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100% treatment by Kshara Sutra treatment of fistula in Ayurveda

100% Permanent Cure of Fistula in Ano through Kshar Sutra

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


Reimbursement and Cashless  TPA  Health Insurance  for the Process Of Kshar Sutra is available now.  In NCR, Ghaziabad and Noida

E-mail:  Ph:+91 – 9219434343,      Mo:+91 – 9412637645,  

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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 15 – 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 1 to 2 minutes and requires no anaesthesia.



The procedure does not require hospitalization for more than 4 to 5 hours

The patient requires minimal bed rest and can resume daily activities within 12 – 24 hours

No painful dressings required

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

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


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


The re-occurrence 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 payogenic 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 re-occurrence rate rises to 21-60%. After an advancement flap procedure, the re-occurrence rate may be as high as 36% some says 60%.

Only and Only Kshar-Sutra is the worldwide recognized process for Fistula-in-ano for 100% treatment with an 99.96% accuracy as compared to other process .

आयुर्वेद का क्षार सूत्र अथवा क्षार कर्म द्वारा भगन्दर का सटीक इलाज हो जाता है, इसके लिये किसी expert क्षार सूत्र चिकित्सक की सेवायें लेना चाहिये

Reimbursement and Cashless  TPA  Health Insurance  for the Process Of Kshar Sutra is available now.  In NCR, Ghaziabad and Noida

E-mail:  Ph:+91 – 9219434343,      Mo:+91 – 9412637645,  

msarogyam whatsapp no


Fistula-in-ano Treatment Diagnosis Classification Symptoms

Fistula-in-ano Classification Symptoms Treatment

WHAT IS AN ANAL FISTULA? Anal fistula, or fistula-in-ano, is an abnormal connection or channel like structure, between the surface of the anal canal and the exterior perianal skin.

Fistula-in-ano: An Ayurvedic Perspective

Bhagandara (Fistula-in-ano): An Ayurvedic Perspective

Definition of Bhagandara (Fistula-in-ano):

(Bhaga= Vagina, Darana= tear, spitting)


ते तु भगगुदबस्ति प्रदेशदारणाश्च ‘भगंदरा’ इत्युच्यन्ते ।

 अभिन्ना: पिडका:, भिन्नास्तु भगंदरा: ।। (Su. Ni. 4/3)


This creates a tear in the area of Bhaga (Vagina), Guda (Anal canal & rectum) and Basti (Urinary bladder), so this is called Bhagandara.

Particularly, in the earliar stage when this is not open, called ‘Pidakaa’ (furuncle). Later on it will get burst and forms the Bhagandara (Fistula-in-ano).

 Probable Causative Factors:

  • Obesity
  • Heavy diet
  • Indigestion
  • Suppression of natural urges
  • Trauma
  • Unhygienic condition
  • Infection of the anal glands
  • Worm infestation
  • Ingestion of foreign bodies
  • Excessive horse  riding or bicycle riding
  • Abrasion by stone, cloth and ground
  • Constipation
  • Excessive drinking of alcohol
  • Straining
  • Excessive coitus


  • According to Dosha Involvement:
  •  Ayurvedic classical texts have classified Bhagandara mainly in eight entities according to doshik involvement.
  • शतपोनक भगंदर (Shatponak Bhagandara)- Vāta dosha dominance
  • उष्ट्रग्रीव भगंदर (Ushtragriva Bhagandara)- Pitta dosha dominance
  • परिस्रावी भगंदर (Parisravi Bhagandara)- Kafa dosha dominance
  • शम्बूकावर्त भगंदर (Shambukavarta Bhagandara)- Tridosha dominance
  • उन्मार्गी भगंदर (Unmargi Bhagandara)- Aāgantuja /Traumatic
  • परिक्षेपी भगंदर (Parikshepi Bhagandara)- Vāta  Pitta dosha dominance
  • ऋजु भगंदर (Rhiju Bhagandara)- Vāta Kafa dosha dominance
  • अर्शो भगंदर (Arsho Bhagandara)- Pitta Kafa dosha dominance

According to opening:

  •  Sushruta (School of Ayurvedic Surgery) again classified each type of Bhagandara according to its opening whether presents externally or internally. He used the terms,
  • पराचीन (Parachina) or  बहिर्मुखम् (Bahirmukham) – blind external and,
  • अवाचीन (Avachina) or  अंतर्मुखम् (Antarmukham) – blind internal.

According to modern contrive:

  •  According to modern texts, fistula-in-ano can be divided in two groups broadly, on whether the internal opening is below or above the ano-rectal ring respectively.
  • Low level fistula
  • High level fistula
  • Low level fistula can be further subdivided into subcutaneous type, submucous type, intersphincteric type, trans-sphincteric type and supra- sphincteric type.
  • High level fistula can be further subdivided into extrasphencteric or supralevator type, trans-sphencteric type and pelvi-rectal fistula.

Symptoms of Bhagandara (Fistula-in-ano):

  • The main symptoms are boil around the anus, anal discharge and pain in anal region.
  • Management (treatment) of Bhagandara (Fistula-in-ano):
  • Local treatment:
  • Aālepa (Paste of Ayurvedic herbal drugs)- for local application
  •  Upanāha (Warm poultice)- for local application
  •  Pariseka (Pouring of Ayurvedic decoctions)- for local application
  •  Swedana (Hot fomentation)- for local application
  •  Rakta vistravana (Blood letting)
  •  Varti application (Application of wick of cotton cloth mix with Ayurvedic herbal oils)
  • General treatment:
  • Follow the ‘Ayurvedic life style’ (look forward on the home page of this site)
  •  Apatarpana (Making the body thin by fasting)
  •  Vamana & Virechana (Ayurvedic Panchkarma Therapy/Ayurvedic Detoxification Programme)

Para-surgical  procedures:

  • Kshāra- sutra Therapy (Application of Alkaline Herbal Seton)
  •  Rakta mokshan (Blood letting)
  •  Agni karma (Thermal cauterisation)
  •  Kshāra karma (Application of Ayurvedic herbal caustics)

Surgical procedures:

  • Bhedana karma- Fistulotomy
  •  Chhedan karma- Fistulectomy

Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

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.


  • 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)
  • a complication from surgery
  • a congenital abnormality (a health problem that you were born with)
  • 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.


  • Anal fistulae can present with many different symptoms such as:
  • Pain
  • Discharge – either bloody or purulent
  • Pruritus ani– itching around the anus
  • Systemic symptoms if abscess becomes infected


  • Diagnosis is by examination, either in an outpatient setting or under anaesthesia. The examination can be an Anoscopy.
  • Possible findings:
  • The opening of the fistula onto the skin may be seen
  • The area may be painful on examination
  • There may be redness
  • A discharge may be seen
  • 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

Fistula Bhagandara best Treatment By Kshar Sutra

Fistula is a deadly disease which occurs most commonly on the rectum.

A yellow liquid gets formed on the area which is very painful.

Bhagandara is the name by which fistula is known as in Ayurvedic practice. Three kinds of the disease are recognised with different treatments. One of the important therapies for curing fistula in Ayurveda is Kshar Sutra.

This involves cutting up some tissues and these take time to heal. Before performing this procedure, several herbs are given to the patient such as Kadali Kshar, Apamarg Kshar, Nimb Kshar, Papaiya Kshar and Snuhi Kshar.


Anal fistula is generally treated through surgery but it is known to recur after some time.

You need to be very conscious of this fact when looking to get your condition treated.

Ayurvedic remedies for fistula are known to cure the disorder for good. Several techniques and therapeutic procedures are available in Ayurveda that eliminate the problem from its root.




Although Kshar Sutra is a slow process on the whole but it is getting global recognition gradually as a very effective treatment for fistula. The great advantage in undergoing this treatment is that the patient does not need to be admitted to a hospital. He can carry on with his regular everyday work without any trouble.

and most of all 100%  treatment without any recurrence.

Agnikarma is another treatment for fistula in Ayurveda. This involves use of hot iron or caustic agent for destroying the affected tissues.

Another Ayurvedic treatment for fistula is known as Enema. In this treatment, hot bath is given to the patient suffering from it. Lower body parts are involved in this therapy. A few other types of fomentation is also recommended. The patient needs to be constantly checked for any signs of suffering for diseases such as hypertension, diabetes, TB or any other.

The main reason for rise of this disease these days is the unhealthy lifestyle which people have started to lead. It is expected that with Ayurvedic remedies for fistula treatment becoming popular, the lifestyle recommended by the holistic system of medicine will also gain ground.

Fistula-in-ano By Ayurveda

What is Fistula-in-ano as Ayurvedic View

Bhagandara (Fistula-in-ano): An Ayurvedic Perspective

Definition of Bhagandara (Fistula-in-ano):

(Bhaga= Vagina, Darana= tear, spitting)

ते तु भगगुदबस्ति प्रदेशदारणाश्च ‘भगंदरा’ इत्युच्यन्ते ।

 अभिन्ना: पिडका:, भिन्नास्तु भगंदरा: ।। (Su. Ni. 4/3)


गुदा के मुकाम पर या रेक्टम के मुहाने  पर या near to ANUS wall के आस पास  यह बीमारी या तकलीफ होती है / सबसे पहले जब इस तकलीफ का आगाज होता है तो पाखाने के मुकाम पर पहले बड़ी खुजली होती है , जिसे खुजलाने में बड़ा मजा आता है और खुजलाने की न इच्छा होये हुये भी बार बार हाथ गुदा तक खुजलाने के लिये पहुच ही जाता है / कुछ दिन बाद इसी खुजली वाली जगह पर एक छोटी सी फुन्सी हो जाती है , जो पहले लाल हो जाती है फिर पकती है और पस से भरा हुआ एक छोटा सा बिन्दु बन जाता है / इसमे दर्द भी होता है, किसी किसी को दर्द नही होता है / अर्थात यह बिना दर्द के ्भी होता है , लेकिन ऐसा देखने में कम ही आता है /


दर्द के होने पर लोग उपचार लेते हैं और फिर लापरवाह हो जाते हैं , इसलिये यह छोटा सा घाव धीरे धीरे जगह बना हुआ गुदा के अन्दरूनी छोर तक जा पहुचता है और फिर तकलीफ देन शुरु करता है / कई बार यह देखा गया है कि जैसा इस  घाव का मिजाज बाहर से अन्दर के रुख की वजह से बनता है तो ठीक उल्टा यह गुदा से बाहर की तरफ भी बनता है  / लोग इस स्तिथि मे अक्सर भ्रम में पड़ जाते हैं और वे समझते हैं कि शायद गुदा में दर्द अन्दरूनी बवासीर के कारण हो रहा है , जबकि यह भगन्दर के घाव के कारण होता है /


बहर हाल भगन्दर का इलाज जैसे ही पता चले, शुरू कर देना चाहिये / आयुर्वेद का इलाज   के समन्वित चिकित्सा व्यवस्था से भगन्दर अवश्य ठीक हो जाते हैं / लेकिन इसके लिये चिकित्सक चाहे वह अकेला हो जिसे तीनों चिकित्सा विग्यान का अनुभव हो या यह न हो सके तो  तीनों चिकित्सा विधाओं के experts से तालमेल करके चिकित्सा व्यवस्था अगर करते हैं तो भगन्दर अवश्य ठीक हो जाता है /

Surgical intervention से भगन्दर ठीक भी होते हैं और नही भी / कई बार कुछ साल ठीक होने के बाद फिर दुबारा तकलीफ हो जाती है , इसलिये सरजरी कराने का निर्णय मरीज की अपनी इच्छा पर निर्भर है /

Only and Only Kshar-Sutra is 100%  for fistula-in-ano.

आयुर्वेद का क्षार सूत्र अथवा क्षार कर्म द्वारा भी भगन्दर का सटीक इलाज हो जाता है, इसके लिये किसी expert क्षार सूत्र चिकित्सक की सेवायें लेना चाहिये

or just visit our clinic MsArogyam Contact Us for Details and get the Final solution for Fistula In Ano .


BHAGANDAR (FISTULA IN ANO) Kshar Sutra Treatment


Anorectal Fistula

  • A fistula is an abnormal communication between two epithelial/endothelial-lined surfaces.
  • A fistula in ano has its external opening in the peri anal skin and its internal opening in the anal canal.


  • Anorectal sepsis can be complicated by a fistula in ano in about 50% of patients during the acute phase of sepsis or within 6 months thereafter.
  • A fistula in ano forms during the chronic stage of an acute inflammatory process that begins in the intersphincteric anal glands.
  • The fistula tracts will follow the course of the original
    abscess cavities and subsequent external drainage.

Causative agents

  • Escherichia coli 60%
  • Staphylococcus aureus 23%
  • Streptococcus, B.Proteus 17%
  • Always mixed infection

Source of Infection

  • Cryptoglandular infection 90%
  • Penetration of rectal wall
    (bone piece, fish bone or any FB)
  • Blood borne infection
    (TB, Syphillis, AIDS, etc.)







BHAGANDAR (FISTULA IN ANO) Kshar Sutra Treatment



Abscess Anatomy


  • supralevator abscess, external, perianal abscess, intersphincteric abscess, ischiorectal abscess, internal sphincter
  • An extension from a cutaneus boil

Other cause of FIA

  • Crohn’s disease.
  • diverticulitis with perforation and fistula to
    the perineum;
  • hydroadinitis suppurativa;
  • pilonidal sinus;
  • malignancies of the distal rectum, anal
    canal or perianal
  • skin tuberculosis;
  • actinomycosis.

Goodsall’s rule

  • If the anus is bisected by a line in the frontal plane, an external opening inferior to that line connects to the internal opening via a short direct tract.
  • if the external opening is posterior to this imaginary line, the fistula tract follows a curved route to the internal opening in the posterior midline.

Goodsall’s rule Classification of FIA

  • Intersphincteric (the most common): The fistula track is confined to the intersphincteric plane.
  • Trans-sphincteric: The fistula connects the intersphincteric plane with the ischiorectal fossa by perforating the external sphincter.
  • Suprasphincteric: Similar to trans-sphincteric, but the track loops over the external sphincter and perforates the levator ani.
  • Extrasphincteric: The track passes from the rectum to perineal skin, completely external to the sphincteric complex.  Clinical classification

High anal fistula-

  • these open into the anal canal at or above the anorectal ring.
    Low anal fistula-
  • these open into the anal canal blow the anorectal ring.

Sign and symptoms

  • Anal fistulae can present with many

different symptoms:-

  • Discharge – either bloody or purulent
  • Pururitis- itching
  • Pain
  • Systemic symptoms if abscess becomes infected


  • Diagnosis is by examination, either in an outpatient setting The examination can be an anoscopy.

Possible findings:-

  • The opening of the fistula onto the skin may be seen
  • The area may be painful on examination
  • there may be redness
  • An area of induration may be felt – thickening due to chronic infection
  • A discharge may be seen
  • 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

Digital Rectal examination Better after enema Find

  • I. Sphincter tone
  • II. Pain or Tenderness
  • III. Palpable Mass
  • IV. Internal opening of Fistula
  • V. Temp

Internal opening of Fistula …… Digital examination

  • vi. Male
    • Prostate, Seminal vesicles, Base of bladder
  • Female
    • Uterus, Cervix, Vagina
  • Male & Female
    • Ischio Rectal Abscess
    • Coccyx


  • Blood- RE
  • RBS
  • CXR
  • Smear C & S
  • Fistulogram

Kshar Sutra Chikitsa

Properity of kshar

  • Distroys the unhealthy tissues.
  • Deberides the wound.
  • Promots the healing of healthy tissues.
  • It distroys the fibrous tissues and acts as fibrolytic agent.

Materials Required

  • I. Lithotomy table within a OT.
  • II. Spot light
  • III. Ksharsutra dressing trolley
  • IV. Instrument box

Preparation of the patient

  • Evacuation of bowel
  • Shaving of local area
  • Inj. T.T.
  • Xylocane sensitivity test
  • Swedan of local area
  • Washing of local area by antiseptic lotion.

Procedure of threading

  • • Patient should be keep in lithotomy position.
  • • Cleaning by antiseptic lotion and covered by a sterile clothes.
  • • Explain the major procedure to patient.
  • • Instruct to patient to relax the anal sphincter.
  • • Now probing should be done through the path of least resistance under L.A. guided by the finger inside the anal canal.
  • • Tip of probe should come out through anal orifice.
  • • Now threaded the plain thread of suitable length in the eye of probe. (Primary threading)
  • • Pull the probe through the anal orifice to leave the thread behind fistulous track.
  • • Now tight the two end of thread moderatly.
  • • Finally dressing by Jatyaditail or Anu tail.
  • • Chang the thread by kshar sutra at a regular interval of 7 days by rail and train method.

Adjuvent Therapy

  • Jatyaditail or anu tail basti
  • Sitz bath
  • Proper antibiotic
  • Haritaki Churn or Panchsakar Churan HS
  • Abhayarista 4 TSF BD.
  • Analgesics and anti-inflmmatory drugs.
  • Diet- nutritious vegetarian diet.
    Sitz bath tub

Cut through

  • • After subsequent changing of thread, in a few week, ksahar sutra comes out with the knot intact from the tract. This is known as cut through. Cut through indicates complet division of track.

How does Kshar Shutra work!

  • • Cutting due to pressure necrossis
  • • Kshar helps in cleaning debris from track, sterilization of track
  • • Quick and Good healing of track
  • • Slow cutting and healing result in nil recurrence and minimal sphincter mechanism distrubances.


fistula treatment ksharsutra

Problem during the therapy

  • I. Duration of treatment- depend on the length of track.
  • II. Allergic reaction
  • III. Discharge
  • IV. Incontinence- may be due to trauma to sphincter, so that never cross the ano rectal-ring.
  • V. Foreign body sensation.
  • VI. Anal stenosis.

Advantage of kshar sutra

  • Minimal trauma and no tissue loss as compare to fistulectomy.
  • Almost no bleeding as compare to fistulectomy.
  • Anesthesia is seldom required.
  • Minimal hospital stay.
  • No dressing as compare to fistulectomy
  • No anal stricture if properly treated.
  • Nil recurrence 99.96%
  • Very narrow and fine scare as compare to fistulectomy
  • Therapy is cost effective.

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