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Anal Fistula is an abnormal tube like passage (communication) between the interior of the anal canal (or rectum) and the outer skin surface around the anus. One opening of the fistula (Internal opening) is inside the anus (or rectum) and another opening (External opening) is on skin surface around the anus. A tube like structure (Fistula track) connect them.

Complications of Fistula

Depending on the effectiveness of the treatment, fistula may result in infection or incontinence of stools.

Recurrence of Fistula
The reoccurrence rate of fistula treated with kshara sutra ligation procedure is less than 2%. This is because the medicines on the thread gradually and continually curate the pyogenic membrane and fibrous tissue in the track and thus leave no pus pockets undrained.

In some cases, the fistula can reoccur despite having surgery. After having a fistulotomy, the reoccurrence rate rises to 21%. After an advancement flap procedure, the reoccurrence rate may be as high as 36%.

Causes of Fistula

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:

1. A growth or ulcer (painful sore)

2. A complication from surgery

3. A congenital abnormality (a health problem that you were born with)

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

1. Irritable bowel syndrome (IBS): a chronic (long-term) disorder that affects the digestive system, causing abdominal pain, diarrhoea and constipation.

2. Diverticulitis: the formation of small pouches that stick out of the side of the large intestine (colon), which become infected and inflamed.

3. Ulcerative colitis: a chronic condition that causes the colon to become inflamed and can cause ulcers to form on the lining of the colon.

4. Crohn’s disease: a chronic condition that causes inflammation of the lining of the digestive system.

Signs and Symptoms

Anal fistula can present with many different symptoms such as:

1. Pain

2. Discharge—either bloody or purulent

3. Pruritus ani– itching around the anus

4. Systemic symptoms if abscess becomes infected

Diagnosis and Testing

Diagnosis is by examination, either in an outpatient setting or under anaesthesia. The examination can be an Anoscopy.

Possible findings:

1. The opening of the fistula onto the skin may be seen

2. The area may be painful on examination

3. There may be redness

4. A discharge may be seen

5. It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula

Ayurveda Treatment

Punarva provides Precision Based Fistula Ayurvedic Treatment in Bangalore, Gurugram, Kochi and in Kadavanthra. Treat Fistula within 1 – 2 days and no painful dressing is required.

Kshara Sutra is utilized in the treatment of fistula in Ayurveda.

Kshara Sutra
Kshara Sutra is a seton thread medicated with organic alkalis, such as Apamargakshara(Achyranthesaspera), Arkakshara(Caltropisgigantea) or Snuhikshara (Euphorbia lingularia). The alkali is repeatedly coated on the seton thread 21 times. Apart from this, natural antibiotic like haridra powder, guggulu, etc are also used to make Ksharasutra. 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. 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. This can be applied and changed periodically till the thread cuts the fistulous tract. Since the sphincter heals by fibrosis, there is no 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 and healing the track. This therapeutic action of the thread lasts for seven days. The old thread is then replaced with a new thread following the same procedure. Depending on the length of the tract and the extent of damage, the kshara sutra may be changed up to 5 times. The changing of the thread is a simple procedure taking about 10 to 12 minutes and requires no anaesthesia.


Punarva Hospitals provides Fistula Treatment through Ayurveda. Ancient Ayurveda surgeon, Susruta has described five types of Bhagandara(Sataponak, Ustragriwa, Parisrabi, Sambukawarta, Unmargi). They have been classified according to the vitiation of the three doshas and the shape & site of the fistula tract.

At Punarva Hospitals, we are proud to say that we have successfully treated those patients who did not get relief even after repeated surgeries. Any drug of any stream of medicine can control the fistula infection but cannot treat fistula completely. So do not waste your time & money in the hope of some miracle. Today, the well accepted Ayurvedic technique – the Ksharasutra treatment – is the treatment of choice for Fistula-in-Ano, After treatment at Punarva Hospitals, there is minimal to no chance of haemorrhoids or abscess recurring. We treat with ksharasutra (also described as Ayurveda Piles Operation), a seton thread medicated with organic alkalis, or Kshara Karma (application of special alkaline medical paste) intervention, supplemented by Panchakarma procedures.

The Punarva protocol is based on the simple premise that the Physician must diagnose and treat only based on sufficient evidence. This evidence should be ‘patient or rogi based’ in addition to being ‘disease or roga based’ in accordance with the fundamental principles of Ayurveda.

How is this made possible?

  • A thorough and      complete recording of the patient’s medical history, capturing every      minute aspect of his/her lifestyle.

  • A thorough      head-to-toe clinical examination, uncovering health risk factors that the      patient is unaware of, directly connected or unrelated with his presenting      medical complaint(s).

  • This process of      detailed history recording and clinical examination- which includes the      classical Srotha-Vikrti pariksha – leads to an accurate understanding of      the Dosha status of the individual and lays the foundation for an accurate      differential diagnosis and medical management.

  • Further, the      patient is entitled to be clearly informed about the diagnosis arrived at,      as also understand the medical management proposed for him. The Physician      shall proceed only with the patient’s informed concurrence.

Key Outcomes

Punarva provides Precision Based Fistula Ayurvedic Treatment in Bangalore, Gurugram, Kochi and in Kadavanthra. Treat Fistula within 1 – 2 days and no painful dressing is required.

1. The procedure requires minimal hospitalization for 1-2 days

2. The patient requires minimal bed rest and can resume daily activities within 5 – 7 days

3. No painful dressings required

4. The drugs coated on the Kshar-Sutra are slowly and gradually released into the track and the wound, leaving no abscess overseen. This abscess is drained out by the action of the drugs.

5. The sphincteric muscles are not dissected and hence the possibility of incontinence is ruled out.

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