Infection and abscess mostly arise in glands or hair roots of the skin. The
infected spot initially erupts and then forms an abscess. The abscess gets
opened and discharges its contents (pus) and then heals. Depending upon the
load of infection, septic conditions like fever and toxic symptoms can result
in the course of an abscess
Abscess will be usually red hot with throbbing pain. The abscess, after getting
fully blown up with pus, usually opens near the surface and lets out the pus
naturally. To save time and live comfortably without pain, abscess is now dealt
with surgically with incision and drainage (I&D). If it is deep,
persistent, not properly drained or becomes chronic in nature, then it gets
reformed as a small cavity or sinus with a single opening. Sometimes, it opens
at both sides/ends and thus becomes a tunnel or tract – namely fistula.
Anus, the exit route of faeces and it surroundings are more vulnerable to
bacterial or fungal infection due to moisture and folded skins. Germs/micro
organisms will also be more concentrated in that area in spite of cleanliness.
Usually, infection occurs and causes boils or abscess due to lack of hygienic
condition, but sometimes the causes remain unknown.
Anal abscess
Abscess is a mere collection of pus which is supposed to drain either
inside or outside where the points are weak and easily prone for an
outlet. Anal abscess mostly presents itself as a tender swelling in or around
the anus with throbbing pain. Even though perianal abscesses are more common
after piles, fissure and gland infection, ischiorectal abscess and submucous
abscess can also be seen. Common bacterias which usually cause infections are
staphy, E.coli, strepto and proteus. Sometimes abscess arises spontaneously
without any cause. Mostly abscess opens externally and drains to cure. But
sometimes it can lead to a tract of deep location to open in and out, giving
rise to fistula. Either way i.e. natural drain or surgical drainage, if it
lacks care in healing, the chances of fistula formations are there.
Fistula – Fistula in general, means abnormal
passage/tunnel/tract which connects gland and skin or mucous membrane and skin.
It occurs as a complication while the abscess gets resolved. It is either lined
with mucosal membrane or may be lined with granulation epithelial tissue. There
are different types of fistula, i.e. anal, umbilical, urethral, perineal,
thyroglossal, salivary, arterio-venous, etc. Usually, the fistula opening will
be indrawn and covered with the crescentic fold of skin.
Anal fistula – Among fistula, anal fistula is the commonest and
most bothersome. Most commonly it arises from perianal abscess. This anal
fistula mostly connects anus / rectum to the outer skin. Sometimes, it may
connect anus and vagina or anus and urethra. The fistula usually traces the
drainage pathway of the abscess. It may have a single or multiple opening(s) in
inner/outer aspect, depending upon the position and direction of the drainage
of the abscess. The fistula having multiple opening should be seriously
investigated for tuberculosis or Crohn’s disease.
Incidence – Males have higher incidences than
females. It usually follows in at least 40-50 per cent of anal abscess cases.
Unhygienic conditions also favour higher incidences.
Pathophysiology – Usually, every abscess opens one day or the other
and lets out the pus. Sometimes it needs surgical intervention to drain,
especially when it is deep. In any case, if it doesn’t heal up properly or if
it is not properly drained after letting out the pus then it will usually
remain as infecting foci and suppurates. Also this will constantly or
intermittently discharge pus or fluid through the outlet/tract. In due course,
this tract gets lined with granulation tissue which resists healing (joining
the other surface). Fistula’s length and openings (internal and external)
usually vary in size and number according to the location of the abscess and
care taken over it. Usually, the fistula tract will be a curved one. Untreated
fistula or clogged outlet of fistula (due to infection or draining debris
obstruction) will usually promote multiple internal/external openings with recurrent
anal abscess and re-formation of tract or tunnel.
Causes – Ill-treated or maltreated infection and abscess
are the main causes for fistula formation, the other causes include
negligence/lack in treatment of piles, anal fissures, Crohn’s disease, cancer,
constipation, etc. Fistula formation is mainly due to improper and inadequate
drainage of pus from abscess with narrow opening or block or high opening or
presence of infective foci or foreign bodies or unhygienic conditions. Another
important cause to be ruled out is nylon underwear which does not absorb
moisture. The major aggravating factor is pressure exerted by physical strain
while passing stool since it will propel the faecal matter into the fistula
tract.
Symptoms
Anal fistula is mostly present with the following symptoms, when there is
infection or strain or block.
Feeling of lump near the anus with stabbing/throbbing
pain
·
Pain will shut off immediately after letting out the pus
·
Continuous or intermittent (on and off) leakage of foul
pus/mucous/faecal matter from the fistula’s external opening, soiling the inner
garments
·
Discomfort and skin infections due to constant wetness
caused by leaked fluids
·
Constipation or diarrhoea
·
If fistula gets blocked, again there will be abscess
formation with the symptoms of swelling, fever, malaise and septicaemia.
Diagnosis
Anal fistula can be diagnosed easily
by physical examination of the anus and its surroundings. Rectal examination,
sigmoidoscopy and fistulography give more details about the abscess, its tracts
and openings.
Management
·
Take plenty of water and fruit juices to avoid
constipation
·
Follow hygienic measures in cleaning and caring
·
Pass stool twice a day to avoid strain to rectum and anus
·
Don’t strain while defecating. It is better to have
semisolid stool for easy defecation
·
Sitz bath – After passing stool, sit in a shallow bath
tub filled with antiseptic lotions or warm salted water for 10 minutes, to make
the condition hygienic
·
Hot compress can help anal abscess by enhancing blood
circulation for diluting the infective toxins over there and healing faster
with supply of nutrients
General treatment
Fistula is usually very difficult to cure with medicines. So, allopaths
mostly opt for surgical excision of fistula namely Fistulectomy. But, even
after surgery, the chances of recurrence are more, which may be due to
leftovers of fistula tract or abscess residuals or suppuration after surgery.
Caution should be exercised during post-operative care for otherwise the
tendency to form abscess will post another innings with a new tract formation.
Other than delayed healing, abscess formation and recurrence of fistula,
surgical removal can also cause incontinence of anus related to urge. These
make the sufferers dejected and shameful.
Preventive measures
·
Follow regular bowel habits without any strain
·
Follow hygeinic measures to keep anal area clean and dry
·
Treat any infections or boils immediately
·
Avoid nylon underwear and use cotton ones
Homeopathic approach to fistula
Homeopathy can help avoid fistula formation, when anal abscess is properly
treated with Homeopathic medicines. Treatment for fistula should be started at
the earliest, to heal it before gets granulations in the tract so that it can
heal completely without giving any residual gaps or chances of recurrences.
Homeopathy usually cares fistula by controlling infection and helping the
wound to heal. It aids natural cure. Patients need patience while getting
treated for fistula since the fistula opening looks like it has healed but
opens suddenly on strain or with a new anal abscess. Everyone can keep hygienic
condition externally, but not internally. Since faecal matter is full of
microorganisms, no one can avoid getting infection unless they have gained
resistance to infection. Homeopathy can provide this. Also, for complete
healing, fistula should get healed or closed from within first. Otherwise, the
outer opening can reopen anytime or open a new tract to a new place.
Homeopathy can abort the tendency to abscess formation and suppuration by
increasing resistance. So it can thus avoid the hindrances to cure by helping
the healing process to continue naturally without interference. Also, to heal
the fistula, first of all, the flow of fluid must get stopped since the
draining fluid itself acts as a layer of separation to resist healing. For
that, the tendency to fluid collection and suppuration must be stopped.
Homeopathy provides this without any surgical measure. If the flow gets stopped,
the pathway dries up naturally and shrinks to get close approximation for
better healing.
Homeopathic medicines commonly used in cases of fistula are – Acid Nit,
Apis mel, Bacilinum, Calc Flour, Calc Phos, Calc Sulf, Calendula Q, Capsicum,
Carboveg, Causticum, Collinsonia, Graphites, Hamemelis, Hepasulf, Hydrastis,
Hypericum, Lachesis, Lycopodium, Mag Phos, Mer cor, Merc sol, Muriatic acid,
Silicea, Sulphur, Thuja, etc.. These Medicines should be taken under the advice
and diagnosis of a qualified Homeopath.
for
new hope
Dr. S. Chidambaranathan, BHMS, MD (Homeo)
Laxmi Homeo Clinic
24 E. New Mahalipatti Road
Madurai, TN 625 001
India
Tel: +91-984-319-1011 (Mob /
Whatsapp)
Clinic : +91-452-233-8833 |
E-mail: drcheena@gmail.com
(Disclaimer: The contents of this column are for informational
purpose only. The content is not intended to be a substitute for professional
healthcare advice, diagnosis, or treatment. Always seek the advice of
healthcare professional for any health problem or medical condition.)