“EFFECTIVENESS OF HOMOEOPATHIC MEDICINE IN CASE OF ANAL FISSURE’’

Abstract

Anal fissure is one of the most painful anorectal diseases which makes the patient seek medical help. The textbooks of modern medicine classify anal fissures into acute and chronic depending on the duration. The position of the fissure and also other underlying diseases if present, predispose the fissure towards chronicity. According to Hahnemannian classification of diseases, anal fissures are tubercular in origin. Combined with Sycotic miasm, the condition becomes aggravated and difficult to cure.

Keywords: Anal fissure, homoeopathic medicines, miasmatic diagnosis

 Introduction

 Anal fissure is one of the most painful conditions among the anorectal disorders. Trauma to the anoderm with the passage of a hard stool is thought to be a common initiating factor. The pain sensation is out of proportion to the trauma. The pathophysiology of anal fissures is not entirely clear. It is probable that an acute injury leads to local pain and spasm of the internal anal sphincter. There is immense scope for anal fissures to heal itself naturally with aid of homoeopathic medicines, with slight modification in life style and few dietary measures. Most commonly, anal fissures occur in the posterior midline; however, in up to 25% of women and 8% of men, a fissure can be located in the anterior midline. In patients who have lateral fissures, the clinician should consider an alternative aetiology such as Crohn’s disease, malignancy, tuberculosis, or HIV infection.

Etiopathogenesis

Etiopathogenesis An anal fissure is a superficial tear in the anoderm distal to dentate line. The dentate line is an irregular line present at the junction of the superior two thirds and inferior one third of the anal canal. The blood supply, innervation and lymphatic drainage of the anal canal grossly vary with respect to the dentate line. The area above the dentate line is sensitive only to stretch while the area below has somatic innervation and is sensitive to touch, pain and temperature making anal fissures one of the most painful anorectal problems. The area below the dentate line is highly sensitive to insults like microtrauma, pressure, and ischemia and gets torn easily. Passage of hard stools, constipation, injury, repeated episodes of diarrhoea (less frequently) form common aetiologies for anal fissures. Acute fissures can develop after repeated vaginal childbirth due to damaged pelvic floor and loss of support to anal mucous membrane. Anal cancer can be a cause in the elderly. Severe spasm of the internal anal sphincter is seen in acute fissures. Bowel movements and attempts at defecation result in more pain, augmenting the sphincter spasm and thereby diminishing anal blood supply. The patient withholds passing stools and this exacerbates the constipation. This cycle continues and hampers the healing process. Persistent sphincter spasm, anal hypertonicity, repeated trauma and decreased perfusion to the posterior commissure predispose the fissure to turn to chronicity. Anal fissures are most commonly located in the posterior midline of the anal canal since this region receives the least blood supply. Exaggerated shearing forces acting at the posterior midline during defecation, relatively less elasticity of the anoderm and increased density of longitudinal muscle extensions at this site contribute to increased rate of occurrence of fissures at the posterior midline.

Clinical Features

• The classic complaint is pain, which is strongly associated with defecation. Pain during defecation. Pain after defecation that can last up to several hours . Streaks of bright red blood on stools or on toilet paper after wiping. Burning or itching in the anal region. A visible tear in the skin around your anus. A skin tag, or small lump of skin ,next to the tear.

Diagnosis and Examination

 A fissure can be easily diagnosed on history alone. The diagnosis can typically be confirmed by physical examination and anoscopy in the orifice if tolerated by the patient. By gentle separation of the buttocks and examination of the anus, a linear separation of the anoderm can be identified at the lower half of the anal canal. On digital examination, chronic fissure feels rough, raised, or fibrotic in the mid-distal anal canal and a skin tag, called sentinal pile also visible.

Miasmatic diagnosis of anal fissure

 Anal fissures are manifestations of chronic miasmatic disease, tubercular in origin. It has the constriction and constipation of Psora and the ulceration of Syphilis. When combined with Sycosis the condition becomes much aggravated and difficult to cure.

Prevention

An anal fissure can’t always be prevented, but you can reduce your risk of getting one by taking the following preventive measures: Take warm Sitz bath. Keeping the anal area dry. Cleansing the anal area gently with mild soap and warm water.  Avoiding constipation by drinking plenty of fluids, eating fibrous foods, and exercising regularly. Treating diarrhoea immediately.

Management of Anal Fissure

The management of the acute fissure is conservative. Stool softeners for those with constipation, increased dietary fiber, topical anesthetics, glucocorticoids, and warm sitz baths are prescribed and will heal 60–90% of fissures. Chronic fissures are those present for >6 weeks. These can be treated with modalities aimed at decreasing the anal canal resting pressure including nifedipine ointment applied three times a day and botulinum toxin type A, up to 20 units, injected into the internal sphincter on each side of the fissure. Both treatments are associated with a fissure healing rate of >80%. Surgical management includes anal dilatation and lateral internal sphincterotomy.

Usually, one-third of the internal sphincter muscle is divided; it is easily identified because it is hypertrophied. Recurrence rates from medical therapy are higher, but this is offset by a risk of incontinence following sphincterotomy. Lateral internal sphincterotomy may lead to incontinence more commonly in women.

 Homoeopathic medicines selected on basis of totality of symptoms are known to cure anal fissures.

Some of the Remedies for anal fissures are as follows :

• Graphites: It is one of the best Homeopathic medicines for anal fissures. This medicine is usually recommended to patients who are obese, overweight, or facing constipation problems. When the stool is really hard and knotty, this medicine helps in treating the condition along with soreness.
• Hydrastis canadensis: Anal fissure with burning and smarting in anus during and after stools, Pain lasting for hours after stool. Constipation with dry, large, lumpy stools with sinking feeling in stomach and dull headache. Colic and faintness. Constriction and spasm of rectum. 
•  Nitric Acid: There is a sharp pain in the anal or rectal region. The person with anal fissure may also feal tear in the rectum and discharge. which may even extend to the urine, stool and even perspiration. Despite the stool being soft or suffering from diarrhea, one has to strain to pass the stool.
• Natrum muriaticum: Anal fissure with burning and stitching pain in the anus after stools. Constipation, stools dry, hard and crumbling. Sensation of constriction in the rectum. Great debility and weakness especially in the morning. Consolation aggravation with Psychic causes of disease
•  Ratanhia: It is another Homeopathic medicine to treat anal fissures. This medicine helps in treating pain during anal fissure. 
•  Paeonia: This homeopathic medicine is mostly to treat the discharge that occurs during anal fissure. The patient feels internal chilliness in the rectal region after using this medicine. 
• Aesculus: This Homeopathic medicine treats the dryness, aching and soreness due to anal fissure. Even burning sensation, itching and throbbing pain in anus after passing stool are taken care of.  
• Causticum: Causticum is for anal fissure which tends to dry up, have a dark-brown or purple edges. This can also be prescribed by a Homeopathy doctor when there is bleeding from anus while walking.
• Ignatia: It is a homeopathic medicine for fissure and piles. When the pain shoots upwards after passing stool after rectal prolapse, this helps in reducing the pain. 

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About Author: Dr. Seema Sahu, MD Scholar Batch 2021-22, Department of Practice of Medicine, Government Homoeopathic Medical College and Hospital Bhopal, Madhya Pradesh.