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Ayurvedic Management of Fistula

    Fistula in ano is an abnormal communication between the anal canal and perianal skin. The anus consist of many small glands that sometimes get clogged lead to the generation of abscess. These abscess burst spontaneously or opened inadequately. Abscess are formed in the surgical spaces in which collection of pus happens around the anorectal canal. The abscess will cause for the formation of fistula.

The incidence of fistula in ano developing from an anal abscess ranges from 26% to 38%. One study showed that the prevalence of fistula in ano is 8.6 cases per 100000 population. In men the prevalence is 12.3 cases per 100,000 population and in women it is 5.6 cases per 100000.

Fistulas may occur in many parts of the body like artery and vein, cervix and vagina, neck and throat etc…

Inflammatory bowel disease such as ulcerative colitis or crohn’s disease can lead to fistula between one loop of intestine and another.

Types: 1. Blind 2. Complete 3. Horseshoe 4. Incomplete


  1. Crohns disease
  2. Radiation
  3. Trauma
  4. Sexually transmitted disease
  5. Tuberculosis
  6. Diverticulitis
  7. Cancer


  • Frequent anal abscess
  • Pain and swelling around the anus
  • Bloody or foul smelling drainage from an opening around the anus
  • Irritation of skin around the anus from drainage
  • Pain during bowel movement
  • Bleeding
  • Fever, chills, and general feeling of fatigue


Fistula is termed as ‘bhagandara’ in ayurvedic classics. It is considered as ashta mahagada ie difficult to cure. Bhagandara is one of the most common disorders which occur in ano rectal region.

General management principles of bhagandra

  1. Virechana- purgation
  2. Eshana- probing
  3. Patana –cutting
  4. Marga visudhi or vrana sodhana
  5. Taila daha- cauterization with oil
  6. Chedana and kshara sutra application

Management of fistula

  1. Preventive
  2. curative

preventive aspect

  1. aetiological factors of bhagandara should be removed
  2. prevention of suppuration of abscess by taking the measures like rakthamokshana, dehasodhana, parisheka

 curative aspect

  1. medical – with medicines
  2. surgical- application of kshara sutra
  3. parasurgical- rakthamokshana, agnikarma, kshara karma and varthi, sitz bath

Application of kshara sutra in fistula

Kshara sutra is medicated thread made up of kshara(ash) of different drugs having different properties like chedya(excision) bhedya(incision) lekhya(scraping). These properties helps the kshara sutra to excise, open the tract and remove the unhealthy granulated tissues in the tract. Also helps for sodhana( removing the impurities like vata,pitta and kapha), ropana(healing) and soshana( remove pus discharges or unhealthy body fluids). The medicines which used to prepare this medicated thread having the property of proteiolytic action, anti-inflammatory and antibiotic action.

The advantage of kshara sutra application

  1. Reduce the chance of recurrence
  2. Because of slow cutting nature of kshara sutra incontinence of bowel will not happen and anal sphincters remains intact.