A Case of Chronic Recto-Vaginal Fistula

A young woman, 29 years, overweight, comes in for consultation for an exacerbation of a recto-vaginal fistula. She has been suffering with this for the past 8 years. She does not speak much English.  She walks in slowly (a wide legged stance), holding onto her husband for support and sits on the couch leaning back with pain, then turns to her left and sits cross legged.

(Talks to me in some English, sometimes her husband translates for her).

I was diagnosed with recto-vaginal fistula about 8 years ago. It all started when I was attending some classes.  I would sit for long hours without drinking any water nor taking any restroom breaks. First time I had constipation, they said there was swelling between the rectum and the va-gina and I was given antibiotics and it took 2 weeks to recover. The second time it came on after 2 years; I had severe pain in the perineum and pus from my vagina. Received homeopathy treatment and it took 10 days to recover. The third episode was 4 years ago after the delivery of my child, when I underwent a C-section.

Currently, I am having burning pains in the area. I feel heat down there. Occasional shivering and a mild low grade fever is present. The doctors have prescribed painkillers and antibiotics for it but I haven’t started with them yet.

I am also having eructations and burning in the abdomen on eating eggs and spicy food. I like eggs but it doesn’t suit me. I also develop constipation on eating spicy food.

Past history- Treated for leucorrhea 12 years back with Ayurveda. Lung infection as a child when 6 years of age, would have pus-like mucus on coughing, took treatment for that for a few years.

I am sensitive by nature, I feel hurt if anybody says anything about me. I am scared of my husband’s parents. I don’t answer back to them. I just cry by myself. I react like a baby. I am currently a homemaker, have a lot of friends in my apartment. I fear going to less crowded places, I avoid taking walks in lonely neighborhoods around my home.

I am sensitive to cold, I cannot drink ice drinks or have ice cream for many days continuously, I will end up with throat pains. Overall I like the warm weather. In the past I would get headaches in the sun, recently haven’t had them.

I have offensive sweat in my underarms, not much sweating on head or feet.

Bowels are usually regular. Only when the fistula is beginning to develop, I go into constipation.

(Burping loudly and constantly throughout the interview. Keeps asking her husband, ‘Will I get better immediately or not?’. Very dissatisfied when I tell her that the healing will be slow and gradual. I had to decide on a remedy with the limited symptoms I managed to get, as she was clearly suffering a lot and was finding it hard to be seated for a prolonged time through the interview).

Remedy: Calcarea sulphurica LM1– once a day for 20 days, to be had with distilled water. The aspects I noticed in her case which were very prominent were:

-She seemed like a very ‘dependent’ person, clinging on to her husband and walking, expecting him to support and talk for her though she could communicate with me directly in English, making gestures which would make her husband hold her. Calcarea’s tend to have a great need to be supported and can be quite dependent in their relationships. She says in the consultation- ‘I cry by myself, I react like a baby’ which further shows the feeling of inadequacy and the dependency.

-Despair of recovery is prominent in the Calcarea’s. She was constantly asking her husband if she would get better and was very unhappy with my reply when I told her that it’s a chronic condition and it would take time to heal.

– Very strong aggravation from eating eggs which could denote the Sulphur aspect of the case. Sulphur has an aversion to eggs and an aggravation from eating eggs. The patient liked eggs (which could be the Calcarea side) but was aggravated from them (the Sulphur part).

-Strong burning in the perineum, burning in the abdomen could denote the Sulphur tendency to have burning pains.

-Calcarea sulphurica is a well-known remedy for suppurating conditions like fistula’s that discharge pus constantly.

Based on these above aspects mainly, I prescribed Calcarea sulphurica.

Differential diagnosis with Pulsatilla, as Pulsatilla can be dependent and wanting consolation. They are emotional, cry easily. Pulstilla  is commonly used for fistula’s and suppurations. But the aggravation from eggs is not so prominent in Pulsatilla, though they can have a lot of gastric disturbances in general. Pulsatilla was my second remedy of choice, in case Calc sulph didn’t do much.

I called them after a month and spoke to her husband. He said: ‘The very next day after we visited you, the pain became severe and she was taken to the ER. The surgeons drained out the pus but have not closed the fistula. She has been on antibiotics till now, has not started with the homeopathic remedy yet’.

I tell him to start with the homeopathic doses as soon as she is done with her antibiotics and call me later to set up an appointment.

Follow up after about 2 months

I started taking the remedy about 2 months ago. I took the doses for 20 days. I didn’t feel anything during that time except that for the first week I felt some pain in the fistula. I went to Pebble beach a few days ago. It was cold there, and I developed this cold and cough from the next day, which is there even up till now. Cough is dry, and it is there early morning and night, sometimes it is continuous for about 5 minutes, then it comes down.

Three months back my periods were not regular. I have not been having a good flow since the delivery of my child 3.5 years ago. After this 20 days of dosing I got my flow better than before. I have had 2 periods since the remedy. I have had a better bleeding. I have had to use 2-3 pads per day in the last 2 cycles and the flow lasted for 5 days each time. Earlier I would get my periods every 25 days, and I would just have spotting for 5 days, no pads were even needed. I feel some pain in the fistula during my periods.

My energy is better than before. I go to the gym and exercise for one hour. I do the treadmill briskly. I don’t feel any weakness. I used to exercise before I developed the fistula but stopped, now I have restarted going to the gym.

My burping issue is completely gone after taking the remedy. I don’t have any burping on eating eggs. The burning in the stomach is completely gone.

My sleep has been good; it was very good during the 20 days of taking the remedy.

I have back pains since 3.5 years, after the birth of my child. In the mornings on waking, I am unable to bend even a little bit forward for about 10 minutes; no X ray was taken.

Remedy: Told her to take another single dose of Calc sulph LM1 for the cough. Also do back and core strengthening exercises on a regular basis for the back pain.

Calc sulph improved the general symptoms in this case – the menstrual cycles were restored, though I had no idea that she had irregular menses during the first consultation when this remedy was prescribed! Energy levels were better. When the general symptoms, which apply to the whole organism (like sleep, energy levels, menstrual cycles, appetite, mood, mental state etc) improve with a remedy, it is better to wait and not change the remedy even if the particular symptoms have not improved significantly at that moment. The direction of cure happens from the generals to the particulars. In this case the gastric problems were better too, though not much was there to report in regards to the fistula as she had no flare ups in those 2 months.

Follow up after 1.5 months since last consultation.

I don’t have any coughing now. I had pain in my lower abdomen 10 days ago and it lasted for 5 days. It would come on suddenly during the day, while sitting, sleeping, on bending; sometimes I couldn’t walk when the pain was there. Once it came on while walking and I had to stop and stand there for 5 minutes. It occasionally felt better after urination and stool. No pain the past 5 days. I have had this kind of abdominal pain during my pregnancy and when my son was about a year old. (Return of old symptoms)

Constipation is not a problem now. My bowels are regular.

I am getting my periods regularly; every 25 days and the flow is good. Sometimes when I eat eggs I have burping.  Back pain is still there and have it only while sleeping. I still find it hard to bend down in the mornings on waking. We tried to swap the sides of the mattress and that time the pain reduced. (Advised them to change the mattress as that might be causing the back pain if it is too old and out of shape).

No pain in the fistula; energy levels  are good. Remedy: Nothing prescribed. Just wait.

Follow up

About a week later I receive a call from her husband. ‘She has been having pain in the fistula since 3 days. It is the kind of pain she gets before the fistula completely develops.

Having difficulty sitting and walking, it’s painful. Constipation since 5 days, pain in the fistula while straining. We went to the gynecologist today and she says there is no problem in the uterus.  I got a stool softener, docusate sodium, but haven’t started it yet. The pain in the fistula is the same as before we started homeopathy.

Remedy: Calc sulph LM1- 3 doses. Asked them to keep me informed if the fistula matures. Go to the hospital and get it drained if needed and then report to me.

Follow up 1.5 months later

Last time the fistula was about to start, the pain began- I took 3 doses of Calc sulph, it was becoming severe. I started to take another homeopathic remedy I got from India, that worked within a day or two and I felt better. I don’t know what it was; it was specifically for the fistula. When the pain is there it is very severe in the vagina. It burns a lot. The pain is so severe that I feel like dying. (Almost in tears as she says it.)

I don’t have any constipation.  I didn’t take the stool softener that was prescribed. Only when I eat spicy foods I get constipated. I am avoiding eating eggs right now out of fear.  I had burping and acidity about 10 days ago. I took one dose of Calc sulph and the next day the burping came down. Whenever I have burping, chest pains, acidity it immediately brings them down. The remedy helps for periods and indigestion but not for the fistula.

Periods are regular. I got my period yesterday, the flow is good.  Husband says:  Health wise she is better. She has good energy, her sleep is good. Back pain is better after using a pillow in the back while sleeping.

RX: Wait. No changes made with the remedy even though she says the Calc sulph didn’t help with the fistula flare ups. Based on the laws of cure; ‘the symptoms which develop first are the last to get cured, and the more recent symptoms are the first to heal’. In this case, her irregular menses and her indigestion, which were more recent symptoms were better. The fistula has been a chronic complaint for over 8 years and will take longer to heal. I decided to wait longer and see if the fistula also improves with the same remedy. Told her to include a lot of fiber in the diet and drink adequate water to prevent constipation and help the fistula heal.

Next follow up…3 months later

No issues with eructation in the last 3 months. Occasionally eggs and spicy food cause a little bit of burping. Constipation has not been a problem.

I have been eating a lot of vegetables.  Fistula has not resurfaced in the past 3 months. I am feeling better since the last follow up. Energy is good, it is improving.

Periods have been on time, every 25 days or so. The flow is good, lasts 5 days. Back pain comes on if I stand for long, like 2-3 hours. I have been doing yoga and jogging regularly. I jog for 20 minutes on the treadmill every day. Irritability is less compared to before. I am not crying as much nowadays.

Husband:  Earlier she used to frequently shout at our son, now it is less. She is overall much better, not much physical problems.

I am taking calcium and multi vitamins. After taking calcium, my nails and skin around the nails have improved. My nails used to break easily earlier, now it is better. (Showing her system was deficient in calcium earlier and was possibly not absorbing the calcium well enough from dietary sources and now is better able to absorb calcium).

I intend to look for a job and start working soon.

Remedy: Nothing prescribed. We stay with Calc sulph LM1 for now.

The treatment is ongoing and the progress has been gradual and steady on all levels- the mental, emotional and the physical.