Ayurvedic Management of Fistula-in-Ano

Ayurvedic Management of Fistula-in-ano

Definition:- Fistula in Ano is an abnormal communication between anal canal or rectum to the exterior ( peri-anal skin). The problem needs immediate medical attention to avoid complexities in future. The fistula treatment using ksharsutra is safe and simple. It has lower recurrence rate as compared to fistulotomy and is affordable too.

Management of fistula in ano

The management of fistula in ano can be divided in 4 major types:

  • Preventive measures
  • Surgical measures
  • Curative measures
  • Adjuvant measures

Preventive Measures

  1. Diet :
  • Guru ( heavy food )
  • Madya ( Excess of alcohol)
  • Asatamaya ahara ( unwholesome food )
  • Virudha ahara (antagonist to each other )
  • Vishama ahara (Incompatible foods).
  1. Lifestyle :
  • Patient should exercise for 30 minutes most days to keep your digestive system moving and in good shape.
  • Keep the anal area dry.
  • Eating fiber daily can keep stools soft and improve fistula healing.
  • Increase the consumption of brown rice, barley, cereals, peas, beans, broccoli, spinach, cauliflower, banana, papaya, orange etc.
  • Avoid spicy and oily foods that may aggravate swelling, pain and burning sensation.
  • Light and small meals at a time that can easily be digestible.
  • Yoga poses or asana which can be done regularly such as Sarvangasana, Sirasana, Vajrasana, Uttanpadasana that ensure fistulas to get cured easily.

Curative Measures

Medical management

  • Application of Vartee (Medicated wick): Vartee made up of kshara dravya are used by virtue of Ksharana (liquefying property) of Kshara, it removes the sloughs and clean the fistulous tract thus facilitates drainage. It is commonly used in blind tracts e.g.: Vartee made up of latex of Snuhi, Arka along with Daruharidra.
  • Application of Kalka (Medicated paste): Kalka made up of drugs like Tila, Haritaki, Lodhra, Reeta, Haridra ,Vacha etc. are used
  • Application of Kasahaya (Decoction): Kashaya are used for washing purposes and also it reduces inflammation and pain. E.g.:- Triphala Kashaya, Kashaya made up of Khadira, Triphala, Guggulu, Vidanga.
  • Application of Taila (medicated Oil): These are useful in controlling wound infection and promotes healing. E.g.: Jatyadi Taila
  • Some of the classical preparations used orally are Saptavinshati Guggulu, Triphala Guggulu and Panchatiktaghrita Guggulu etc. Surgical Measures

General Principal of management of fistula is:-

  • Virechana (enema for bowel expulsion).
  • Eshana (probing).
  • Chedana (excision)/ Patana ( laying open of the tract )
  • Marga Vishodana (cleaning of fistulous tract )
  • Dahana ( Cauterization)
  • Varanachikitsa (post operative wound management )
  • Kshara-sutra therapy (use of Ayurvedic medicated thread).


Kshara-sutra is a kind of kshara-therapy, which is applied with a help of thread. It is used as an adjuvant to the surgical procedure in fistula but ksharasutra owes the credit of standing as a complete treatment of fistula without the aid of any other operative procedure.

This procedure is done by specially made thread medicated with organic alkali such as Apamargakshara, Arkakshara or Snuhikshara.

Preparation of kshara-sutra –

Materials needed prepare kshara-sutra:

Snuhi ksheera – Latex of Euphorbia nerifolia

Apamarga Kshara – Alkali extract of whole plant of Apamarga (Achyranthes aspera).

Haridra Churna – Powder of Turmeric (curcuma longa).

Kshar Sutra cabinet

Sutra (thread to prepare kshara sutra) –Barbour Linen Thread No .20 is used.

No. 20 is frequently used because the tensile strength of this thread is reduced to the least extent in comparison to other threads after the complete procedure.

Medicating the thread:-The thread used for kshara sutra is given several coatings. Over all 21 coatings are given. They are as follows:-

  • Snuhi Ksheera bhavana / lepa – The first 11 coatings to the thread are given with the fresh milk of Snuhi Latex(Latex of Euphorbia nerifolia).
  • Snuhi Kshara and Apamarga Kshara – The next 7 coatings are given with the combination of Snuhi Ksheera (Latex of Euphorbia nerifolia) and Apamarga Kshara (alkali of Achyranthes aspera).
  • Snuhi Ksheer and Haridra – The next 3 coatings should be done with Snuhi Ksheera (Latex of Euphorbia nerifolia) and Haridra (turmeric powder).

Adjuvant measures

  • Swedan, Parishek, Avgahan
  • Vranashodhan& Vranaropana Lepa
  • Varti, Taila, Guggulu, Shothahar Drugs
  • Deepana, Pachan, Mridu Rechak drugs used as adjuvant measures for treatment of fistula.