• Fistula-in-ano is an abnormal connection between the epithelia zed surface of anal canal and the per anal skin. • Anal fistula originates from the anal glands which are located between two layers of anal spinsters’ and which drain into the anal canal. • Acc to ayurveda Anal fistula is known as bhagandar.

1. FISTULA –IN-ANO (BHAGANDAR)
Fistula-in-ano is an abnormal connection between the epithelia zed surface of
anal canal and the per anal skin.
Anal fistula originates from the anal glands which are located between two layers
of anal spinsters’ and which drain into the anal canal.
Acc to ayurveda Anal fistula is known as bhagandar
The deranged Vata, Pitta, Kapha and extraneous causes such as blow etc., give
rise to bhagandara.
The pustules’ which appear in anal regions are called as pidakas in their
unsupported stage, while they are in a stage of suppuration. It is called as
bhagandara.
Symptoms:
Pain about sacral bone
Itching in anus
Accompanied by swelling
Burning sensation
Discharge – blood or purulent
Types of bhagandara acc to ayurveda:
Sataponaka:
The layers, excited, condensed & rendered Motionless by a course of
unwholesome food give rise to pustule within or two fingers length from the
rectum, by vitiating the flesh & blood.
If neglected at the outset, the pustule runs into suppuration.
The suppurated pustule exudes a kind of slimy secretion & becomes covered
with hundreds of small sauce like hole through which a constant frothy discharge
is secreted in large quantities.
Ustragrivah:
The enraged pitta carried down by vata find lodgment there in and there gives
rise to a small, raised, red pustule which resembles the neck of a camel in
shape. The pustule not treated runs into suppuration.

2. Parisravi:
Enraged Kapha carried down by vata and lodged there in give rise to a white,
hard, itching pustule
If neglected runs into suppuration.
The ulcer becomes hard & swollen, Marked by excessive itching.
Sanvukavartah:
Enraged vata, in conjunction with the aggravated pitta & kapha carried down and
lodgment giving to pustule of the size of first toe & characterized by piercing
pain, burning etc., If neglected speedily suppurates.
Unmargi:
Particles of bones, eaten with meat by an imprudent, greedy, gluttonous person,
may be carried down with hard & constipated stool by apanavata, thus scratching
& abrading the margin of anus. The scratch or abrasion is soon transformed into
ulcer.
Prognosis:
All the types of fistula – in- ano yield to medicine after a prolonged course of
treatment and are hard to cure.
Sannipata & unmerge type of bhagandar are incurable
Pustule appearing about the region of anus and characterized by slight pain and
swelling and spontaneously subsiding, should be regarded as simple pustule
and healed I medicines
If the pustule is with violent pain and swelling and takes a long time to heal is
considered as fistula
Ayurvedic Treatment:
Parisheka (Irrigating)
Alepa (Plastering)
Apatarpana (Fasting Low Diet)
Kshar sutra
Kshar sutra Procedure:
kshar sutra is a special technique of excision without the use of knife but by
means of mechanical pressure and chemical action.
Kshar sutra is nothing but an alkaline herbal thread which has the property of
cutting & healing the fistula track.

3. The medicine used to prepare the kshar sutra thread will dissolute the fistulous
track and stimulates healthy granulation tissue for healing.