Dr. Muhammad Mahtab Hossain Mazed

Today is Thursday (May 23). As decided by the United Nations General Assembly, this day is observed every year around the world to raise public awareness about obstetric fistula. This day is being celebrated in Bangladesh today with various arrangements. Child marriage, superstition, illiteracy, poverty, lack of minimum communication system, living in remote areas are among the many causes of fistula in Bangladesh. Although the extent of fistula problem in Bangladesh has been unclear for a long time, it is now clear.

According to the National Survey on Maternal Health and Maternal Diseases conducted in 2016, the total number of female fistula patients in Bangladesh is 19,500. That is, 4 out of every 10,000 women who have been married at least once in their life in Bangladesh suffer from fistula disease.

The United Nations has announced a goal to end fistula within this generation. Its simple meaning is to make the world fistula free by 2030. The Government of Bangladesh has set specific strategic goals in the light of these goals of the United Nations.

The target is - from 2030, women will not be affected by obstetric fistula again. And to ensure medical care for all those who are currently suffering from fistula, be it obstetric or surgical. Ensuring rehabilitation facilities for fistula patients who have recovered after treatment and who require rehabilitation facilities. To facilitate the reunification of those who have been separated from family or society. Provide a continuum of care for women who have not improved or are unlikely to improve after treatment.R Fistula disease is called the common fistula disease in BengalMany suffer from the painful disease called fistula. It is a complex disease of the rectum. Fistula or boil in anus is a known disease. Pus is sometimes discharged through one or more boils inside the anus.

Fistula disease has been known to doctors since the beginning of medical science. There are different types of fistula. Complications depend on how deeply the tube has penetrated the rectum.

There are different techniques and procedures for treating different types of fistula. Patients' perception is that there is a high risk of fistula recurrence in our country.

History of Fistula :-

Fistula is also discussed in books dating back 2000 years. Usually, the anal gland closes and becomes infected, and the abscess ruptures and forms a drain. 50% of patients with rectal abscess develop fistula. Sometimes fistula and boil appear simultaneously.

Fistulas also occur from rectal tuberculosis, colitis and rectal cancer. Children usually do not have fistulas. According to a study, eight to nine people out of every 100,000 people suffer from fistula.

Males are affected more (almost twice) than females.

A patient presents to the physician with a history of pain, swelling near the anus, and a history of previous operations for spontaneous rupture of purulent discharge or abscess. After the pus-water is applied, the pain subsides and the patient feels comfortable and the patient gets better for some time. The disease reappears after two months of dormancy. Hippocrates (about 430 BC) is the first to treat fistula surgically. From the late 19th century to the early 20th century, surgeons such as Goodsell, Miles, Milligan and Morgan, Thompson etc. made important contributions to fistula treatment. The classification of Parks fistula in 1976 is still well known. Later many methods were discovered to treat fistula. However, doctors are yet to come to a consensus on which is best or appropriate.

> What causes fistula and how does it occur?

This disease is caused by a specific infection of the anus. There are many glands inside the anus that swell due to infection. This abscess once bursts and oozes out through a hole around the anus, and pus starts to ooze out. This infection causes a lot of pain in the anus. The patient complains of pain throughout the day. After the pus is drained, the pain subsides. We call fistula or fistula when pus comes out from time to time through one or more mouths in a place adjacent to the anus.

Fistula also occurs in rectal cancer and inflammatory bowel disease. Tuberculosis in the anus can also cause fistula.

> What are the types of fistula?

Simple Fistula: It is easier to treat as it does not penetrate too deep into the rectal muscle.

> Complex Fistula: It has different types and depends on how deep the tube penetrates the rectal meatus and how far it has traveled to the outer mouth. Their treatment is really difficult. Then if this channel is more than one then there is no question. The main drawback of the operation of this disease is that if the operation is not performed correctly, the patient may lose the ability to retain stool.

> Signs or symptoms of fistula or fistula

The symptoms of this disease are mainly three. For example- 1. Swelling, 2. Pain and 3. Discharge or discharge of pus and mucous.

Most of the patients reported previous rectal abscess. Abscesses inside are swollen and painful for air. When they burst and release some pus through the mouth, the pain and swelling decreases. Discharge or pus is usually intermittent. Sometimes the disease is latent for 2-4 months.

Sometimes pus and mangoes are passed along with the stool. Because the problem is not persistent, patients often think that they will probably get better. But after two or four months, when the same problem occurs again, they come to us again and say, Sir, what can be done now?

> What tests are required

* Proctoscopy, Sigmoidoscopy * Colonoscopy

* Barium Xor * Anal endosonography.

> Home remedies-

_ Use warm water three to four times a day to get relief from fistula pain. Let sit in a large bowl of lukewarm water for 10 minutes. It will reduce the pain.

_ To avoid this problem must eat fiber rich food. Junk food should not be eaten at all. Also, make a habit of drinking honey mixed with warm water regularly on an empty stomach. You can also eat Tokma seeds or Isubgul husks.

_ You can also use oregano oil or coconut oil on the fistula site. These oils contain antibacterial, antifungal, antibiotic and anti-inflammatory properties. Which will act as an anti-inflammatory to the wound.

_ Drink plenty of water. Also drink ginger tea, turmeric milk. It will reduce the problem of constipation.

_ Do not sit in the same place for a long time. Use a pillow when sitting on a chair if necessary.

_ Maintain personal protection. Be aware every time you use the toilet.

_ Eat healthy food to boost the body's immune system. Consume fish, olive oil, omega 3, omega 6, vitamins regularly.

_ If the problem of fistula is increasing, take medicine as per doctor's advice.

> Homeopathy Treatment Management:-
Fistula or fistula is best treated with medication. Because the anus is a sensitive area, there are many cases of infection after the operation. Complications increase if the site becomes infected. It is possible to get rid of this disease if you take and use medicine regularly for three to four months. So there are many homeopathic medicines of different potencies to treat these complex and painful diseases of the anus. A homeopath basically takes the patient's history and takes into account his overall physical condition and genetic condition and prescribes specific medicines in specific strengths for a specific period of time. According to the symptoms, the experienced doctors use the following medicines first. Medorinum:- When the foul-smelling juice from the anus comes out like water for washing meat, Medorinum is invalid.* Silicea: The pus is thin and foul-smelling. Throbbing pain while walking or outside. * Belladonna: In the first stage of fistula, the anus is red, very painful, if the patient is bleeding, belladonna is needed* Acid Fluor: It is an antidote to Silicea and useful in fistula. * Barbaris: Pain to touch, difficulty sitting, itching of anus.* Sulphur: Swelling of anus, burning, stabbing pain after passing stool. * Hypersulph : Fistula is very painful and pain lasts for some time. Later, if it suddenly turns into an abscess, the pain subsides, the abscess bursts quickly and the patient feels relief. * Myristica: Its pain is more severe than hipa. It is applied when the pain is very great but not relieved in hyper.* Phosphorus : If there is any lung defect with fistula. In rectal lesions and discharge of purulent blood in persons with phosphorus metal. * Causticum: Sudden stabbing pain in anus, pain to touch, itching in anus. * Hydrastis : Hemorrhoids with constipation, wounds with fetid discharge. * Lachesis : In drunkards and old fistula. * Ratanhia:-Always discharge of juice in the anusBurning, the burning is relieved by cold water, it is beneficial. Stools are hard, very hard, cramping during stool, and pain continues after stool. Anus feels as if being pierced by a piece of glass. Anus ruptures, great pain and burning in rectum. . * Acid not : Terrible burning during and after stool, anus cracks and sores. * Pyonia :- Anus is always wet with juice, it is useful for the symptoms of colic pain, pus etc. Long lasting pain in anus, severe pain in anus cannot walk, with stool. Blood is mixedPaenia is a useful medicine in case of fistula with abdominal pain. *Graphitis, fissures in the anus, bleeding. * Aram Meur : Pooja does not dry quickly. The pus is like thin rasani or kaltani, mixed with blood, very foul smelling. *Sedum RC: This may be a lesser known homeopathic medicine, but Sedum RC is useful in treating contractile pain in fistula anus. * Netrum mure: Anus as if shortened - after stool tearing, bleeding, throbbing, pain. Homeopathic medicine Natrum Muur helps when it is hard and dry. It is effective in bleeding and burning pain when stool is transient due to rectal contraction* Aloe Psychotrina: Anus like a bunch of grapes, tender blue color, pushing pain, bleeding lesions cannot be touched. Warm feeling in anus, relief in cold water. Can't sleep because of itching and burning in anus. No one should use medicine by themselves without doctor's adviceFinally it can be said that treatment of fistula patients can be done by an experienced homeopathic doctor and fistula cures with proper treatment. Do not be ashamed of the disease, discuss openly with the doctor, stay healthy.

Writer, physician, columnist and researcher Founder Chairman,Jatiya Rogi Kallyan Society