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 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 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.

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.

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 anusDon’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

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 abort the tendency to abscess formation and suppuration by increasing resistance 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 Homoeopath.

Fissure in ano :

A fissure literally means a cleft crack. Medically, fissure refers to linear crack in the skin. Skin cracks can arise anywhere in the body. But the cracks are most commonly seen in edges or at the junction of two different types of skins

Causes - The major causes are supposed to be,

• Physical strain -Pressure exerted while passing stool
• Defecation – Anal fissure is most commonly caused by constipation. The hard, dry stool tears the anus when it stretches the anus forcibly while defecating. It can also be caused by diarrhoea due to sudden purge or straining after enema.
• Foods – Low fibre diet, more spices, alcohol and lesser intake of water can produce hard dry stool, which needs more strain in defecation
• Weakened anus sphincter muscles – due to any diseases
• Dry skin disorders which affect lower part of anus
• Small tight anus – congenitally small or spastic tight anus

Symptoms :

• Cruel pain is the major symptom of fissure – Pain may be burning, stabbing, pricking and a feeling of glass pieces or thorns in the anus. Pain is usually aggravated after defecation. The patients used to suffer with pain for more than half-an-hour after passing stool or for the remaining whole day.
• Bleeding usually occurs at the time of defecation which appears as a streak in the stool. Usually it will be fresh and is supposed to come in drops after defecation but never passes mixed with the faeces.
• Tightness or spasms of the anus usually interrupt in passing the stool
• The fissure is always visible / felt as a swollen traingular (thickened) area with the skin tag in its lower end
• With the fear of pain, patients usually avoid the act of defecation and develop constipation from there which further worsens the condition

Diagnosis - of fissures is easy, since a simple examination with slight stretch of anus can identify the fissure. Digital examination will be very painful in all the case of fissures due to spasm and tightness of anal sphincters, so it is avoided mostly.

Management – Many fissures can be healed with simple management as follows.

• Take plenty of water and fruit juices
• Avoid non-veg and fatty diet
• Take easily digestible, simple food with plenty of vegetables
• Use Indian style toilets since squatting position will be a better position for pain and natural defecation.
• Follow hygienic measures in cleaning and caring
• Pass stool twice a day to avoid dry hard stool and strain to rectum and anus
• Never suppress an urge. Go for stool whenever there is a call since it will be easy then
• Sitz bath – Before passing stool, sit in a shallow bath tub of warm salt water for 10 – 15 minutes to relax the anal sphincter and to relieve the anal spasm. This technique usually pacifies all the painful anal conditions

Do and Don’t:

• Sporting activities, long-distance walking / travelling / cycling during healing process
• Any friction or injury
• Dry cleaning by toilet papers. Go for wash with warm water which usually soothes
• Scratching, since it may become red, sore and infected.
• Non-veg, fast foods, oily foods, etc.
• Spices and chillies
• Smoking, drinking alcohol and coffee

Prevention – It is well said that prevention is better than cure. Always follow these procedures to avoid anal sufferings

• Take plenty of water for easy defecation and to avoid constipation.
• Follow regular bowel habits
• Take hygeinic measure to keep anus clean and dry
• Treat constipation or diarrhoea immediately

Surgery - Mostly anal fissure heals without surgery, if it is cared for in its initial days itself. But if it becomes chronic and persistent, then, as a last resort, surgery can be opted.
Ahen one opts for the treatment in case of fissure. Also, surgery cannot cure all cases of fissure. Even after surgery it can recur if the root cause is not cured. So, Homeopathy treatment is the best way to root out the disease and cure fissure in ano without any side-effects.

Homeopathic medicines : commonly used in case of fissure are -Acid Nit, Bryonia, Calc Flour,

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