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Case Study

Colo-Rectal Disorders
Dr S Mohamed Aleem
'Bar-c / Op / Nux-v / Raph / Merc-dulcis / Asaf / Acon / Caust / Gels / Aloes / Ars-alb / China / Iris-t / Bapt / Apis / Lyc / Bry / Bell / Lach / Coloc / Lac-d / Plb / Spig / Typh

The large intestine is about 1.5m (5 feet) long and about 50mm(2 inches) in diameter. It consists of two main sections - the colon and the rectum. Caecum is the first part of the colon where the small intestine ends. Then the colon runs up the right side of the abdomen (ascending colon), across to the left side (transverse colon), down the left side (descending colon), and loops (sigmoid flexure / sigmoid colon) to join the rectum. Rectum, a short tube - about 12 cm (5 inches) long, runs downward to the anus.

Throughout the proximal half of the large intestine, enzymes from the small intestine complete the digestive process, and bacteria produce the B vitamins (B12, thiamin, and riboflavin) and Vitamin K. The primary function of the colon is to lubricate waste products, absorb remaining fluids and various mineral salts and store waste products until ready to be passed out from the body. Most absorption occurs in the ascending and transverse regions, where the liquid material received from the small intestine is dehydrated to form a fecal mass.

Medical problems associated with the colon range from constipation, diarrhea, gas discomfort, Diverticulosis and inflammations of colon (Colitis) to the more serious Megacolon (enlarged colon), polyps and cancer. It is said that colonic and rectal disorders are far more common in the Western world than they are in Africa and Asia because of the kind of food that is consumed in the Western Countries. But now even in most developing countries like India, these disorders are getting more common due to popularisation of western fast foods like pizzas, soft drinks, etc.

Disorders of Appendix and Caecum :
The commonest disorder of Appendix that a Homeopathic physician encounters is Appendicitis. Appendicitis is often caused by infection or obstruction by faecolith, enlarged lymph nodes, and tumours or by tapeworms.

For acute pain, my first prescription is Aconite 1M in water to be taken 2 Tsp every 10 to 15 minutes till the pain is better or surgeon takes over. This prescription delays the complications, reduces pain, restlessness and fear, and gives a good background to the surgeon to perform the surgery.

Subacute and Chronic Appendicitis is often easily treated with homeopathic medicines.

The inflammation of the Caecum called Typhlitis, is a disorder often misdiagnosed as Appendicitis. This is also amenable to homeopathic treatment. Think of it when patient comes with Appendicitis-like-syndrome after an Appendectomy.

Proper homeopathic treatment puts an end even to the recurrence.
Iris-tenax is a pathogenically similar remedy to most subacute and chronic Appendicitis and Typhlitis. If selected, give Iris-tenax 30 - 2 pills 3 or 4 times / day till pain is relieved.

For persistent low-grade fever with or without history of Typhoid, I have found Baptisia very useful. Bapt 30; dosage same as Iris-tenax.

Apis-mel, is another handy remedy for Appendix and Caecal disorders. Its homoeopathicity to these disorders is due to its elective action on the serous membranes especia

lly on the peritoneum with right-sided laterality. Stinging and burning pains, thirstlessness and concomitant oliguria confirm the prescription. Lycopodium and Bryonia are two other remedies to be considered on the basis of the elective action on serous membrane and right-sided laterality.

Belladonna - indicated when severe throbbing pain in the appendix area with fever and the signs and symptoms of cephalic congestion like throbbing headache, infected eye, etc.

Lachesis, well known as a left-sided medicine, is useful in Appendicitis and Typhlitis when: Pain in appendix area is worse after sleep, worse for slight touch, better with hard pressure; the pain relieved by passing stools or flatus.

Colocynthis for spasmodic affections of Appendix or Caecum, though not effective for inflammatory condition. The spasmodic condition is mainly due to mental disturbances like anger or less likely due to obstruction with faecolith or tapeworms etc.

Obstruction with faecolith is common in constipated people. In addition to Bryonia, Lac defloratum and Plumbum-met get indicated here.

The classical symptoms of Bryonia - stitching pain in Appendix area aggravated by movement, ameliorated by absolute rest and pressure; dry, scanty and hard stools; thirst for large quantity of cold water with long intervals - help in deciding the prescription.

Lac-defloratum is indicated when these patients with constipation suffer from concomitant migraine headache. Plumbum, though less frequently indicated in Appendicitis, helps those people with constipation when the abdomen is retracted with severe pain. The well-known objective symptom of Plumbum - bluish line on the lower gums - is often present.

Sometimes well known (polychrests) but not known to cure Appendicitis or Typhlitis may also come in. The following case illustrates this point.

Miss D aged 20; a student staying in a hostel in Chennai, went abroad during vacation to her parents. Within few days of staying there, she suddenly developed intense pain in her whole abdomen. She was taken to a hospital there, was diagnosed as Appendicitis and was advised to undergo an emergency operation. As the patient refused to undergo operation, she was treated with antibiotics and analgesics. Within one day the pain went off. After two weeks she came back to Chennai. About a month later, she developed similar pain again. Her roommates urged her to get herself admitted in a hospital. But she refused to go to the hospital for the fear of operation and was brought to me.

When she came to me the pain was severe around the navel with temperature of about 1000 F. O/e she was having severe tenderness in the Rt.iliac fossa. She also complained that she had not passed stool properly for a few days. She was passing lot of foul flatus. Her tongue was white coated and she had halitosis.

I told her that I suspected Acute Appendicitis and that she had to go for operation. But the patient begged me not to send her to the surgeon because she couldn't bear the idea of undergoing an operation. I asked her the reason for her irrational fear. She told me that she was having intense fear of knife since her childhood. Spigelia 1M - 5 pills dissolved in 1/2 glass of water - 3 teaspoonfuls repeated every 10-15 minutes brought down her pain in about 3 hours. The next day she had mild diarrhoea. When she passed stools the second time, she also passed flatus very occasionally and it was not foul. Her tongue became clean and no more fetor oris. It is now more than two years and she is normal without an operation.

A clinical tip: Typhoidinum 200 or 1M prescribed as intercurrent remedy prevents recurrence of Typhlitis. This is due to the fact that Caecum is the reservoir for S. Typhi in Typhoid carriers.

Appendicular Abscess , a complication of Appendicitis, is a risky disorder to treat with medicines. Appendicular abscess is the result of cordoning off the inflamed appendix by omentum. This prevents the spread of infection and the formation of peritonitis. A well-indicated remedy may break open the abscess and may lead to peritonitis, a fatal complication. It is always safe (for both patients and the physicians) to refer these cases to the surgeons. The same is applicable to other complications of Appendicitis like Perforation and Peritonitis.

Disorders Of Other Parts Of Colon
Non-inflammatory disorders like Diverticulosis and Megacolon are mostly difficult to treat with Homeopathic medicines. But, with patient's co-operation and the physician's Homeopathic acumen, some cases may be treated with Homeopathic medicines.

Though Diverticulosis per se cannot be cured with medicines, most of the complaints arising due to Diverticulosis can be well treated with Aloes, Ars- alb, Asafoetida, Baryta carb, Lachesis, Lycopodium, Opium, Nux- vomica, Raphanus, Merc-dulcis, etc. Clinically I find Lachesis as the most homeopathic one to Diverticulosis and Diverticulitis. Asafoetida and Raphanus rank next. Merc-dulcis is a near specific.

Lachesis, the predominantly left sided medicine, with its aggravation by light touch, amelioration by hard pressure, amelioration by discharges (flatus, stool, etc), and with its bleeding tendency, becomes the major medicine in treating Diverticulosis.

Asafoetida, another Lt.- sided medicine: offensive diarrhoea, reverse peristalsis, excessive flatulence, flatus passing upwards and none downwards.

Raphanus is indicated in Diverticulosis with constipation and flatulence; no flatus emitted upward or downward. The abdomen is distended (predominantly left-sided) with respiratory discomfort.

Merc-dulcis gets indicated when there is a violent pain in abdomen. Abdomen is bloated, hot and tender. The anus is sore and burning. Dysenteric, small stools of mucus and blood, covered with bile.

Megacolon is a distended and thick-walled colon due to some obstruction below the level of the obstruction. There are two types of Megacolon - Congenital and Acquired.

Congenital Megacolon called Hirschsprung's disease or aganglionic Megacolon is an idiopathic disorder.

Acquired Megacolon is commonly caused by a combination of defective toilet habits and emotional disorders during childhood, in which the child withholds defecation.

Administration of laxatives, often needed in more and more increasing doses, damages the intrinsic innervation of the intestinal wall. A huge, dilated rectum full of feces develops over the years. The impacted feces act as an obstruction, and further fecal material piles up behind, with voluminous dilatation of the whole colon in some cases. The same phenomenon is occasionally encountered in those with schizophrenia and severe depression. It may be related to neurological disorders such as paraplegia, to unrecognized rectal strictures, and to some metabolic disorders. Severe degrees of constipation, often running in families also lead to Megacolon.

Congenital Megacolon invariably turns to be a surgical case. Acquired Megacolon often responds to timely and well-selected homeopathic medicine like Alumina, Baryta- carb, Causticum, Gelsemium, Lac. Defloratum, Lachesis, Opium and Plumbum.

Non-Specific Colitis is due to non-specific inflammation of mostly unknown origin. This covers a wide range of diseases like Irritable Bowel Syndrome, Ulcerative Colitis, Crohn's Disease, Diverticulitis, Sigmoiditis, Typhlitis, etc.

(Irritable Bowel Syndrome is tackled in detail elsewhere in this issue.)

Ulcerative Colitis: is a long-term condition in which ulcers develop in places along with lining of the large intestine. These ulcers may originate in the rectum (proctitis) and gradually spread upwards into the colon. In many cases, the entire large intestine is affected. Aetiology is unknown. Sometimes it can resemble Crohn's disease and as the two conditions have many features in common they are studied together.

All the Mercurial preparations like Merc-sol., Merc-cor., Merc-dulcis are useful along with Aloes, Ars-alb. Asafoetida and China.