Anal Fissure :: A case of anal fissure – prescribing on the seat not the site
An anal fissure is a cut or tear occurring in the anus (the opening through which stool passes out of the body) that extends upwards into the anal canal. Patients may try to avoid defecation because of the pain. The pain may also affect urination causing dysuria, frequent urination, or the inability to urinate. Bleeding in small amounts, itching (pruritus ani), and a malodorous discharge may occur due to the discharge of pus from the fissure.
The fissure may be caused by a hard stool, recurrent diarhoea, insertion of a rectal thermometer, enema tip, endoscope, or ultrasound probe (for examining the prostate gland), during childbirth, anal cancer, Crohn’s disease, leukemia as well as many infectious diseases including tuberculosis, viral infections (cytomegalovirus or herpes), syphilis, gonorrhea, chlamydia, chancroid (Hemophilus ducreyi), and human immunodeficiency virus (HIV).
An acute fissure if well managed will heal with homoeopathic remedy. The presence of Chronic or recurrent fissure requires a careful constitutional homoeopathic prescribing. Bowel habits can be improved with a high fiber diet, and plenty of fluids. Lukewarm hip baths for 10-20 minutes (Sitz Bath) each day especially after defecation are soothing and promote relaxation of the anal muscles.
The homoeopathic literature is rich in medicines for this condition like Ratanhia, Nitric acid, Paeonia, Graphites, Ignatia, Silica etc. each with its specific and distinct indication.
A 29 year old man consulted for painful defecation with bleeding since last 1 year. He was of short height, thin built, and had dark eyes and hair, sharp nose, dark stained teeth with caries at the edges of teeth and black mole with a hair coming out of it on the right eyebrow. His nails had a peculiar brown/ gray discoloration longitudinally.
He had painful defecation since his school time on and off but since he came to Delhi, about an year back, his complaint had aggravated and been persisting. He now regularly had pricking pain which would aggravate after stool. Pain was also worse on sitting and better standing or lying on abdomen.
He also complained of pain in both the shoulders since 2-3 years.
He had suffered with Chicken pox in childhood and Jaundice about 2 years back.
His family history revealed:
He was born and brought up in Assam. After grad he had worked in various places and finally been in Delhi for last one year. He was also smoking about 12-14 cigarettes every day for last 12 years or so. He consumed alcohol almost fortnightly. He had also been addicted to grass for an year some time back.
Appetite: Can’t tolerate when hungry; Non vegetarian diet
Thirst: Less; Loved chilled water
Cravings for Fish and Ghee
Aversion to sour
Sleep: On abdomen; snoring; in slight light
Dreams: Of his native place- of being there with his friends and enjoying
Perspiration: Not much
Thermal Reaction: Hot
He has always been impatient, short tempered and moody. He missed his native place because he had to manage his things here all alone. Though his mother had been unwell but he was not able to leave his work and go. Explaining this, he said that this is the only time in his life when he could work and make money.
Life and circumstances
Being the only child of his parents he had been pampered a lot. Thus he had gotten into the habit of smoking, taking alcohol and drugs (grass) in school time. He had had numerous casual sexual relations but had never had any STI. He had broken up with his childhood girlfriend because she found out about his numerous relations. He felt no remorse about that because he felt that he was not yet ready for any commitment, would think about it after some years.
Prescription and follow up
He was prescribed a dose of Sepia 30 along with placebo. In his first follow up, a month later, he reported that the very next day his pain and bleeding had vanished and he had not had any trouble ever since. He just visited us once more, 6 months later with another person suffering with a similar problem.
Analysis and Discussion
The Site of the disease (Location), for the homoeopathic physician, is of importance only in those cases, where the pathology has advanced so much so as to obliterate the General features of the patient. When we talk about Seat of the disease, we are talking about the entire morbid constitution that is giving rise to manifestations in the form of various illnesses, in this case fissure. Homoeopathic treatment means correction of this basic constitution or soil that is tainted/ polluted (Seat of the disease) so that healing takes place at the fundamental level of the being. This basic difference between the Site and Seat of the disease should be kept in mind by every homoeopathic physician especially those who wish to cure!
In this case the most striking feature was ‘Indifference’- his indifference towards mother (who was lying unwell, yet he was not taking out time to visit her), his disregard of his (now ex) girlfriend and his own self (manifested in his disregard for his health and indulgence in drugs). This was the basis on which Sepia was chosen and prescribed. The other symptoms like pain in fissure < Sitting, Intolerable hunger, Less thirst etc. corroborated with the remedy chosen.
Another interesting thing that I have also learnt from my Guru Prof L M Khan is that Sepia is also one of the drugs which has ailments/ aggravation from sexual excesses. It is also interesting to know that sex for sepia patient is entirely a mechanical phenomena just like its source, the cuttlefish .