FISTULA
- IN - ANO
This is the commonest type of external fistula. It is
lined by unhealthy granulation tissue and fibrous tissue and has one end
communicating with the perianal skin and the other end with the anal canal or
rectum.
ORIGIN
The causes of fistula may be either constitutional or
local. In all cases, however, the commencement of the trouble is an abscess.
Usually it follows a perianal abscess. Occasionally, a fistula may be
Tubercular
In association with Crohn’s disease
A complication of Carcinoma of rectum
CLASSIFICATION
Fistulae may be
Extra-sphincteric - The track lies immediately deep to
skin and mucous membrane
Trans-sphincteric - The track traverses through the
fibers of sphincters
Subsphincteric - The track passes entirely deep to
both the sphincters
The fistula may be
Complete - A complete fistula is one in which there is
an opening in the rectum, communicating with an opening in the integument by a
sinus.
Incomplete - The track ends blindly. A blind external
fistula is one in which the canal does not open into the rectum, but terminates
at the outer surface. A blind internal fistula is one in which the track
extends from the rectum to the integument, but the latter remains intact.
Fistulae may also be classified as
Single
Multiple - This condition is termed as ‘Water can
perineum’.
CLINICAL
FEATURES
It appears to be almost unknown in childhood and old
age, being more frequent between the ages of twenty-five and forty. Men are
more frequently affected than women. There is a typical history of perianal
abscess, which following rupture or incision, fails to heal and leaves behind a
discharging opening. If this is neglected, there are recurrent attacks of
perianal abscess formation. The new abscesses burst out either through the old
opening or make fresh external openings. This is how multiple fistulae are
formed.
At first the walls of the sinus will remain raw, but
soon they become covered with a plastic deposit which may gradually assume the
character of mucous tissue, or more that of the ordinary pyogenic membrane.
There is much variation in number, size, tortuousity, length, and number of
openings in fistula. Usually they are single, with a single opening at each
extremity, but there maybe several external openings. The length of the track
is usually less than half an inch, while some cases occur in which it has
reached two inches, owing to extreme tortuousity, the internal opening being at
the usual distance from the anus.
After the subsidence of an anal or rectal abscess,
should there remain for days or months a slight discharge fecal in odor, an
examination must be instituted at once. Should a fistula exist, the integument
will be found discolored, thickened, and quite painful to pressure. On close
examination a small puncture will be observed, usually within the folds of the
anus, exuding on pressure a small amount of fluid, more or less purulent, with
a fecal odor.
Cases of tuberculosis have been reported to suffer
from anal fistula and in which the cure of a fistula, by operative measures,
has been followed by rapid phthisis. The very uncertainty that surrounds this
subject, at present, should teach us caution in instrumental interference.
HOMOEOPATHIC
APPROACH AND MANAGEMENT
Homoeopathic approach to a case of anal fistula is both
acute and chronic. Cases of acute fistula-in-ano need for the treatment acute
acting remedies. Cases that improve with the remedy should then be followed up
by deep acting indicated homoeopathic similimum.
REPERTORIAL
REFERENCE
Aur-m., Berb., Calc-p., Calc., Carb-v., Carc., Caust.,
Kali-c, Nit-ac., Sil.
Aloe., alum., fl-ac., graph., hep., hydr., kreos.,
lach., lyc., merc., petr., phos., sep., staph., sulph., syph., thuj.
Ant-c., ant-t., aur., bar-m., bell., bry., cact.,
calc-s., calc-sil., carb-s., cur., ign., kali-sil., myris., nux-v., paeon.,
puls., pyrog., querc., rat., sarr.
* Alternates with chest disorders: Berb., Calc-p.,
Sil.
* Itching, with: Berb.
* Operation, after: Cal-p.
* Palpitation, with: Cact.
* Pulsating: Caust., Lach.
* Recto-vaginal: Thuj.
THERAPEUTIC
INDICATIONS
SILICEA
Suppurative processes. It is related to all fistulous
burrowings. Ripens abscesses since it promotes suppuration. Silica patient is
cold, chilly, hugs the fire, wants plenty warm clothing, hates drafts, hands
and feet cold, worse in winter. Lack of vital heat. Prostration of mind and
body. Great sensitiveness to taking cold. Intolerance of alcoholic stimulants.
Ailments attended with PUS FORMATION.
Feels paralyzed. PAINFUL, WITH SPASM OF SPHINCTER.
STOOL COMES DOWN WITH DIFFICULTY; WHEN PARTLY EXPELLED, RECEDES AGAIN. Great
straining; rectum stings; closes upon stool. Faeces remain a long time in
rectum. CONSTIPATION ALWAYS BEFORE AND DURING MENSES; with irritable sphincter
ani. Diarrhoea of cadaverous odor.
NITRIC ACID
Pain as from splinters. STICKING PAINS. Amelioration
while riding in a carriage. Pain during stool, as if rectum were torn.
Discharges very offensive. IRRITABLE, hateful, vindictive, headstrong. Hopeless
despair. Sensitive to noise, pain, touch, jar. Fear of death. Great straining,
but little passes. Tearing pains during stools. Violent cutting pains AFTER
STOOLS, LASTING FOR HOURS. Haemorrhages from bowels, profuse, bright.
CALCAREA PHOS
Bleeding after hard stool. Diarrhoea from juicy fruits
or cider. Green, slimy, HOT, sputtering, undigested, WITH FETID FLATUS. Fistula
in ano, alternating with chest symptoms. Involuntary sighing. Chest sore.
Suffocative cough; better lying down. Hoarseness. Pain through lower left lung.
BERBERIS VULGARIS
Constant urging to stool. Diarrhoea painless,
clay-colored, burning, and smarting in anus and perineum. Tearing around anus.
WORSE motion, standing.
CAUSTICUM
Worse after eating fresh meat; smoked meat agrees.
Sensation of ball rising in throat. Acid dyspepsia. Soft and small, size of
goose-quill. Hard, tough, covered with mucus; shines like grease; small-shaped;
expelled with much straining, or only on standing up. Pruritus. Partial
paralysis of rectum. Rectum sore and burns.
CARBO VEG
Flatus hot, moist, offensive. Itching, gnawing and
burning in rectum. ACRID, CORROSIVE MOISTURE FROM RECTUM. A musty, glutinous
moisture exudes. Soreness, itching, moisture of perineum at night. Discharge of
blood from rectum. Burning at anus. Painful diarrhoea of old people. Frequent, involuntary
cadaverous-smelling stools, followed by burning. PAIN after stool.
KALI CARB
LARGE, difficult stools, with stitching pain an hour
before. Itching, ulcerated pimples around anus. Large discharge of blood with
natural stool. Burning in rectum and anus. Easy prolapse.
WORSE, after coition; in cold weather; from soup and
coffee; in morning about three o'clock; lying on left and painful side. BETTER,
in warm weather, though moist; during day, while moving about.
DR. SUMIT GOEL M.D. (Hom)