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Case Study

Haemorrhoids, Fissure And Fistula
Dr V K Sivaraman
'Lyc / Sulph / Nux-v / Calc-carb / Sep

Haemorrhoids or Piles are the enlargement of the veins of the rectum and give rise to itching, burning and throbbing pain. They develop due to straining eg constipation or during labour. Piles may appear singly or in clusters, like bunches of grapes; when multiple, they occur at 3, 5 and 11'o clock positions.

Fistula-In-Ano means a pipe like canal with one opening at or near the anus and the other opening into the bowel. It requires long treatment to affect a radical cure. But in most cases it has to be operated.

Fissure is seen as a narrow slit at the external sphincter. It is extremely painful and is the most common cause of painful bleeding PR.

Prominent Remedies for Piles: Aecsculus-hip, Aloes, Nux-vomica, Nitric-acid and Sulphur. Fissures: Nitric-acid leads all.

Fistula: Nitric-acid and Silica. But, sometimes, these medicines fail to give relief. Then we have to take the totality of symptoms of the patient and find out the correct constitutional remedy of that patient which will finally cure him of his disease.
The following are some cases treated on generals.

Case 1
Mr R, aged 38, had piles since 2 years. Pain in anus during stools, which remains for 5 hrs. Stools are initially very hard, and then soft. Also he feels swelling and thickness in anus after stools. Piles < flatulent items (Food) and fish. Avoids cool drinks. Sometimes tight feeling around abdomen and at other times a feeling of distended abdomen after stools. Desires company but < crowd and noise. Pre-mature ejaculation during coition. Constipated after coition.

Repertorised Using Kent's Repertory:
Desire for company + < crowd + < Noise and < flatulent items (food)- Ars-a, Calc-c, Kali-c, Lyco, Puls, Sep.
Quick ejaculation - Calc-c, Lyco, Sep.
Hard stools first, followed by soft stools---- Calc-c, Lyco.
Lycopodium 200 weekly once for 3 months. Patient was cured completely.

Case 2
Miss K, 29, had piles since 10 yrs. Took treatment from other systems without relief. All advised surgery but she was unwilling. Pain after stools with burning > with hot application and washing. Desires spices. Oil bath and head bath produce sneezing. Sun Headache > hot coffee Likes to be alone, dislikes crowds and noise. Regular menstruation, once in 30 days, normal flow, pain in hip before and during periods, leucorrhea when body becomes heated:

Desire for loneliness + dislikes crowd + < Noise + Sun Headache ----
Acon, Aloe, Bar-c, Calc-c, Nat-c, Nat-m, Nux-v, Phos, Puls, Stan, Sulph
Oil bath < (head bath <) - Bar-c, Calc-c. Phos, Puls, Sulph
Coffee hot > (warm drinks >) Sulph
Sulphur 200 weekly one dose for 6 months gave complete relief.

Case 3
Mr M.H, 30, was suffering from anal fissures. No bleeding, no constipation, was eating more of non-vegetarian food but eggs would give him an upset stomach. Chicken too <. Head bath, oil application on head <. Always likes to be with friends. Developed back pain due to riding on scooter. Back pain > by pressure.

Fissures and eggs - Calc-c, Sulph
Headbath < Calc-c, Sulph.
Desire for company Calc-c
Calc-carb 200 weekly once cured him completely in a few months.

Case 4
Mr S aged 25 had anal fissures since 5 years. Burning pain + bleeding + prolapse of rectum + constipation were the presenting symptoms. He was sensitive to the heat of summer when he would be more irritable. Depending on the mood either he liked company or loneliness. Desire for company and loneliness - Bell, Bufo, Calc-c, Elaps, Gels, Hep-s, Ign, Lyco, Nux-v, Phos, Sep

Anal Fissures - Calc-c, Ign, Nux-v
Sun exposure - Calc-c, Ign, Nux-v
Summer <. Nux-vom
Nux-vomica 200 weekly once was given for 4 months and the patient was fine.

Case 5
Mr Z aged 40 was suffering from Fistula-in-ano since 4 yrs. It would bleed sometimes, at other times large quantity of pus would ooze out. During the fistulous discharge the penis would become painful. Urination +++ esp. after coition. Sleep - Position - one leg over the other, palpitation > lying on right side, loss of sleep <. Desire to be in AC room but urination increased then. Likes company but avoids crowd and noise.

Desires for company +< crowd + < noise + urination more coition after----
Arg-n, Calc-c, Con, Kali-c, Kali-p, Lyco, Nux-v, Phos, Sep
Palpitation < lying on left - Arg.n, Calc-c,Con, Kali-c, Lyco, Phos, Sep
Anus, fistula - Calc-c, Kali-c, Lyco, Phos, Sep
Sleep after amel. ---- Calc-c, Phos, Sep
Loss of sleep aggr ---- Sep
Sepia 200 one dose a week for 7 months was given.
The discharges from the fistula completely stopped and the opening has shrunk considerably. He is still under observation.