Fistula-In-Ano (Bhagandara)

Background

Fistula-in-ano {Bhagandara) is a track which opens deeply in the anal canal or rectum and superficially on the skin around the anus. Sometimes, the track may have a single opening which is called as sinus. Generally, this track develops from ano-rectal abscess {Bhagandara Pidika) that burst spontaneously or after inadequate incision. An anal fistula may occur with or without symptoms. There may be intermittent swelling with pain, discomfort and discharge of pus in the perineal region. This track does not heal usually due to fecal contamination, presence of unhealthy granulation and lack of rest to the part. This is a purely surgical condition but surgery has lot of complications and recurrence rate is also quite high after surgery.

Ksharasutra, a para surgical procedure and a unique technique advocated by Ayurveda is described in Sushruta Samhita. Ksharasutra is a medicated thread prepared by wetting the cotton thread with latex of Snuhi (Euphorbia nerifolia) and smearing it in the powder of Haridra (Curcuma longa) and Apamarga (Achyranthes aspera) kshara followed by drying in specially designed cabinet.

Intervention/ Approaches

Ksharasutra procedure mentioned in the classical texts of Ayurveda was further developed after standardization and tried on large number of patients. The same approach is mentioned here for the treatment of fistulain-ano. However, this procedure should be advocated by a qualified and experienced physician/surgeon only.

Ksharasutra procedure

With all aseptic precautions the Ksharasutra with the help of a probe should be introduced from external opening of fistula to the orifice inside the rectal canal and the two ends of the thread should be tied. Every week the old thread should be replaced by a new one by rod and reel method. The wound should be dressed with medicated oil/ghee and T-bandage should be applied. Patient should be advised to have sitz bath with warm water after each defecation. This should be repeated till the fistulous tract is fully open. Later, the wound management should be done till the complete healing.

The conservative medicines will be given for the management of pain and for soft passage of stool as per the need.

Medicinal Plants Useful in Fistula-In-Ano (Bhagandara)

Source : Central Council for Research in Ayurvedic Sciences