Fistula

Overview of  Fistula

• It is a communicating track between two epithelial surfaces, commonly between a hollow viscus also the skin (especially external) or between two hollow viscera (specifically internal). [2]
• In detail, This communication or tract may be lined by granulation tissue but may become epithelialized in chronic cases. [1]

Indian epidemiology then other

Causes of Fistula

Congenital i.e.:

• Branchial
• Tracheoesophageal.
• Congenital AV.
• Umbilical

Acquired i.e.:

• Trauma (especially abdomen)
• Instrumental (during delivery)
• Surgical
• Inflammatory (either intestinal tuberculosis or actinomycosis)
• Malignancy (for example; recto vesical fistula in carcinoma of rectum).[5]

Classification of Fistula

External fistula i.e.

• Oro-cutaneous
• Branchial
• Thyroglossal
• Enterocutaneous
• Appendicular

Internal fistula i.e.

• Tracheoesophageal
• Cholecysto duodenal
• Colovesical
• Recto-vesical [4]

Risk factors are things that make you more likely to develop a disease in the first place.

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Sign & Symptoms of Fistula

Different discharges e.g.:

• Purulent—Bacterial infection
• Caseous—Tuberculous
• Sulphur granules—Actinomycosis
• Mucus—Branchial
• Saliva—Parotid
• Faeces—Faecal
• Bile—Biliary, duodenal
• Bone—Osteomyelitis sinus
• Urine – Urinary [4]

Pain i.e.:

• If pain is associated with, additionally inflammatory nature is assured.

Fever and redness of the surrounding skin i.e.:

• In brief, It also suggests inflammatory origin [2]

Clinical / Physical Examination

Inspection

• Branchial: especially, Anterior border of lower third of stemomastoid
• Parotid: In the parotid region
• Thyroglossal: specifically, Mid line of neck below hyoid bone
• Appendicular: particularly, Right iliac fossa

Palpation

• Induration is present in chronic type, actinomycosis, also osteomyelitis.
• Submandibular stone may be palpable as in submandibular type.

Relevant clinical examination

• Submandibular gland enlargement- i.e. Bidigital examination.
• Alveolar abscess can be found as in median mental sinus.
• Per rectal examination and proctoscopy- i.e. Internal opening of the fistula. [3]

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Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Fistula

Examination of the discharge i.e.-

• Macroscopically
• Physically
• Chemically
• Microscopically
• Bacteriologically

X-ray Examination i.e.-

• Straight X-ray
• Injection of radio-opaque fluid

Examination using coloured solution i.e.-

• Charcoal powder
• Coloured drug (i.e. Pyridium)

Fistulography [2]

Treatment of Fistula

• Treat the cause
• Excision of fistulas. In detail, Always specimen should be sent for histology. [4]
• Antibiotics
• Adequate rest
• Adequate drainage [3]

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Homeopathic Treatment of Fistula

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Fistula:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Berberis:

• Violent burning in anus, as if surrounding parts were sore.
• Frequent also constant desire for stool.
• Burning, stitching pains during, before also after stool painful pressure in perineum, stitches in perineum, extending deep into (left side of) pelvis.
• Tearing extending around anus.
• Short cough and chest complaints; additionally biliary colic.

Calcarea Phos:

• After surgical interference for the fistula.
• Fistula-ani alternating with chest symptoms or in persons who have pains in joints with every spell of cold stormy weather, especially in tall, slim persons.
• Burning also pulsating in anus; bearing down towards anus.
• Sore feeling in anus when getting up in the morning.

Causticum:

• Frequent, sudden, penetrating, additionally Pressive pain in rectum.
• Anus very sensitive to contact.
• Itching also sticking in rectum.

Hydrastis:

• It occurs with constipation, piles also ulceration.
• Offensive, dirty-looking discharge from anus, obliging him to wear a bandage.

Lachesis:

• In brief, It occurs in drunkards with tendency to pulmonary complications.

Nux Vomica:

• Gastritis also constipation, aggravation after mental exertions, after eating

Phosphorous:

• Ulceration of rectum, with discharge of pus also blood.
• Moreover, Tuberculosis in tall, slender, rapidly growing persons, suffering from frequent bronchial attacks.

Silicea:

• Fistula in ani.
• Sharp stitches in rectum while walking.
• Abdominal pains aggravation especially by warmth.
• Suppuration of abscess; purulent sputa. [7]

Diet & Regimen

Do’s:

• Eat different coloured fresh vegetables and fruits.
• Additionally, Eat whole grains instead of refined foods.
• Then, Drink plenty of liquids.
• Use clean and hygiene dresses to avoid infection.
• All in all, To reduce the inflammation, take omega-3 rich fatty fishes.

Don’ts:

• Don’t have heavy meals at once.
• After that, Never sleep immediately after a heavy meal.
• Then, Avoid spicy and salty foods.
• Never stop your urge to defecate.
• Besides this, Never drink much water with meals.
• Don’t use cleaning agents especially in the effected region too often. [6]

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References 

[1] Bailey_and_Love_s_Short_Practice_of_Surgery

[2] Clinical Surgery S. Das

[3] Manipal Manual of Surgery (PDF Drive)

[4] SRB_s Manual of Surgery, 3rd Edition

[5] SRB’s Clinical Methods in Surgery

[6] https://www.lybrate.com/topic/diet-for-fistula?utm_source=indo&utm_medium=cps&utm_campaign=gkart&lpt=AFLT_INDO

[7] Homeopathic Therapeutics by Lilienthal

Frequently Asked Questions

What is Fistula?

A fistula is an abnormal communication between two epithelially lined surfaces.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Fistula?

• Berberis
• Calcarea Phos
• Causticum
• Hydrastis
• Lachesis
• Nux Vomica
• Phosphorous
• Silicea

What causes Fistula?

• Congenital
• Trauma
• Instrumental
• Surgical
• Inflammatory
• Malignancy

What are the symptoms of Fistula?

• Different discharges
• Pain
• Fever and redness of the surrounding skin

Give the types of Fistula?

• Oro-cutaneous
• Branchial
• Thyroglossal
• Enterocutaneous
• Appendicular
• Tracheoesophageal
• Cholecysto duodenal
• Colovesical
• Recto-vesical