Ayurveda Fistula Treatment

August 27, 2025

Overview

Fistula -in-ano is characterised by a tract between the perianal skin and anal canal. The quality of life of an individual is greatly affected by this condition, which causes recurrent pus discharge, swelling, pain, and irritation. If not treated, it is prone to recurrent infections and recurrence and usually arises as a result of an untreated or prior anal abscess.

In Ayurveda, fistula-in-ano is referred to as “Bhagandara”, which is one of the eight major diseases (Ashta Mahagada), that are considered difficult to treat due to their chronic and relapsing nature. The term Bhagandara is derived from “Bhaga” (perineum) and “Darana” (tearing or breaking), indicating the pathological tearing of the Bhaga (perineum), guda (anal region) and vasthi (bladder region). When it is in a blister stage, it is called Pidaka, and if it is ripened (pakwa avastha). It is called Bhagandara (fistula). The causative factors in Ayurveda include impaired Agni (digestive fire), accumulation of Ama (toxins), and vitiation of doshas, especially Vata and Pitta, leading to suppuration, abscess formation, and tract development.
Apollo AyurVAID adopts an integrated, individual, and protocol-driven approach (Precision Ayurveda), addressing the root causes of piles rather than merely suppressing its symptoms.
A whole-person health assessment by an expert team of Ayurveda physicians is conducted to design a personalised treatment protocol. This includes classical Ayurveda medications and therapies, targeted anorectal care, and individualised diet and lifestyle modifications.
The treatment protocol includes classical Ayurvedic medications to correct the deranged Agni and dosha’s, reduce inflammation, and promote tissue healing. If the tract is chronic or complex, specialized Ayurvedic para-surgical procedures such as Ksharasutra therapy — a medicated thread ligation technique — are used. This method gradually cuts, and heals the fistulous tract, there by reducing the chance of recurrence. Along with Ksharasutra therapy, the treatment plan also includes personalized diet advice, bowel regulation strategies, and lifestyle modifications to strengthen digestive health, support immunity, and prevent future aggravation.
The integrative and multidisciplinary care at Apollo AyurVAID not only manages the symptoms but ensures sustainable healing and long-term relief from fistula-in-ano.

Who Can Benefit and Who May Not: Ayurveda Treatment Scope

Who Benefits from AyurVAID’s Treatment?

Patients with Simple, Low-Level Fistula
Chronic or Recurrent Cases
Patients Seeking Natural, Long-Term Healing
Patients who are looking to avoid invasive surgeries

Who May Not Benefit from Ayurveda Treatment?

Complex or High Anal Fistula
Associated Systemic Illnesses
Any other situations requiring immediate surgical management

What Patient’s Can Expect from AyurVAID’s approach?

Improved Digestion: Increased digestive fire resulting in improved bowel movements.
Tissue Healing: Strengthening anal tissues to avoid recurrence.
Personalised lifestyle plan: Diet and habits tailored to your body.
Long-Term Prevention: Treats the root cause to avoid future flare-ups.

Begin Your Journey to Root-Cause Healing from Anal Fistula

Book a consultation today to identify your dosha imbalance and start personalised Ayurveda care.

Risk Factors for Anal Fistula

Perianal abscess: If not treated properly, it recurs and leads to tract formation.
Prolonged sitting: Long period of sitting causes reduced blood supply in the perianal region leading to increased pressure and moisture further causing infection and inflammation of anal glands.
Inflammatory bowel diseases: Like Crohn’s disease, the incidence of fistula is more
Tuberculosis, HIV: In these conditions, the body’s immune system weakens aking the patient susceptible for infection and delayed healing
Chronic constipation: Continuous straining leads to increased intra abdominal and rectal pressure causing anal fissures, if not treated may get infected and causes abscess formation.
Poor anal hygiene: Inadequate cleaning of the area leads to bacterial growth and glandular infection which causes abscess
Obesity: This causes increased pressure, sweating and moisture retention in the perianal region, which can cause skin friction, poor hygiene and impaired immunity. All these leads to recurrent infections and further fistula formation.

Relief from Pain, Swelling & Discharge – Gentle Yet Effective Care

Take the first step to control symptoms naturally with Ayurveda Ksharasutra therapy.

Causative Factors (Nidanas) for Anal Fistula

Ayurveda explains Bhagandara (Anal Fistula) as a disease of guda(anorectal region) which is caused by the imbalance of the doshas like vata, pitta, and kapha, that leads to the dushti of raka, mamsa, and medo dhatu.

Acharya’s explain it as a complication of untreated parikartika (fissure in ano) and Pidaka (abscess/boil), which further leads to Bhagandara (Anal Fistula). And the causes can be broadly classified as Aharaja, Viharaja nidanas, and due to preexisting conditions.

The conventional medicine explains Anal Fistula as a result of cryptoglandular infection, ie, infection of the anal glands, leading to abscess formation, which, when does not heal completely causing Anal Fistula. Also, the risk factors include dietary and lifestyle causes.

Untreated abscess: The most common cause is an untreated abscess or an abscess that bursts but is not drained properly.
Chronic constipation or diarrhoea: Long-standing conditions like constipation and diarrhoea can increase the risk of infection of the anal glands
Lack of proper hygiene: Leads to infection in that area
Inflammatory bowel diseases like Crohn’s disease contribute to fistula formation
Other infections and Cancer: Like TB, STDs(sometimes), Carcinoma of the rectum may lead to fistula formation
Diet and lifestyle: Intake of improper diet, prolonged sitting, and incompatible foods (virudha ahara) leads to imbalance of the doshas and mandagni (compromised digestive function)
Trauma or surgery: Ayurveda also gives this as a cause of bhagandara. Any foreign body in the anal region or previous injury can lead to a fistula if not properly treated.

Signs (Lakshanas) and Symptoms (Rupas) of Anal Fistula

Common symptoms:

Pain and swelling in the anal region which aggravates while sitting
Formation of small openings near the anal region
Recurrent pus discharge from the openings
Blood-stained pus or foul-smelling discharge
Itching, irritation and fever due to chronic infection
Recurrent perianal abscess

Acharya Susrutha explains 5 different types of bhagandara based on the dosha involvement

Vataja type:

Severe piercing and throbbing pain around the anal region
Multiple openings like a sieve or multiple fistula
Red frothy discharge

Pittaja type:

Single raised pustule appearing like a camel’s neck
Severe burning sensation
Hot and foul-smelling discharge

Kaphaja type:

Large firm pustule
Mild pain and severe itching
Continuous thick whitish discharge

Combination of Vata, Pitta and Kapha (Sannipataja type):

A large ulcer the size of a big toe
Horseshoe-type tracts
Migratory pain in the anal canal
Multi coloured discharge

Agantuja (Due to external trauma):

Injury-induced tract, due to worm infestations,
No specific course of tract
Multiple openings with ulcers
Discharge of pus, urine, faeces, semen, and flatus through the openings.

Pathogenesis (Samprapti) of Anal Fistula

Due to the above causative factors, the doshas gets imbalanced at their natural sites. These doshas then move from their original sites and spread throughout the body and eventually localize in the anal region and affects the rakta and mamsa. At this point the patient may experience the prodromal symptoms like pain, itching, burning sesation in the anal region, developement of pidika (boil/abscess). When not treated at this stage, the disease then becomes fully manifested and pidakas (boils/abscess) gets suppurated and bursts leading to different types of discharges. If ignored at this stage, the condition may worsen and leads to tracts extending into bladder, scrotal region which causes discharge of urine, semen and feaces through the multiple openings formed.

Heal Naturally, Without Major Surgery

Minimally invasive Ksharasutra treatment ensures recovery with less pain and without major scars

AyurVAID's 4-Step Approach to Determine Root Cause and Create Individualised Treatment Plan

1. Whole-Person Health Assessment

Conducted by our specially trained doctors, this assessment includes an in-depth evaluation of present and past complaints, Nidana Panchaka (causative factors), and disease pathways using clinical methods such as Ashta Sthana Pariksha (8-fold examination), Dasha Vidha Pariksha (10 factors), and Srota Pariksha, along with clinical examination (proctoscopic examination). The assessment encompasses a comprehensive medical history, which includes any associated conditions such as constipation, liver disorders, or pregnancy. Advanced diagnostic procedures may include colonoscopy or sigmoidoscopy to rule out other conditions when clinically indicated.

2. Disease Tree

A comprehensive disease tree, from root cause to all signs and symptoms, is derived from causative factors, imbalances in doshas, involved sub-systems, and progression.

3. Personalised Protocol-Based Care Plan

Based on the disease tree and assessments, we create:

Customised treatment protocols targeting specific dosha imbalances
Phase-wise treatment approach from acute symptom management to long-term prevention
Integration of internal medicines, external therapies, and procedural interventions (ksharasutra)
Personalised dietary and lifestyle modification plans

Yoga and exercise recommendations specific to piles management

4. Disease Monitoring and Outcomes Tracking

The Perianal Disease Activity Index (PDAI) and Visual Analogue Scale (VAS) are the scales used to monitor treatment success and disease progression.

The assessment parameter includes fistuolus discharge, pain and restriction of activities, sexual activity restriction, degree of induration, and functional assessment to gauge overall well-being.

AyurVAID's Protocol-Driven Treatment for Fistula-in-ano (Precision Ayurveda)

The Apollo AyurVAID’s protocol-driven approach for Ayurveda treatment for Anal Fistula focuses on symptom relief, healing of damaged tissues, restoration of normal bowel function, and prevention of recurrence. Anal Fistula Treatment in Ayurveda – duration and approach are individualised based on the grade, type, and severity of fistula.

Phase 1: Acute Symptom Management and Detoxification (7-10 days)

Primary Aims:

Initial relief from pain, pus discharge, and inflammation
Detoxification and elimination of metabolic toxins (Ama)
Re-establishment of digestive fire and function (Agni)

Treatment Regimen:

1. Internal Medicine:

Digestive enhancers to enhance Agni and minimise Ama formation
Anti-inflammatory preparations to minimise swelling and pain
Mild laxatives to maintain regular soft bowel motions

2. External Therapies:

Sitz baths with medicated decoctions (Avagaha Sweda)
Local application of healing ointments and pastes (Lepa)
Prakshalana (medicated enemas) for local cleansing and healing

3. Dietary Modifications:

Light, easily digestible foods to decrease digestive burden
High-fiber diet to avoid constipation
Adequate hydration with warm water
Avoidance of dry, astringent taste foods and processed foods

Phase 2: Specialised Fistula Treatment and Tissue Healing (10-15 days)

Key Goals:

Targeted treatment of fistulous tissue
Anal and rectal muscles strengthening
Restoration of normal anatomy and function

Treatment Protocol:
1. Specialised Procedures:

Kshara Sutra Therapy: Employing medicated thread to fistulous tract, allowing it to cut and heal the tract over time and eventually slough and reduce. Following which, regular therapies are done in order to facilitate early healing and reduce post-op infections and pain. The thread is changed every week until it cuts the tract and falls off completely.
Agni Karma: Therapeutic thermal cauterisation for individual cases where bleeding is excessive
Raktamokshana: Therapeutic bloodletting if indicated

2. Panchakarma Therapies:

Anal Fistula Treatment in Ayurveda incorporating Panchakarma treatment is beneficial during the initial grade (Grade I and II) of bhagandara (Anal Fistula), when the symptoms are confined to bleeding, pain, and intermittent pus discharge. Specific Vasti treatments (Matra Vasti) for healing and fortifying Abhyanga with special oils for enhancing circulation are also administered post ksharasutra therapy.

3. Advanced Internal Medicines:

Clinically effective proven medicines, Rasayana preparations for regeneration of tissues, Specific dosha predominance-based combinations

Prevent Fistula Recurrence with Apollo AyurVAID

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Phase 3: Strengthening and Prevention (1-3 months)

Primary Objectives:

Fulfillment of complete healing and fortification of tissues
Prevention of recurrence
Lifestyle modification
Long-term maintenance of digestive health

Treatment Protocol:
1. Rasayana Therapy:
Tissue-specific rejuvenative medicines
Immunomodulatory herbs to avoid infections
Digestive tonics for long-term maintenance of Agni

2. Lifestyle Integration:
Disciplined exercise regimen including yoga asanas
Techniques of stress management and meditation
Planned long-term diet and counselling
Follow-up and monitoring policies on a regular basis

3.Preventive Measures:
Bowel training and good defecation techniques
Occupational changes for risky occupations
Seasonal diet changes
Promoting regular detoxification

Measures to Maintain Treatment Outcomes and Prevent the Recurrence of Anal Fistula

1. Nidana Parivarjana (Evading Causative Factors):

Avoid sitting for long periods, particularly on hard surfaces
Avoid constant constipation through diet and lifestyle modification
Avoid intense straining while passing stools
Reduce kashaya rasa pradhana foods, dry, and processed food
Moderate alcohol and stop smoking

2. Dietary Suggestions:

Fiber-rich diet with adequate fruits, vegetables, and whole grains
Sufficient water intake (8-10 glasses per day)
Frequent but regular meal times with proper chewing
Consume buttermilk, yogurt, and fermented foods for digestion
Avoid gas-producing, bloat-inducing, or digestive-disturbing foods

3. Lifestyle Changes:

Exercise and physical activity regularly to enhance circulation
Adequate toilet habits – do not read or use phones while defecating
Having healthy skin and body weight
Stress management practices
Sufficient rest and sleep

4. Special Yoga Asanas and Exercises:

Pavanamuktasana (wind-relieving pose) for digestive health
Malasana (deep squat) for pelvic floor muscle strengthening
Vajrasana (diamond pose) post meals for improved digestion
Walking and swimming for overall fitness
Pelvic floor strengthening exercises

5. Home Care Practices:

Frequent sitz baths with warm water
Application of coconut oil or ghee for local comfort
Gentle anal hygiene with soft, unscented materials
Avoid rough wiping or abrasive toilet papers

6. Regular Monitoring:

Annual follow-up even after full healing
Early treatment for recurrent symptoms
Periodic consultation for lifestyle modifications
Seasonal Panchakarma for preventive detoxification

By following this comprehensive approach, AyurVAID’s protocol-driven Ayurveda treatment for fistula-in-ano offers lasting relief while addressing the root cause and preventing recurrence through personalised, holistic care.

Case Studies

Case 1: A 48-year-old female with chronic Fistula-in-Ano (Bhagandara)

Case Summary:

The patient had been experiencing pain in the anal region with pus and blood-mixed discharge for 2–3 months. She previously consulted multiple doctors and was treated with medications, but symptoms recurred. TRUS (Transrectal Ultrasound) confirmed a complex fistulous tract with abscess and cephalad extension. She also had second-degree hemorrhoids.

She underwent a 3-day inpatient Ayurveda treatment involving Kshara Karma for hemorrhoids and fistula tract management, including abscess drainage and external wound widening. The treatment was supported by internal herbal medications and dietary modifications.

At discharge, the patient reported significant relief: no bleeding or discharge, normal bowel and bladder function, and improved general condition. Continued wound care and dressing were prescribed for 15 days.

Case 2: A 12-year-old boy with chronic anal ulcer and Fistula-in-Ano (Bhagandara, Dushtavrana)

Case Summary:

The patient presented with a 7-month history of a non-healing ulcer near the right side of the anus, painful defecation, and bloody pus discharge. Symptoms were aggravated while sitting and during bowel movements. Despite 4 months of allopathic treatment, there was no significant relief. He approached AyurVAID for root cause management. Clinical examination and MRI confirmed a low-type transsphincteric fistula and a suspicious intersphincteric tract, with signs suggestive of Crohn’s disease from a CT scan.

He underwent a structured Ayurveda regimen spanning multiple therapies over several weeks, including Snehapana, Abhyanga, Bashpa Sweda, Virechana, and Takradhara, along with internal medications.

By the end of the treatment, ulceration severity reduced from 7/10 to 2/10, pain reduced from 5/10 to 2/10, gas formation and indigestion resolved completely, and his overall wellbeing improved from 3/5 to 4/5. The patient completed treatment without adverse effects. Continued internal medications, dietary restrictions, and lifestyle modifications were prescribed.

Scientific Publications

Clinical Evaluation of Kshara Sutra Therapy in the Management of Bhagandara (Fistula-in-Ano): A Prospective Study; 2007, Research Article: A prospective study of 50 patients treated with Ksharasutra at CCRAS, New Delhi, showing only 5.88% recurrence and minimal sphincteric damage over 18 months.
Comparative Clinical Study of Guggulu-Based Ksharasutra with and without Partial Fistulectomy in Management of Bhagandara; 2018, Research Article: Randomized trial (n=42) comparing Guggulu-based Ksharasutra alone versus with partial fistulectomy, demonstrating faster symptom relief and lower unit cutting time in the combined approach.
A Randomized Open-Labelled Controlled Clinical Study of Udumbar Ksharasutra and Snuhi Ksharasutra versus Apamarga Ksharasutra in Bhagandara”; 2019, Research Article: Thirty patients randomized to Udumbar, Snuhi, or Apamarga Ksharasutra groups; Udumbar formulation yielded the fastest unit cutting time and best symptom relief.
A Randomized Controlled Clinical Trial Comparing Koshataki Ksharasutra with Apamarga Ksharasutra in Bhagandara Management; 2025, Research Article: Forty participants treated with either Luffa acutangula–based or Achyranthus aspera–based Ksharasutra, showing comparable healing times but superior patient comfort with Koshataki thread.
Complex Anal Fistula Treated with IFTAK (Interception of Fistulous Tract with Application of Ksharasutra): A Case Report”; 2023, Case Study: A complex cryptoglandular fistula managed by IFTAK under EAUS guidance, achieving complete healing without incontinence and no recurrence at 4-month follow-up.

Frequently Asked Questions (FAQs)

What exactly is a fistula in ano?

A fistula in ano is an abnormal tunnel connecting the anal canal to the skin surface around the anus. It usually develops after an infection, creating a path that allows drainage of pus and fluid, leading to persistent discharge and discomfort.

Is the Ayurveda treatment for fistula painful?

Ayurveda Treatment may cause minimal discomfort and pain during thread changes. These can be managed with local anesthesia and internal medicines provided during the procedure. The pain and discomfort decrease during healing progresses.

Can fistula recur after Ayurveda treatment?

Ayurveda treatments can prevent recurrence to great extent. After the whole treatment course is finished, lifestyle changes, regular follow up care and control of the underlying conditions are necessary.

What is Ksharsutra therapy for anal fistula?

Ksharsutra therapy is an Ayurveda treatment method involving the use of a medicated thread made from herbal extracts and minerals. It is inserted into the fistula tract to gradually cut and heal it.

How does Ksharsutra therapy work in treating anal fistula?

The Ksharsutra thread, being medicated, helps in promoting tissue healing while simultaneously cutting through the fistula tract. It induces controlled inflammation, which aids in the natural closure of the abnormal passage.

Is Ksharsutra therapy a surgical procedure?

Ksharsutra therapy is a minimally invasive procedure and is not considered a conventional surgery. It involves the placement of a medicated thread without extensive tissue cutting.

How long does the Ksharsutra treatment process take?

The duration of Ksharsutra therapy varies depending on the complexity and length of the fistula tract. In general, it may take several weeks to a few months for the complete healing of the fistula.

Can Ksharsutra therapy be used for all types of anal fistulas?

Ksharsutra therapy is effective for various types of anal fistulas, including complex and recurrent cases. However, a qualified Ayurveda practitioner will evaluate each case individually to determine its suitability for this treatment.

What is the fastest way to heal a fistula wound?

The fastest way to heal a fistula wound is to follow a combined approach:
1. Undergoing Kshara Sutra Treatment.
2. Maintain proper wound hygiene and adhere to post-operative care.
3. Consume a balanced diet rich in fiber, vitamins, and hydration.

How do I know if my fistula is healing?

During the Fistula wound healing process, these signs can be seen.
1. Reduced pain and inflammation in the affected area.
2. Decreased drainage or pus discharge over time.
3. Formation of healthy tissue without excessive redness or infection.
4. Improved overall well-being and digestive health.

Is fistula 100% curable?

Yes. If rightly treated, then a fistula can be totally cured. Kshara Sutra therapy, combined with the modifications in lifestyle, diet, and medical follow-ups, has given excellent results with no reported recurrence.

What is not to eat for a fistula patient?

People suffering from a fistula must avoid spicy, oily, processed, and junk, because they slow digestion. Dairy items (not all, maybe) can cause increased bloating. Alcohol and caffeine dehydrate, causing increased fistula wound healing time. Red meat and heavier proteins can cause constipation, leading to fistula wound not healing.

How many days of rest are required after fistula surgery?

Usually, 7 to 10 days of complete rest is advised. But full recovery may take 3–6 weeks, depending on your healing speed and the technique used.

Can we sit after fistula surgery?

Yes, but sit mindfully. Use cushions. Avoid hard surfaces. Limit sitting to short periods, especially in the first few weeks.

What are the restrictions after fistula surgery?

Avoid sex, strenuous exercise, constipation, smoking, and alcohol. Follow dietary rules. Stay clean. And stick with the care plan your doctor gives you.

Hear from our patient!

“I had recurrent anal fistula and even underwent three surgeries, but the problem kept coming back.
I turned to Apollo AyurVAID and consulted Dr. Kalpita Thakre, who listened
carefully to my history and conducted thorough scans. After her Ayurvedic treatment, my condition improved
drastically—I can now sit, walk, and sleep comfortably, and feel confident that there will be no recurrence.
I am truly grateful for the skill and compassionate care at Apollo AyurVAID, and highly recommend them to
anyone with similar issues.”

Mr. PG, 35 years

References

Gupta, R., Sharma, P., Singh, A., & Kumar, S. (2024). A Comprehensive Review of Ayurvedic and Modern Surgical Approaches in the Treatment of Bhagandara (Fistula-in-Ano). Ayushdhara, 11(5), 123–130.

Patel, S., Desai, M., & Mehta, N. (2022). Role of Karanjadi Ghrita for the Management of Bhagandara (Fistula-in-Ano). Ayushdhara, 9(3), 45–52.

Gupta, A., Bhatia, V., & Singh, M. (2018). Comparative Clinical Study of Guggulu-Based Ksharasutra in the Management of Bhagandara (Fistula-in-Ano). Ayu, 39(1), 22–28.

Rao, K., & Sharma, L. (2023). Bhagandara in View of Ayurveda: A Literary Review. Yashayurved, 1(1), 10–18.

Jain, P., & Kulkarni, D. (2022). A Case Study on a Complex Fistula-in-Ano by Ayurvedic Management. International Journal of Ayurvedic and Pharma Research, 10(2), 75–82.

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Disclaimer

The information provided in this blog is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, Ayurvedic practitioner, or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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