Dr Puneet Kumar Misra
Abstract- mere cor is the inattention medicine in the common clinical practice in the gastric disorder, but this medicine having a remarkable and quick effect on the acute as well chronic disorder of the rectal region associated with large intestine along with gastric and small intestine due to dietary habit or illness .
Introduction – the Diarrhea and Constipation is the disordered defecation. but many patient have normal tendency of defecation, but before ,during and after defecation the mild to moderate pain, burning and uneasiness in the rectal region with or without lower abdomen pain with feel of incomplete defecation and which associated with dietary change in many person .
Key words – Diarrhea, Constipation, Defecation,
Abbreviation- IBS- Irritable bowel syndrome . GI-gastrointestinal , UC- ULCERATIVE COLITIS,
DEFECATION – Tonic contraction of the puborectalis muscle, which forms a sling around the recto anal junction, is important to maintain continence; during defecation, sacral parasympathetic nerves relax this muscle, facilitating the straightening of the recto anal angle. Distention of the rectum results in transient relaxation of the internal anal sphincter via intrinsic and reflex sympathetic innervations. As sigmoid and rectal contractions, as well as straining (Valsalva maneuver), which increases intra abdominal pressure, increase the pressure within the rectum, the recto sigmoid angle opens by >15°. Voluntary relaxation of the external anal sphincter (striated muscle innervated by the pudendal nerve) in response to the sensation produced by distention permits the evacuation of feces. Defecation can also be delayed voluntarily by contraction of the external anal sphincter. 1
Diarrhea is loosely defined as passage of abnormally liquid or unformed stools at an increased frequency. For adults on a typical Western diet, stool weight >200 g/d can generally be considered diarrheal. A careful history and physical examination generally allow these conditions to be discriminated from true diarrhea. 1,2,3
Constipation is a common complaint in clinical practice and usually refers to persistent, difficult, infrequent, or seemingly incomplete defecation. A person whose parents attached great importance to daily defecation will become greatly concerned when he or she misses a daily bowel movement; some children withhold stool to gain attention or because of fear of pain from anal irritation; and some adults habitually ignore or delay the call to have a bowel movement.1,2,3
Signs and Symptoms The major symptoms of UC are diarrhea, rectal bleeding, tenesmus, passage of mucus, and crampy abdominal pain. Other symptoms in moderate to severe disease include anorexia, nausea, vomiting, fever, and weight loss. Physical signs of proctitis include a tender anal canal and blood on rectal examination. With more extensive disease, patients have tenderness to palpation directly over the colon. 1,2
Although CD usually presents as acute or chronic bowel inflammation, the inflammatory process evolves toward one of two patterns of disease: a fibrostenotic obstructing pattern or a penetrating fistulous pattern, each with different treatments and prognoses. The site of disease influences the clinical manifestations.
Because the most common site of inflammation is the terminal ileum, the usual presentation of ileocolitis is a chronic history of recurrent episodes of right lower quadrant pain and diarrhea.
Extensive inflammatory disease is associated with a loss of digestive and absorptive surface, resulting in malabsorption and steatorrhea.
COLITIS AND PERIANAL DISEASE
Patients with colitis present with low grade fevers, malaise, diarrhea, crampy abdominal pain, and sometimes hemato chezia. Gross bleeding is not as common as in UC and appears in about one-half of patients with exclusively colonic disease. . Perianal disease affects about one-third of patients with Crohn’s colitis and is manifested by incontinence, large hemorrhoidal tags, anal strictures, anorectal fistulae, and perirectal abscesses. Not all patients with perianal fistula will have endoscopic evidence of colonic inflammation 12
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of detectable structural abnormalities. Furthermore, IBS symptoms are prevalent in non cardiac chest pain patients, suggesting overlap with other functional gut disorders.1,2
Allen’ s keynotes and characteristics with comparisons.
Dysentery and summer complaints of intestinal canal, occurring from May to November. Tenesmus: of rectum, not >. by stool [ <. by stool, Nux]; incessant, persistent; stool hot, scanty, bloody, slimy, offensive; shreds of mucous membrane and terrible cutting, colicky pains. 6
Boerickes new manual of homoeopathic materia medica with repertory. #General
This salt leads all other remedies in tenesmus of the rectum, which is incessant, and is not relieved by the stool.7
A Dictionary of Practical materia medica vol 2nd
Pains in liver and right shoulder. Stitches as if in middle of liver. Bloated abdomen, painful, very painful to least touch. Cutting below navel. Bruised pain in abdomen, especially in caecal region and over transverse colon. Pressive pain in inguinal glands. Lancinating drawing in left inguinal region.
#Stool and Anus
Diarrhoea, yellow, green, bilious, bloody, with membranous shreds, of faeces with mucus and dark clotted blood. Burning in rectum and anus, during stool. Faeces loose, with bilious and fetid evacuations, green or brown, or composed of thin and sanguineous mucus, accompanied by almost incessant cuttings in abdomen and discharge of small quantities of bloody mucus, almost unsuccessful pressing, straining and tenesmus. Ineffectual want to evacuate. Tenesmus with dysenteric discharges, vomiting of bile, cramps in calves, and stitches in side. (Spasm of rectum after coitus.) _ Painful bloody discharge, with vomiting.
Dysentery. Corrosive ichol oozes from anus, excoriating the parts. Itching about anus (while walking). Very persistent distressing tenesmus and cutting colicky pains, after stool burning and tenesmus of rectum and bladder, stools hot, frequent, scanty, nothing but mucus tinged with blood. Stool pasty, dark green, bilious, blackish, offensive. Constipation, tenacious faeces.8
The guiding symptoms of our materia medica Volume VII
Abdomen Abdomen swollen, hard and sensitive to pressure, especially about umbilicus. Cutting below navel. Bloated abdomen, very painful to least touch. Peculiar bruised sensation in abdomen, especially in cecal region and following course of transverse colon; painful to moderate pressure, as though bruised. Intolerable cutting pains in abdomen and constant urging to stool, followed by slight discharge of blood and mucus; despondent, walks up and down.9
Lectures on homeopathic materia medica
In <dysentery> there is more violence; copious bleeding; great anxiety, can scarcely leave the stool a second, great tenesmus of rectum and bladder; urging to urination and stool is constant; great burning in the rectum. It is a violent case of dysentery. I would prefer <Merc.> in ordinary <Merc.> cases, but if this patient is not relieved he will not live, and Merc. cor. is needed here.10
Leaders in homoeopathic therapeutics
Most persistent and terrible tenesmus before,during and after stool; stool scanty, mucus tinged with blood. Of MERCURIUS CORROSIVUS we have to say that it leads all other remedies for TENESMUS OF THE RECTUM. This tenesmus is incessant. Stool does not relieve it,11
A manual of pharmacodynamics
But when the large intestine are affected , whether with simple inflammation , with chronic ulceration, or with dysentery ,its effects are amongst the most brilliant thing in medicine .hahnemann was the first to recommend in the dysentery ,say (1822) that he had found it almost specific in the common autumnal invasion of the complaint .he gave the 15th dilution in the single dose ; but dr ringer reports correspondingly good result with hourly repeated dose of a hundredth of a grain .12
Concordant Reference Complete Classic Materia Medica
Generals . this salt lead all other remedies in tenesmus of the rectum ,which is incessant and not >by the stool .13
The Continues observation of drug action on the complaint of defecation in normal or deformed state of stool with mild to moderate pain, burning and uneasiness in the rectal region before ,during and after defecation. during the course of three year in all weather condition on the 64 case mention below in table.
03y to 74y
- The discomfort in the rectal region before ,during and after defecation is not an specific disorder it associated with meal ingredients and eating habits along with whole GI system .
- Most of the patients come with this complain having the highly spices and fried food habits and remedy with normal meal gives the fast relief.
- The nature of stool in the most of the case is unexplained .
- The many patient having the upper or lower abdominal pain complaints with this disorder .
- The 30c given better improvement in the children group and 200c having remarkable improvement in both children as well as adults in the BID frequency.
- When this disorder associated with the cramp in the lower abdomen then its association with Nux Vomica 30/200 give rapid improvement
- When this disorder associated with the distension of abdomen then its association with Mag Phos 30/200 give rapid improvement
- When this disorder associated with the upper abdomen discomfort then its association with Phosphorus 30/200 empty stomach give rapid improvement
- In the most of acute case BID dose is sufficient for the 4-7 days ,
- When patient having the recurrent tendency of discomfort then night dose of the mere cor after meal and empty stomach phosphorus on the onset of disorder shows good response for inhibit the tendency .
- When the patient having an external cause(skin eruption or ulcer around anal region ) of discomfort then no improvement after internal use of medicine.
- The future study provide the more evidence if treatment done with ultra sound whole abdomen and colonoscopy along with CBC AND LFT.
The mere cor is the predominated a rectal tenesmus medicine, at acute state the rectal Discomfort is only clinical main manifestation but with chronic tendency of disorder head and abdomen manifestation are seen and control by this medicine,this shows that medicine predominantly act on the rectal and its associated part of the large intestine along with whole gastrointestinal tract .
- Harrison T. R. Harrison’s Principles of Internal Medicine. 20 Editions. By McGraw-Hill Education; 2018. page 259-70,2258-82,
- Davidson Sir Stanley. Davidson Principal & Practice of medicine. 23nd Edition. Elsevier Ltd; 2018. Page 783,786,787,813-25,
- Dr Robert Hutchison .Hutchison’s Clinical Methods. 24th editions. Elsevier Ltd; 2018.Page 242,243
- E Noble Chamberlain. Chamberlain’s Symptoms and Signs in Clinical Medicine. 13th edition. Edward Arnold (Publishers) Ltd; 2010. Page 112-14
- Alan G Japp Colin Robertson. Maclode’s clinical diagnosis. 1st Edition. Elsevier Ltd; 2013.page 88-93
- H C allen. Allen’s keynotes and characteristics with comparisons. 49th impression. New Delhi: B Jain publishers (p) Ltd; 2018. Page no 207
- Dr W Boericke. Boerickes new manual of homoeopathic materia medica with repertory. 41st impression. Delhi: B Jain publishers (p) Ltd; 2018. Page no 387-88
- Dr John Henry Clarke. A Dictionary of Practical materia medica vol 2nd. Reprint edition1999. New Delhi. B Jain publishers Pvt.Ltd; 1999. Page 464
- Dr C.hering. The guiding symptoms of our materia medica Volume VII. 12th impression. New Delhi: B Jain publishers (p) Ltd; 2018. Page no414
- DR James Tyler Kent. Lectures on homeopathic materia medica . Reprint edition2006. Delhi: B Jain publishers (p) Ltd; 2006.page 742-43
- E B Nash .leaders in homoeopathic therapeutics. reprint edition 1995. Delhi: B Jain publishers (p) Ltd; 1995.page 43
- Richard hughes. A manual of pharmacodynamics. edition 6th . Delhi: B Jain publishers (p) Ltd; 2016.page 658
- Frans Vermeulen. Concordant Reference Complete Classic Materia Medica.1st edition:2011.B Jain Archibel S.P.R.L Belgium Europe.Page 1328
Dr Puneet Kumar Misra B.Sc, BHMS
Lecturer(Practice of Medicine
Govt Pt J LN H M C Kanpur