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Fistula in Ano

भगन्दर (फिस्टुला) के बारे में हिंदी में जानने के लिए यहाँ क्लिक करें।

Fistula in ano or Bhagandar has been described one among the eight difficultly curable disease (Asta Mahagadas) by the Great Indian Surgery Sage Acharya Sushruta. Fistula presents usually in the form of a boil in an area nearby to anus (perianal region) which communicates through inside of anal canal or rectum. There are structures known as anal glands and anal crypts, located just inside the sphincter muscle of anus, inside the anal canal. When these anal gland or crypt gets infected or blocked, an abscess can form which advances towards the perianal skin and leads to the formation of a passage between perianal skin and inside of anal canal or rectum. This is known as track of Fistula and the disease is itself known as Fistula in ano or Anal fistula.


Fistula in ano Symptoms: 


Initially when the boil appears, may lead to pain, which is due to local inflammation and collection of pus. The boil may burst spontaneously or may be incised by a surgeon in an attempt to drain the pus. So, the following symptoms are visible;

  • Pain in perianal region at the site of boil
  • Discharge of purulent material (Pus)
  • Discharge of faeces or flatus is also seen sometimes
  • Itching at the site of boil Itching in anus (Pruritus)



Fistula in ano Causes (Possible mechanism of Fistula formation)

Anal fistulas commonly occur due to an anal abscess. An abscess is a collection of pus and infected fluid. An anal abscess usually develops after a small gland, just inside the anus, becomes infected with bacteria. A fistula may occur if an abscess has not completely healed, or if the infected fluid has not been entirely drained away. An anal fistula may also develop as a result of: A growth or ulcer (painful sore), an infected Fissure, a complication of surgery, a congenital abnormality (a health problem that you were born with).

Sometimes Anal fistulae are also a common complication of conditions that result in inflammation of the intestines. Some of these conditions include:;

  • Irritable bowel syndrome (IBS): a chronic (long-term) disorder that affects the digestive system, causing abdominal pain, diarrhoea and constipation.
  • Diverticulitis: the formation of small pouches that stick out of the side of the large intestine (colon), which become infected and inflamed.
  • Ulcerative colitis: a chronic condition that causes the colon to become inflamed and can cause ulcers to form on the lining of the colon.
  • Crohn's disease: a chronic condition that causes inflammation of the lining of the digestive system.


Fistula in ano; Types

Acharya Susruta has described five types of Bhagandara (Sataponak, Ustragriwa, Parisravi, Sambukawarta, Unmargi). They have been classified according to the vitiation of the three doshas and the shape & site of the fistula tract.
Roughly Fistula in ano can be classified into two types based on ease of treatment;

1-LOW ANAL FISTULA OR LOW TYPE:- Those which have their track course internal opening below the anorectal ring - they are called as Low type or Low anal.

2-HIGH ANAL FISTULA OR HIGH TYPE:-Those which have their extension above the ano-rectal ring towards the rectum - they are called as High type or High anal Fistula.
Thrombosed Hemorrhoids - Anal Hematoma/External piles: This is a painful condition. There occurs clotting (thrombosis) of blood within the external pile mass.

Fistula in ano: Diagnosis

The diagnosis of the disease Fistula in ano can be made by a local examination by your physician. Usually the external opening is visible at any point in perianal region. Digital examination (Check-up by finger) gives an idea of possible site of internal opening while probing is the technique which is used to find out the direction and depth of Fistula track. Radiological investigations like Fistulography and/or MRI pelvis region, provide the information about the course of the Fistulous track.

Fistula in ano; Ayurveda treatments

Fistula is ano is a 100% surgically curable disease. NO medicines can cure the disease completely. Among surgical techniques the classical operation of laying open the track has not been proved to be very much successful and there are high recurrence rates, especially in high types of fistulae.

Ayurveda surgical approach viz. Kshara sutra treatment, has been proved to be extremely effective in curing the Fistulae of all kinds. Kshara Sutra is a seton thread medicated with organic alkalis, such as Apamarga kshara (Achyranthus aspera aqueous extract), Arka ksheera ( Milk of Caltropis gigantea) or Snuhi ksheera (Milk of Euphorbia lingularia). The alkali is repeatedly coated on the seton thread 15 to 21 times. Apart from this, natural antibiotic like haridra powder, guggulu, etc are also used to make Kshara sutra.

The mechanical action of the threads and the chemical action of the drugs coated , collectively do the work of cutting, curetting, draining, and cleaning the fistulous track, thus promoting healing of the track wound by forming a clean base. This also acts both as the antiseptic and fibrotic agent to induce healing. The process of healing starts from deeper tissues and moves towards the periphery.

The kshar sutra is changed changed periodically usually on weekly basis till the thread cuts the fistulous tract completely. Since the sphincter heals by fibrosis, simultaneously with the cutting, there are practically nil chances of incontinence.


Under local anaesthesia, the kshara sutra is inserted into the tract and the two ends of the thread are tied forming a loop. The alkalis coated on the thread are continuously released throughout the length of the track there by cutting, curetting, draining, cleansing (debridment) and healing the track. This therapeutic action of the thread lasts for seven days. The old thread is then replaced with a new thread by a special technique known as Rail road technique by the surgeon. Depending on the length and depth of the tract many sittings of kshara sutra may be required repeatedly and old thread is changed by the new one usually on weekly basis. The changing of the thread is a simple procedure taking about 2 to 5 minutes and usually requires no anaesthesia. Though the entire duration of treatment of Fistula in ano by kshara sutra may be longer than classical excision surgery, the safety, efficacy and the permanent results and the chances of recurrence and incontinence are almost nil, makes this treatment an ideal choice.

Kshara sutra procedure for Anal fistula: Know more about it?