Parathuvayalil Hospital | Ayurvedic Treatment For Anorectal Disorders

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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.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.

A fistula may occur if an abscess has not completely healed, or if the infected fluid has not been entirely drained away.

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.

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.


  • Pain
  • Discharge - either bloody or purulent
  • Pruritus ani– itching around the anus
  • Systemic symptoms if abscess becomes infected


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


Kshara Sutra is a seton thread medicated with organic alkalis,like 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.


An anal fissure is a small tear in the skin that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. An anal fissure typically causes pain and bleeding with bowel movements.


Anal fissures can be caused by trauma to the anus and anal canal. The cause of the trauma can be one or more of the following:

• Chronic constipation

• Straining to have a bowel movement, especially if the stool is large, hard, and/or dry

• Prolonged diarrhea

• Anal stretching

• Insertion of foreign objects into the anus

Other causes of anal fissures (other than trauma) include:

• Longstanding poor bowel habits

• Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus)

• Scarring in the anorectal area

• Presence of an underlying medical problem: such as Crohn’s disease and ulcerative colitis; anal cancer; leukemia; infectious diseases (such as tuberculosis); and sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)

• Decreased blood flow to the anorectal area


• Pain during, and even hours after, a bowel movement

• Constipation

• Blood on the outside surface of the stool

• Blood on toilet

• A visible crack or tear in the anus or anal canal

• Burning and itch that may be painful

• Discomfort when urinating, frequent urination, or inability to urinate

• Foul-smelling discharge


Ayurveda advises internal medication as well as topical ointment application in the treatment of anal fissures. To avoid further irritation to the damaged tissue, medicines which soften the stools and promote healing of the tissues are utilized. Ointments which are natural anti-bacterial and anti-septic are used for topical application.


Piles (Arshas) are swollen and inflamed veins around the anus or in the lower rectum. Rectum is the last part of the large intestine leading to the anus.Piles are of two types viz. EXTERNAL PILES - which are located under the skin around the anus and INTERNAL PILES - develop in the lower rectum which may protrude or prolapse through the anus.

What causes piles

• straining during bowel movement

• chronic constipation or diarrhoea

• sitting on the toilet for long periods of time

• a lack of fiber in the diet

• weakening of the connective tissue in the rectum and anus in old age

• pregnancy may cause piles by increasing the pressure in the abdomen

Symptoms of piles

• bright red blood in the toilet bowl while passing stools

• non prolapsed internal piles are usually painless

• prolapsed piles often cause pain, discomfort and anal itching

• blood clots in external piles are called thrombosed piles which cause severe pain, bleeding and hard lump around the anus


• simple diet and lifestyle changes often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms.

• eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining

• good sources of fiber are fruits, vegetables, and whole grains. These fibers cannot be digested by the human body but helps in improving digestion and preventing constipation

• regular intake of takra(butter milk), mooli (radish), soorana (yam) are very much useful in piles

• drinking six to eight 8 - ounce glasses of water or other non-alcoholic fluids each day

• sitting in a tub of warm water for 10 minutes several times a day

• exercising to prevent constipation

• not straining during bowel movements


• If the above measures fail to relieve the symptoms, medical treatments may be needed

• In mild to moderate conditions piles can be treated with the Ayurvedic medicines like Kankayana vati, Arshoghna vati, Bhallataka vati, Chitrakadi vati, Kanchanara guggulu, Triphala choorna,Avipathikara choorna, Kutajarishta, Abhayarishta etc., according to the constitution of the patient , prescribed by a qualified Ayurvedic doctor under his supervision


• When the medical management is not effective alone, the specialized ayurvedic procedures should be adopted

• medicated oil enema (maatra vasti) will reduce the size as well as the pain in uncomplicated piles

• sitz baths using special ayurvedic herbal powders

• external application of ksharas / tailas

• application of kshara sutra as a ligature which will give rise to the pile masses to falloff usually within 7 to 10 days.