Ayurvedic treatment for Anal fistula

Anal fistula

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  • Definition
  • Causes
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Anal fistula Ayurvedic treatment


Sometimes an infection develops near the anus leading to pus formation in the nearby area. When the pus drains, it may leave a cavity behind which is called anal fistula.1

Fistula in anal is called as Bhagandara in Ayurveda as described in the classical text - Sushruta Samhita. It is caused due to sedentary life style, irregular & inappropriate diet and prolong seating etc.2


Anal fistula


Incompatible changes in diet and lifestyle result in an imbalance of Jatharagni (digestive fire) and disturb the balance of doshas which leads to all anal diseases. Prolonged constipation can lead to infection in anus which may ultimately develop into fistula.3

Most anal fistulas are preceded by an anal abscess (pus filled boil) which), and are caused when anal abscess don’t heal properly after the pus has drained away.

It's estimated that one in every two to four people with an anal abscess (pus filled boil) will develop a fistula.

Less common causes of anal fistulas include:

  • Crohn's disease: A long-term condition in which the digestive system becomes inflamed
  • Diverticulitis: Infection of the small pouches that stick out of the side of the large intestine (colon)
  • Hidradenitis suppurativa: A long-term skin condition that causes infective boils (pus filled boil) and scarring
  • As complication of surgery near the anus
  • Anorectal tuberculosis (TB)
  • HIV+ status


Anal fistula


Symptoms of an anal fistula can include2:

  • Skin irritation around the anus
  • A constant, throbbing pain that may be worse when sitting down, moving around, or during a bowel movement or cough
  • Smelly discharge from near the anus
  • Passing pus or blood during defecation
  • Swelling and redness around the anal area and fever, if there is presence of an abscess
  • Difficulty controlling bowel movements.


Anal fistula


Your doctor will ask questions about the symptoms and may examine the infected area. Certain laboratory tests such as urine, blood and pus examinations will be recommended in identifying the condition. 


Anal fistula


Anal fistulas usually require surgery as they rarely heal if left untreated.2 The main options include a procedure (fistulotomy) that involves cutting open the fistula so it heals into a flat scar2

Ayurveda believes anal fistula is a surgically curable condition.3 Para-surgical procedures like ksharasutra and agnikarma are also recommended for its management. Along with surgical treatment, basic diet and lifestyle changes can help relieve the symptoms.

Kshar sutra ligation:  Kshara Sutra therapy is a minimal invasive ayurvedic parasurgical procedure and tested ayurvedic technique for the management of anorectal disorders including anal fistula and other sinus diseases. The Kshara Sutra is inserted in the fistula with the help of a probe and both ends of the Kshara Sutra are tied together. The Kshara Sutra is replaced by a new one after an interval of one week. The Kshara Sutra gradually cuts and heals the tract. Finally the whole fistulous tract heals after cutting. 5 

Diet Recommendations (Aahar)

Recommended diet includes cow milk, butter, buttermilk, wheat, ghee, rice, green vegetables and regular diet. Avoid chilies, fried foods and constipating foods.4 

Lifestyle changes (Vihar)

Sitz baths (sitting bath with medicated warm water) are beneficial. Avoid constant sitting and excessive straining during defecation.4


Anal fistula
  1. What is GERD?

Acid reflux disease - also commonly known as Gastro-esophageal reflux disease (GERD) is condition in which acid from the stomach regurgitates or moves up into the esophagus (gullet).

  1. How are fissures caused?

An anal fissure may occur when due to passing of hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. One may experience spasms in the ring of muscle at the end of the anus (anal sphincter).

  1. Can a fissure heal completely?

With appropriate treatment and following of pathya apathya, a fissure can heal completely. Although care should be taken not to be constipated and have high amount of fiber in food.

  1. What is a kshar karma? How is it different from other surgery

Kshar karma is a specialized Ayurvedic surgical procedure that involves minimal blood loss and provides excellent relief in hemorrhoids and fistulas. It involves the applying of a sclerosing agent, such as apamarg kshar snuhi kshar etc.

It differs from conventional surgery as in it does not require anaesthesia, shows minimal blood loss and need not require inpatient admissions.

  1. What are the risk factors of developing bowel incontinence?

A number of factors can increase the risk of developing fecal incontinence. These include:

  • Age: It is more common in middle-aged and older adults.
  • Female gender: Fecal incontinence is slightly more common in women. One reason may be that fecal incontinence can be a complication of childbirth.
  • Nerve damage: People who have long-standing diabetes or multiple sclerosis — conditions that can damage nerves that help control defecation — may be at risk of fecal incontinence.
  • Dementia: Fecal incontinence is often present in late-stage Alzheimer's disease and dementia.
  • Physical disability: Being physically disabled may make it difficult to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage, leading to fecal incontinence. Also, inactivity can lead to constipation, resulting in fecal incontinence.
  1. What exercises can be done to have better control on the motions?

Certain asanas that help strengthen the pelvic floor (muscles around the anal opening) are recommended for better control over the anorectal area. These are -

Utkatasana                   Virabhadrasana                 Ananda Balasana             Shlabhasana


  1. Can celiac disease lead to anything serious?

Untreated, celiac disease can cause the following complications:

  • Malnutrition: The damage to your small intestine means it can't absorb enough nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can cause slow growth and short stature.
  • Calcium loss of calcium and low bone density: Malabsorption of calcium and vitamin D may lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteoporosis) in adults.
  • Infertility and miscarriage: Malabsorption of calcium and vitamin D can contribute to reproductive issues.
  • Lactose intolerance: Damage to your small intestine may cause you to experience abdominal pain and diarrhea after eating lactose-containing dairy products, even though they don't contain gluten. Once your intestine has healed, you may be able to tolerate dairy products again. However, some people continue to experience lactose intolerance despite successful management of celiac disease.
  • Cancer: People with celiac disease who don't maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.
  • Neurological problems: Some people with celiac disease may develop neurological problems such as seizures or peripheral neuropathy (disease of the nerves that lead to the hands and feet).

In children, celiac disease can also lead to failure to thrive, delayed puberty, weight loss, irritability and dental enamel defects, anemia, arthritis, and epilepsy.

  1. Who gets affected by pancreatitis?

Acute pancreatitis is more common in middle-aged and elderly people, but it can affect people of any age. Men are more likely to develop alcohol-related pancreatitis, while women are more likely to develop it as a result of gallstones.

  1. What are the common causes of developing ulcers in stomach?

Common causes of peptic ulcers include -

  • Long-term use of non steroidal anti-inflammatory drugs (NSAIDs)
  • An infection with the bacteria Helicobacter pylori (H. pylori)
  • Rare cancerous and/or noncancerous tumors in the stomach, duodenum, or pancreas

Addtionally, intake of alcohol and smoking also increase the chances of having a gastric ulcer.

  1. What causes hemorrhoids?

Swelling in the anal or rectal veins causes hemorrhoids. Several factors may cause this swelling, including -

  • Chronic constipation or diarrhea
  • Straining during bowel movements
  • Sitting on the toilet for long periods of time
  • A lack of fiber in the diet

Another cause of hemorrhoids is the weakening of the connective tissue in the rectum and anus that occurs with age.

Pregnancy can cause hemorrhoids by increasing pressure in the abdomen, which may enlarge the veins in the lower rectum and anus. For most women, hemorrhoids caused by pregnancy disappear after childbirth.



Anal fistula
  1. Mayo Clinic. Anal fistula. Available at http://www.mayoclinic.org/diseases-conditions/anal-fistula/basics/definition/con-20032352 accessed Aug 23rd 2016
  2. NHS Choices. Anal fistula. Available at http://www.nhs.uk/conditions/Anal-fistula/Pages/Introduction.aspx accessed on Aug 23rd
  3. Borkar KM, Shekokar AV, Mutha S. Role of Virechan Karma before Ksharasutra Procedure in the Management of Bhagandara w.s.r. to Fistula in Ano. Int. J. Ayur. Pharm Res. 2014;2(4):129-134.
  4. Gupta R, Gupta GD. Importance Of Diet (Aahar) And Life Style (Vihar) In AnorectalDisorders (Gudroga). Int Ayu Med J. Jul 2015; Vol. 3(7): 2070-73
  5. Dabur: Ayurvedic products and drugs. Available at http://www.daburmediclub.com/product.aspx accessed on Aug 19th
  6. KSHARA SUTRA THERAPY (MEDICATED CAUSTIC THREAD). National health portal. http://www.nhp.gov.in/kshara-sutra-therapy-medicated-caustic-thread-_mtl accessed on Aug 30th
  7. Mishra N, Sharma HP. Hemorrhoids–(Arsha): a Comprehensive Review on Its Causes And Treatment. UJAHM 2013, 01 (03): Page 31-33 

Disclaimer: The information on this page is not intended to be a substitute for professional medical advice. Do not use this information to diagnose or ayurvedic treatment of gastro-intestinal-diseases and/or anal fistula without consulting the doctor. Consult your physician before beginning an exercise regime. "While we have products /ayurvedic medicines for gastro-intestinal-diseases and/or anal fistula, you must consult an authorized physician before taking any of the products. For more information on products, visit www.dabur.com or call 1800-103-1644"