Ayurvedic Treatment for Anal Fistula: An Ayurvedic Treatment Guide

ANAL FISTULA/BHAGANDARA

Anal fistula/Fistula in ano can be defined as an inflammatory tube like tract with one opening in the anal canal and the other in the perianal (skin around anus) skin.

What are the causes of Anal Fistula?

·       Most commonly, Fistula arises from an anorectal abscess, which then bursts spontaneously.

·       Ano rectal abscess, which was opened inadequately.

·       Crohn‘s disease, Tuberculosis, Diverticulitis, Cancer, and Trauma can also lead to a Fistula

·       Other causes include Radiation therapy, AIDS, Chlamydial infections, and Diabetes.

What are the Signs and Symptoms of Anal Fistula?

·       In most cases, a history of recurrent abscess followed by discharge

·       Perianal and anal discharge

·       Swelling and Bleeding

·       One or more secondary openings can be inspected

·       Once an Abscess is formed, it ruptures, leaving behind a discharging sinus which heals itself. This repeats, resulting in multiple fistulae.

What are the types of Anal Fistula?

1. based on External Opening

·       Single Fistula

·       Multiple Fistula

2. based on Internal Opening

· High-level Fistula

-        Extra sphincteric/supra levator

-        Trans sphincteric

-        Pelvi-rectal/high intersphincteric

· Low-level Fistula

-        Subcutaneous

- Submucous

-        Inter sphincteric

-        Trans sphincteric

-        Supra sphincteric

What are the treatment modalities?

Surgical Intervention through –

1.     Fistulotomy

2.     Fistulectomy

3.     Seton placement

4.     Mucosal advancement flap

AYURVEDA CONCEPT OF ANAL FISTULA

In Ayurveda, Anal fistula can be correlated with Bhagandara.

Bhagandara can be defined as a condition characterized by a Dharana/splitting type of pain in the Guda or Basti/Anal region. 

It is named as such because it causes bursting of the rectum, the perineum, and the bladder. The abscess seen in this area in Apakwa avastha is called Bhagandara Pidika, and in Pakwa avastha it is called Bhagandara.

NIDANA/CAUSES OF BHAGANDARA

·       Ahara – Diet

·       Vihara – Habits

·       Abortion and Miscarriage

·       Vega dharana - Suppression of natural urges

·       Mandagni – Low digestive power

·       Papa Karma – Evil/sinful actions

·       Kaṭhina Utkaṭaka Asana (sitting for long periods on a hard and uneven surface)

POORVAROOPA/ SYMPTOMS

·       Kati Kapala vedana – Low back pain

·       Kaṇḍu - Itching

·       Daha -  Burning sensation

·       Guda Shopha – Pain in anal region

CHIKITSA/ TREATMENT 

·       Treatment Protocol for a Balavan Rogi (patient who is strong): -

1.     Virechana (therapeutic purgation)

2.     Eṣaṇa (probing)

3.     Patana (incision)

4.     Shodhana (purification)

5.     Taila daha (cauterization with oil)

6.     Vranavat Chikitsa (wound treatment)

·       Treatment Protocol for a Daurbalya Rogi (weak patient): -

1.      Esaṇa (probing)

2.      Ksarasutra (medical thread incision)

3.      Vranavat Chikitsa (wound treatment)

·       Bhagandara Piḍika - Jalaukavacharaṇa (leech therapy)

APATHYA/ UNWHOLESOME REGIMENS

·       Vyayama - exercise

·       Maithuna – sexual intercourse

·       Krodha - Anger

·       Prshtayana – sitting for a long time

·       Guru Ahara – heavy foods

How is an ano fistula treated in Ayurveda?

In Ayurveda, the mode of treatment is according to the Strength of the Patient, the strength of the condition, the dosha aligned with the Bhagandara, if the bagandara is ripe(pakwa) or unripe(apakwa), etc. 

Is Ksharsutra better than surgery?

Compared to an open surgery, kshara sutra which is a minimal invasive method usually Is found to have less recurrence, lesser pain, less anal incontinence, low rate of complications, minimal bleeding etc. and also cost effective.

What is the latest treatment for fistulas?

Latest treatment methodologies for management of anal fistula are fistulotomy, fistulectomy, seton placement, ligation of intersphincteric fistula tract, etc.

Can fistula be treated permanently?

Yes. Anal Fistulas can be cured permenantly. With procedures like Ksharasutra and internal Ayurvedic medications, management of Anal fistula is possible with lower rate of recurrence.

What is the success rate of the Ksharsutra?

Ksharasutra is a minimally invasive method using a cotton seton smeared or coated with Ayurvedic medicines. Studies have shown lower rate recurrence, lesser pain, less anal incontinence, low rate of complications and minimal bleeding with ksharasutra procedure.

How much time does Ksharsutra take to heal?

Ksharasutra treatment wound heals usually within 2 to 3 weeks, according to the complexity of the condition of the Fistula.

How painful is Ksharsutra?

Pain experienced in the procedure of ksharasutra is found to be minimal. Written by Dr. Dyuthi Mukundan