Ayurvedic Approach to Complex Fistula in Ano: Role of Ksharasutra - A Case Study

Abstract

Fistula in ano, or Bhagandara as described in Ayurveda, is a chronic and recurrent anorectal condition, often presenting with pus discharge, pain, and discomfort. Complex fistulas, involving significant portions of the anal sphincter or multiple tracts, pose a challenge to both surgical and conservative management. Ksharasutra therapy, a minimally invasive Ayurvedic parasurgical technique, has shown promising results, especially in complex cases. Methods: A 20-year-old male patient presented at the OPD of Mahadev Medical and General Health Care, Kuchera, Nagaur, with complaints indicative of a complex fistula in ano. After clinical evaluation and diagnosis, Ksharasutra therapy was initiated. The procedure involved the insertion of a medicated thread (Ksharasutra) into the fistulous tract. The thread was regularly changed and gradually tightened to promote simultaneous cutting, curettage, and healing of the tract. Follow-ups were conducted weekly to assess tract healing, evaluate for complications, and ensure patient compliance. Results: Over the course of treatment, progressive healing of the fistulous tract was observed without any major complications or signs of recurrence. The patient tolerated the therapy well, and no sphincter damage or incontinence was reported. Complete healing was achieved with satisfactory cosmetic and functional outcomes. Discussion: This case highlights the effectiveness of Ksharasutra therapy in managing complex fistula in ano. Its ability to gradually cut and heal the tract while preserving sphincter integrity makes it a valuable alternative to conventional surgical approaches. With proper case selection and regular follow-up, Ksharasutra offers a safe, cost-effective, and minimally invasive treatment option for complex anal fistulas.

Introduction

Fistula-in-ano, known as Bhagandara in Ayurveda, is a chronic abnormal tract between the anal canal and perianal skin, often resulting from abscesses in anal glands. It is characterized by pus or blood discharge, pain, swelling, and itching. Ayurveda classifies it among Ashta Mahagada (eight major diseases) due to its chronicity, complexity, and high recurrence. Conventional classifications of fistula include Milligan-Morgan and Park’s classification, with the most common types being subcutaneous, intersphincteric, and transsphincteric.

Ayurvedic Treatment (Ksharasutra Therapy):

• Kshara is a medicinal alkaline substance that destroys vitiated tissue while balancing the body’s Doshas.

• Ksharasutra is a medicated thread used to gradually cut through the fistula tract, promote drainage, and heal without major surgery.

• Preparation involves coating a Barbour thread with Euphorbia neriifolia latex (Snuhiksheera) and turmeric powder, repeated over 21 days and dried in sunlight to preserve medicinal properties.

Case Summary:

• Patient: 20-year-old male with 8-month history of swelling, pus discharge, and pain in the perianal region. Previous allopathic treatment was ineffective.

• Findings: Three external fistula openings at 1 o’clock, 3 o’clock, and 9 o’clock positions, with hypergranulation tissue at 9 o’clock. Digital and probe examination confirmed fistula tracts, some interconnecting, with one extending to the anorectal junction. No history of systemic disease (diabetes, TB, Crohn’s, HIV) was present.

Diagnostic Methods:

• Clinical features, local inspection, palpation, and probing were used.

• Investigations (CBC, ESR, CRP, HIV/HCV/HBsAg, chest X-ray) were normal.

Operative Procedure:

• Patient placed in lithotomy position; local anesthesia administered.

• Ksharasutra thread inserted into fistula tracts using a malleable probe, internal openings negotiated, and threads ligated with knots, leaving a 2–3 cm loop.

• Hypergranulation tissue was also ligated.

Postoperative Care:

• Monitoring of vitals, diet recommendations, antibiotics, painkillers, Ayurvedic medications, sitz baths, and topical Jatyadi oil applications.

Follow-up & Outcome:

• Weekly follow-ups included thread tightening and reapplication as needed.

• Progressive reduction in fistula tract length and healing of hypergranulated tissue observed.

• By the 12th week, all tracts healed completely with no pain, discharge, or tenderness.

Conclusion

This case illustrates that Ksharasutra therapy, when appropriately applied, offers a safe, effective, and non-recurrent treatment for even complex cases of fistula-in-ano. The Ayurvedic approach, blending surgical technique with herbal pharmacopeia, provides not only tract resolution but also promotes systemic healing and immune balance. This reinforces the clinical value of integrating Ayurvedic parasurgical methods with modern diagnostic protocols in managing chronic anorectal conditions.

Copyright

Copyright © 2026 Dr. Manish Choudhary , Dr. Vasudha Joshi, Dr. Rakesh Kumar Sharma. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.