ANAL FISTULA

Definition:
1. an abnormal passage from the rectum to the outside originating above the internal sphincter
Etiology:
1. usually from spontaneous or surgical drainage of the pyogenic abscess or occasionally granulomatous
disease of the intestine (regional enteritis or TB)
2. most originate in the anorectal crypts; others may result from diverticulitis, neoplasm or trauma
3. in infants, these are congenital and are more common in boys
4. rectovaginal fistulas may be congenital or may follow radiation therapy, pelvic surgery, childbirth or
malignancy
Signs and Symptoms:
1. history of recurrent abscess followed by discharge
2. one or more secondary openings visible in granulomatous disease
3. discharge may be watery and the margins of the opening reddened
4. cord-like tract may be palpated
Lab Findings:
1. anoscopy or sigmoidoscopy is often required
Course/rognosis:
1. if the fistula is secondary to pregnancy or trauma the prognosis is good with surgical intervention
2. wound heals with granulation with generally good results
3. if secondary to degeneration of the surrounding tissues, the health of the connective tissue must be
addressed before the fistula can satisfactorily resolve
Differential Diagnosis:
1. hidradenitis suppurativa
2. pilonidal sinus
3. dermal suppurative sinuses
4. urethroperineal fistulas must be differentiated from cryptogenic fistula
Nutrition:
1. foods rich in vitamin , !, "
2. fla#seed tea (bid)
A!oid:
1. meat, alcohol, hot sauces, fried, fatty, rich, salty, spicy, sweet foods, coffee, caffeine, sugar
Supplements:
1. vitamin ($%,&&& '( qd)
2. vitamin ! ()&&& gm qd, buffered)
3. vitamin " (*&& '( qd)
4. +inc picolinate (,& mg qd)
5. essential fatty acids (fla#seed oil, $ T, qd)
"ydrot#erapy:
1. constitutional hydrotherapy
#ysiot#erapy:
1
ANAL FISTULA
1. diathermy (long or short wave)- indifferent electrode over bladder, rectal electrode or pad electrode on top
of ) or . towels, treatment /% min at warm dosage
2. copper sound into fistula tract attached to (0) pole, inactive pad under hip, )-% m, for % min, repeat in ) 1.
days
$otani%als:
1. !ollinsonia canadensis - due to bowel stasis, patient feels hot and heavy in lower body
2. 2hytolacca decandra (to#ic)- ulcerations of the outlets of the body
3. Thu3a occidentalis - with itching; restores normal blood quality and glandular secretions
4. 'ncrease circulation and immunity
"omeopat#y:
1. loe - heaviness and stricture of rectum; sensation of heat and burning in rectum; itching, pulsating in
rectum, 4 sitting; after stool, burning weight and itching in anus; cutting as if more will come; fullness and
pressing out of the anus
2. urum metallicum - stools hard, knotty; burning in rectum; nocturnal diarrhea; stool large in si+e
3. Berberis - stools with violent burning in anus, as if the surrounding parts were sore; tearing around anus;
fistula in ano; frequent and constant desire for stool; burning, stitching pains during, before and after stool;
painful pressure in perineum; stitches in perineum, e#tending deep into (left side) pelvic; short cough and
chest complaints, biliary colic; tetter on edge of anus
4. !alcarea carbonica - itching of anus; anal abscess; large bleeding; burning ulcers in anus and rectum;
burning in anus during stool
5. !alcarea phosphorica - fistula in ano, alternating with changing symptoms; boils and abscesses about and
near the anus discharging blood and pus; fistula in TB pts; persons who have pains in 3oints with every
spell of cold, stormy weather, esp5 in tall thin persons; burning and pulsating in anus; bearing down
towards the anus; sore feeling in anus when getting up in the morning
6. !arbo vegetabilis - patient lies in bed and oo+es thin bloody fluid from anus; fistula in ano; itching of anus;
stitches towards anus; burning in anus after stool; soreness of anus; sticking in anus during stool, as with
heedless passage of mucous with urging in anus
7. !austicum - rectum sore, burns; fistula and large hemorrhoids; pain and strong pulsation in perineum; anus
sensitive to contact; itching and sticking in rectum
8. 6luoric acid - constipation, tardy, infrequent, hard stools; itching within and around anus
9. 7ydrastis canadensis - fistula ani, with constipation, piles and ulceration; offensive, dirty looking discharge
from anus, obliging him to wear a bandage
10. 8ali carbonicum - fistula of the anus; burning, 9 sitting in cold water, with sitting on foot so as to press anus
4 after stool
11. :achesis - fistula ani in drunkards with tendency to pulmonary complications; full feeling in rectum;
sensation of little hammers beating
12. ;itric acid - constant acrid moisture around the anus; fistula in ano; periodic bleeding of rectum, itching and
burning in anus, violent cutting pains
13. 2aeonia - biting, itching in anus, with orifice swollen, burning in anus after stool, then internal chilliness;
atrocious pains with and after each stool; sudden pasty diarrhea, with faintness in abdomen; painful ulcer;
oo+ing offensive moisture on perineum
14. <ilica - patient with tendency to TB that are sub3ect to abscesses in the rectum, that open inside or out;
fistula in anus with chest symptoms; sharp stitches in rectum while walking; abdominal pain, 9 warmth
15. Thu3a - burning pain in anus and perineum; 4 from motion; itching, sticking, smarting in anus; condylomata
at anus
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