Ayurvedic Management of Anal Fistula

The Kshara karma is one of the Anushastra karma, a minimal invasive para-surgical measure. Ksharsutra is the method of Ksharakarma mainly employed in fistula-in-ano (anal fistula) and hemorrhoids (piles). This unique method has many advantages over conventional surgical methods, as this is an ambulatory and cost effective method.

What is Fistula-in-ano?

• Fistula-in-ano is a disease of the anorectal region and the description of which could be traced from dates back from Ayurvedic treatise - Sushruta Samhita.

• It is prevalent and occupies the second position amongst all anorectal diseases after the haemorrhoids.

• Fistula-in-ano is a track which opens, deeply in the anal canal or rectum and superficially on the skin around the anus.

• Sometimes, the track may have a single opening, which is called, as sinus.

• Generally, this track develops from anorectal abscess (Bhagandara pidika) that bursts spontaneously or is drained inadequately.

• An anal fistula may occur with or without symptoms. There may be intermittent swelling with pain, itching, discomfort and discharge of pus in the perineal or perianal region.

• This track does not heal due to frequent discharge, presence of unhealthy granulation and lack of rest to the part.

• This is purely a surgical condition and certain operative procedures are usually associated with complications like loss of gluteal cushion, infection, and recurrence and require prolonged hospitalization.

• Research studies conducted on fistula-in-ano at various renowned medical institutions worldwide revealed higher rate of recurrence after surgery.

Ksharsutra - Ayurvedic Para Surgical Measure for Anal Fistula

• Though several operative procedures have been described for the treatment of fistula-in-ano, Ksharsutra (a unique minimal invasive ayurvedic para surgical measure) has been advocated as a treatment of choice by ancient ayurvedic scholars.

• Ksharsutra is prepared by repeated smearing of alkali of Achyranthes aspera plant, latex of Euphorbia neriifolia and turmeric powder on a surgical linen thread, which possesses proteolytic, caustic and antiseptic properties and promotes simultaneous wound healing.The ksharsutra therapy provides cutting and healing process simultaneously.

• The ksharsutra is inserted into the fistulous tract under suitable anesthesia with the help of a specially designed probe and is replaced with a newer ksharasutra on every 7^th day till the fistulous tract is completely healed up.

• Application of ksharsutra in cases of fistula-in-ano is a minimal invasive, simple, cost effective procedure.

• This needs no hospitalization and can be carried out at OPD levels.

This measure was revived, developed and standardized in early seventies by eminent scientists. Considering the importance and unique nature, further validation was done by ICMR (Indian Council of Medical research) through randomized, double blind, multi-centric clinical trials. These revealed that the recurrence rate in patients of fistula-in-ano treated with ksharsutra therapy was just 4 percent while about 11 percent in patients treated with surgery. The research studies over the years, added a scientific basis to this art, as an effective, amble and viable alternative to surgery with better compliance. Ksharsutra can also concomitantly be applied in patients suffering from fistula-in-ano or anorectal diseases associated with diabetes, hypertension, neurogenic disorders, cardiac diseases and also in tuberculous/cancerous fistulae.

The Central Council for Research in Ayurveda and Siddha (CCRAS) has standardized the method of preparation of ksharsutra and patented. The efficacy studies at CCRAS institutes revealed 93 % cure rate with minimal recurrence.

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