotton ones

Homeopathic approach to fistula – Homeopathy can help avoid fistula formation, when anal abscess is properly treated with Homeopathic medicines. Treatment for fistula should be started at the earliest, to heal it before gets granulations in the tract so that it can heal completely without giving any residual gaps or chances of recurrences.

Homeopathy usually cares fistula by controlling infection and helping the wound to heal. It aids natural cure. Patients need patience while getting treated for fistula since the fistula opening looks like it has healed but opens suddenly on strain or with a new anal abscess. Everyone can keep hygienic condition externally, but not internally. Since faecal matter is full of microorganisms, no one can avoid getting infection unless they have gained resistance to infection. Homeopathy can provide this. Also, for complete healing, fistula should get healed or closed from within first. Otherwise, the outer opening can reopen anytime or open a new tract to a new place.

Homeopathy can abort the tendency to abscess formation and suppuration by increasing resistance. So it can thus avoid the hindrances to cure by helping the healing process to continue naturally without interference. Also, to heal the fistula, first of all, the flow of fluid must get stopped since the draining fluid itself acts as a layer of separation to resist healing. For that, the tendency to fluid collection and suppuration must be stopped. Homeopathy provides this without any surgical measure. If the flow gets stopped, the pathway dries up naturally and shrinks to get close approximation for better healing.

Homeopathic medicines commonly used in cases of fistula are – Acid Nit, Apis mel, Bacilinum, Calc Flour, Calc Phos, Calc Sulf, Calendula Q, Capsicum, Carboveg, Causticum, Collinsonia, Graphites, Hamemelis, Hepasulf, Hydrastis, Hypericum, Lachesis, Lycopodium, Mag Phos, Mer cor, Merc sol, Muriatic acid, Silicea, Sulphur, Thuja, etc.. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)