Perianal fistula is a chronic inflammatory condition characterised by an abnormal tract between the anal canal and perianal skin. Conventional management primarily involves surgical intervention, yet recurrence rates remain significant.
Homoeopathy offers a non-invasive, individualised therapeutic approach with an emphasis on holistic symptomatology. This case report documents the successful management of an intersphincteric and extrasphincteric perianal fistula in a 19-year-old male over a period of 14 months using individualised homoeopathic treatment.
A baseline sonofistulogram (April 2021) revealed two fistulous tracts: a 0.6 cm inter-sphincteric tract and a 2 cm curvilinear extrasphincteric tract.
The patient presented with painful defecation, constipation, incomplete stools, intermittent urinary flow, post-micturition dribbling, and perianal swelling. Emotional traits included irritability, sudden anger, a tendency to weep, and a soft-hearted disposition.
Remedies prescribed during the treatment course included Nux vomica 200C/1M, Sulphur 200C, and Cantharis 200C, along with supportive medicines (SL powder).
Gradual symptomatic improvement was observed over successive follow-ups, with marked reduction in constipation, urinary symptoms, and perianal discomfort.
A repeat high-resolution transperineal ultrasound (May 2022) showed complete resolution of fistula with no evidence of inter- or extrasphincteric tracts, confirming radiological cure.
This case demonstrates the potential of individualised homoeopathic therapy for complete healing of perianal fistula without surgical intervention. Such outcomes may be attributed to precise remedy selection based on the totality of symptoms, miasmatic evaluation, and consistent follow-up. Further controlled studies are warranted.
Keywords: Homoeopathy, perianal fistula, inter-sphincteric fistula, extrasphincteric fistula, Nux vomica, case report.
INTRODUCTION
Anal fistula is a chronic condition arising from infection of the anal glands and subsequent tract formation. Surgical modalities such as fistulotomy, fistulectomy, and seton placement are standard treatments yet carry risks of recurrence, incontinence, and morbidity¹. Homoeopathy has been reported to benefit fistula cases by promoting internal healing and preventing recurrence².
This report presents a completely resolved fistula case confirmed by repeat sonofistulogram, demonstrating the potential of individualised homoeopathic treatment in complex fistula types (inter-sphincteric + extrasphincteric³.
Symptoms of Perianal Fistula in This Case
Patient Information
- Name: (Initials Only) H.T.
- Age: 19 years
- Sex: Male
- Location: Bengaluru
- Fistula in ano
- Painful defecation
- Constipation
- Incomplete stools
- No bleeding, no pus discharge
- Intermittent urine flow
- Post-void dribbling
- Perianal swelling
- Emotional Traits: Soft-hearted, a tendency to weep, sudden anger, sudden irritability.
- Past History: Non-contributory.
INVESTIGATIONS
Baseline (13 April 2021) – Sonofistulogram
- Inter-sphincteric tract – 0.6 cm
- Extrasphincteric tract – 2 cm (curvilinear)
- No abscess
- Diagnosis: Inter-sphincteric & Extra-sphincteric Perianal Fistulae
Follow-up Investigation (31 May 2022)
- No supra/inter/intra/trans-sphincteric fistulae
- No perianal tract or abscess
- Anal sphincters normal
- Radiological conclusion: Complete resolution of fistula
Treatment Timeline and Follow-Up
| Date | Clinical Findings | Prescription |
|---|---|---|
| 14-08-2021 | Painful defecation; Incomplete stool sensation; Perianal swelling; Intermittent & painful urination |
Nux vomica 200 (OD, night); Sulphur 200 (once weekly); Cantharis 200 (SOS) |
| 18-09-2021 | 25% improvement; Swelling reduced; Incomplete stool sensation improved |
Nux vomica 200 (OD); Sulphur 200 (once weekly) |
| 22-10-2021 | Mild improvement (~10%); Persistent constipation; Emotional irritability |
Nux vomica 1M (single dose) |
| 01-12-2021 | Recurrence of perianal pain; Constipation improved |
Nux vomica 1M (single dose) |
| 02-01-2022 | Perianal pain reduced; Intermittent urinary flow persists |
Nux vomica 1M (OD); Supportive medicines (SL BD) |
| 23-01-2022 | Improved stool consistency; Post-micturition dribbling (2–3 drops) |
Nux vomica 1M (OD); Supportive medicines (SL BD) |
| 06-03-2022 | Significant overall improvement; Bowel & urinary symptoms stable |
Nux vomica 1M; Supportive medicines (SL BD) |
| 12-04-2022 | 90% clinical improvement; Minimal residual symptoms |
Supportive medicines (SL BD) |
| 02-06-2022 | Transperineal ultrasound: No evidence of fistula or abscess |
Supportive medicines (SL BD) |
| 31-07-2022 | Occasional hard stools; Urinary symptoms resolved |
Nux vomica 1M (thrice weekly) |
| 30-11-2022 | Single episode of constipation; Otherwise asymptomatic |
Nux vomica 1M (OD × 3 days) |
| 07-02-2023 | Mild intermittent constipation; No perianal pain or discharge |
Nux vomica 1M (once weekly) |
| 18-03-2023 | Hard stools; Small painful perianal pimple; No fistulous symptoms |
Supportive medicines (SL OD); Disket BD |
- Psora: Constipation, irritability, incomplete evacuation
- Sycosis: Fistulous tract formation, recurrent swelling, mucus issues
- Syphilis: Chronic tract, destructive pathology
Dominant miasm: Syco-syphilitic, guiding the choice of Nux vomica, Sulphur, Silicea.
REMEDY JUSTIFICATION
Nux Vomica¹⁴
- Great remedy for straining, incomplete stools, and ineffectual urge
- Intermittent urination, dribbling
- Anger, irritability
- Frequent urging for stools and urine
Silicea²
- Chronic suppuration tendency
- Tendency for fistula formation
Sulphur³
- Anti-psoric
- Clears blockages and incomplete evacuation
Cantharis⁴
-
Intense urinary burning, intermittent stream
Gradual tapering and chronic constitutional management led to complete healing.
RESULTS : Fistula Healed Without Surgery
- 25% improvement within 1 month
- 90% improvement by April 2022
- Complete radiological cure by May 2022
- No recurrence until the March 2023 follow-up
Before
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After
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BEFORE–AFTER RADIOLOGY SUMMARY
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BEFORE–AFTER RADIOLOGY SUMMARY
| Parameter | April 2021 | May 2022 |
|---|---|---|
| Inter-sphincteric tract | Present (0.6 cm) | Absent |
| Extrasphincteric tract | Present (2 cm) | Absent |
| Abscess | Absent | Absent |
| Overall | Fistula present | Complete resolution |
DISCUSSION
Homoeopathy has demonstrated potential in fistula management in several observational studies⁵⁶. This case adds radiology-documented evidence of healing of a chronic dual-type fistula. Nux vomica acted both as an anti-sycotic and anti-syphilitic agent, correcting bowel habits and pelvic floor dysfunction. Consistent follow-up and miasmatic prescribing with Sulphur and Silicea likely enhanced long-term outcomes.
CONCLUSION
Individualized homoeopathic treatment resulted in the complete resolution of inter-sphincteric and extra-sphincteric perianal fistula in this 19-year-old patient, verified through imaging. This case demonstrates homoeopathy as a viable non-surgical therapeutic option for selected fistula patients.
ETHICAL STATEMENT
Written informed consent was obtained from the patient for publication of clinical details and investigation images, with identity fully anonymised.
REFERENCES (Vancouver Style)
- Parks AG. Pathogenesis of anal fistula. Br J Surg.
- Banerjee A. Homoeopathy in fistula-in-ano. HMAJ.
- Clarke JH. Dictionary of Practical Materia Medica.
- Boericke W. Pocket Manual of Homoeopathic Materia Medica.
- Nayak C et al. Role of Homoeopathy in chronic surgical diseases. CCRH.
- Rastogi DP. Miasmatic prescribing in fistula. IJRH.
Disclaimer
This content is for educational purposes only. It does not replace medical or surgical consultation. Individual results may vary. Always consult a homoeopathic professional before starting any treatment.
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