‘Fistula–in-ano’ is an inflammatory track which has an external opening (secondary opening) in the perianal skin and an internal opening in the anal canal or rectum, which is lined by unhealthy granulation tissue and fibrous tissue. It is classified as low level or high level fistula depending on whether the internal opening is below or above the anorectal ring respectively.
It usually originates from a perianal abscess in the inter-sphincteric space of the anal canal from infection of the anal gland; other causes include Ulcerative colitis, Colloid carcinoma of the rectum, Crohn’s disease, Tuberculosis etc. (the last 2 are associated with multiple fistulous openings, TB being more common in India)
Patients usually present with pain in the perianal region, fever, and/or discharge of pus which maybe bloodstained.
For recovery maintenance of proper hygiene is a must. Bowel habits can be improved to ease pain with intake of a high fiber diet and plenty of fluids. Sitz Bath for 10-15 minutes especially after defecation is soothing and promotes relaxation of anal muscles.
Surgical treatment(?) of the fistula is the only mode of treatment for the dominant school. John Henry Clarke has mentioned in his works that not infrequently it has been observed that surgical correction (or in-correction!) of the disease is often followed by chest ailments (Calc phos, Silica etc.) For the homoeopathic physician, it is a deep seated miasmatic disturbance which demands a homoeopathic similimum.
Our literature is rich in medicines for this condition like Calc phos, Silica, Nitric acid, Kali carb, Graphites, Mercurius, Fluoric acid, Sulphur, Syphilinum etc. each having its specific indication to be prescribed according to symptom totality.
We must go through the small but beautiful monograph ‘Fistula & Its Radical Cure’ by James Compton Burnett, in which he describes it as a disease fully amenable to internal medications.
I am forever indebted to Prof. L. M. Khan who as my Guru has taught me whatever little I know of homoeopathy and humbly submit that this disease is indeed completely curable with the indicated homoeopathic medicines chosen and prescribed as per the directions that Hahnemann laid down in Organon.
I share below 2 of my clinical successes:
Case no 1
Mr. A.M. 26 years old consulted us in April ’06. He was short with dark hair and eyes, a sharp nose with a prominent angle below the glabella, numerous black moles all over the body and trembling hands.
- Pain with discharge from the perianal region for about 1 year.
- Low backache for 1 year.
- Tendency to get pain in the right side of the abdomen with loose stools after eating out since childhood.
He was diagnosed as a case of right sided fistula-in-ano which was operated upon. Few months later he developed a left sided peri-anal abscess which too was surgically drained. For last 1 year again there is diffuse pain in the perianal region with discharge which is purulent, sticky and bloodstained. Associated itching and burning is present in the entire area.
- Twice had convulsions with high fever and diarrhea when 6-8 months old
- Typhoid during school time with relapse
- Chicken pox (severe) – 7 yrs back
- Tinea cruris 2-3 times in the last 3-4 years (more often on right side) treated with topical antifungals
- Father: Piles
- Mother: Asthma
- Sisters: Carcinoma; Epileptic convulsions
Born in U.P.; in Delhi for the last 12 years; single, working and a vegetarian
- Appetite: normal, can tolerate hunger
- Thirst: good; likes cold water++
- Desires: sweets++; ice cream ++; alcoholic drinks (vodka, beer) ++
- Aversion: milk products++; brinjal & gourd
- Bowels: normal, cleared once or twice
- Urine: normal
- Sleep: refreshing; on abdomen; salivation during sleep; thumb sucking during sleep as a child which still occurs occasionally
- Dreams: numerous
- Perspiration: profuse ++; on face; while awake
- Thermal reaction: loves rains and cloudy weather+++; loves strong winds
Life and Circumstances
He grew up watching fights and arguments between his parents all through; developed hatred for father because of his behavior towards his mother as he grew up- Never been able to come up with his feelings, his anger is pent up all inside him. Came to Delhi about 12 years back to pursue studies. He could not clear the MBA entrance exam after engineering and had to struggle to get a job. During the last 3-4 years he has got habituated to alcohol which he attributes to stress.
His anger against his father was as palpable as soft corner for his mother. While talking about the situation at home he casually mentioned that he could not bear to see anyone in trouble and tried to do much as he could to help.
- Abdomen: NAD
- Respiratory system: normal breath sounds on auscultation
- Peri-anal: fistula at 7’o’clock
14/4/06 Rx Causticum L.M 1 B.D
Analysis & Discussion
His sympathetic nature, love for rainy weather, right-sidedness of affections (both in fistula and tinea) and thirst for cold water formed the basis of prescription.
Under Causticum (LM 1 to LM 5) he improved and his discharge decreased and was no more blood-stained. He now complained only occasionally of pain in buttocks and perianal region. Backache too became infrequent. But the tendency for pain in the right side of the abdomen with loose stools after eating out persisted.
The pain had decreased considerably but there was a milky white discharge almost every alternate day with accompanying itching off and on. Backache again became more prominent.
We had also observed that during all he visits he would call and confirm his appointment and yet reach much before the scheduled time. He also said that he would go to the washroom a number of times just to check himself even when he did not feel any discharge or discomfort. He also had a constant apprehension of something going wrong and would repeatedly ask ‘I will be alright doctor? I hope I don’t have to undergo knife again.’
He further disclosed that he was always nervous and restless before the exams.
Rx Argentum nitricum L.M 1 B.D
30/6/06 No pain at all; discharges absent; Backache-absent.
He received Argentum nitricum LM 2 – LM 4 B.D. and LM 5 -LM 9 O.D. and recovered completely. The fistulous opening closed and he could work more comfortably; his backache also vanished. Now he could tolerate food from restaurant more comfortably though too frequent eating out still caused indigestion.
He has been off medicines for last 1 year and reports doing well. For any trivial complaint he still receives placebo on telephone!
Case no 2
Mr. V.J., 24 years old first visited us in March ’07. He was obese and had dark hair and eyes, a dry pouting lower lip and was perspiring on nose and forehead. He was noticed sitting with his arms folded across his chest and he had eaten most of his nails.
- Discharge (often blood-stained) with pricking pain and itching from left sided openings in the perianal region for 1 year.
- Pain in the perianal region (left side) for about 1 year.
It all started as a painful solitary eruption on the left buttock somewhere in summer ’06. Later it began to discharge pus and blood during defaecation or even anytime through the day with occasional itching. A surgeon diagnosed it to be fistula-in-ano at 3’0’ clock and 5’o’clock for which he took homoeopathic treatment (Silica, Flouric acid, Nitric acid etc.) without any relief.
- Chicken pox in early childhood
- Fracture (hairline) of Rt ankle twice in childhood
- Monkeybite when 4-5 yrs of age
- Left facial herpes zoster in august ‘06
- Eosinophilia in November ’06.
- Father: lichen simplex chronicus
- Paternal grandmother: cancer
- Paternal uncle: HT & obesity
- Paternal aunt: Brain tumor
- Mother: asthma and piles
- Maternal uncle: diabetes mellitus
- Maternal grandfather: cancer and piles
- Maternal grandmother: piles and allergic cough
Belongs to Delhi; is unmarried and working (in a BPO) with shift duties.
- Appetite: normal
- Thirst: normal
- Desires: sweets++; warm food++; yellow butter+
- Bowels: regular; occasionally hard stool
- Urine: normal
- Perspiration: profuse and easy; more when awake
- Sleep: Disturbed; irregular sleeping pattern due to changing timings of office duties; on abdomen; occasional salivation
- Thermal reaction: doesn’t tolerate extremes of temp well
Life and Circumstances
Youngest of three (2 elder sisters), he was born and brought up in a joint family background and grew up seeing his mother being ill-treated by his paternal aunts and overworking too. His father didn’t ever pay any heed to this and never supported or consoled her. Instead, he would discriminate between his own and his brother’s children, and was more inclined towards them.
Consequently he grew up with numerous insecurities which is reflected in his habit of nail biting, defensive sitting posture and tendency to sleep on abdomen. He couldn’t mix well with people and surroundings or make friends with ease all through his life.
He is extremely touchy, defensive, insecure, nervous and short tempered. He is extremely particular about things; he also disclosed that his colleagues and associates often said that he was too high-headed and argumentative by nature.
- Abdominal examination: could not be done properly as he was extremely ticklish
- Local examination: 2 openings at 3’o’clock and 5’o’clock positions
On 29 /3/07 Kali Carbonicum LM 1 BD
Analysis & Discussion
The most striking feature was his insecurity which was evident in his inability to blend with people and make friends and his habit of nail biting. As he grew up in an unhealthy family atmosphere without his father’s affection, he became extremely sensitive and short tempered (touchiness).
His high-headedness and argumentative nature was just a mask to cover his indwelling insecurities.
Kali carb was the drug of choice as it covered his entire persona- his sensitiveness; his insecurities; his desire for sweets; being ticklish and tendency to sweat freely.
- Pricking pain felt along with burning during later part of defecation but much better than before.
- Discharge occasional and watery now. Very slight itching now.
- Bleeding very occasional.
- App: good; Bowels: normal
Over a period of 5 months he received Kali carb LM 1 – LM 8 B.D. and Kali carb LM 9- LM 11 O.D. and recovered completely. He has been without any medication for last 18 months and has also referred to us 3 more cases fistula-in-ano.
Dr Gyandas G Wadhwani
Sr Medical Officer (Homoeopathy), ISM & Homoeopathy, Ministry of Health & Family Welfare, Govt. of NCT Delhi. India.