A clinical study on comprehensive ayurvedic approach to bhagandar and anal incontinence: Exploring ksharasutra and beyond

Fistula-in-Ano is a chronic inflammatory condition characterized by a tubular tract having one opening in the anorectal canal and the other on the perineum or perianal skin. The presence of an external opening with chronic pus discharge in the perianal region is a key diagnostic feature indicating a fistulous tract. Factors such as prolonged sitting, unhygienic practices, obesity, and repeated irritation from hair may increase the risk of its occurrence. In Ayurveda, fistula-in-ano is correlated with Bhagandara. Acharya Sushruta has described five types of Bhagandara and advocated Shastra Karma (surgical intervention), Kshara Karma (caustic alkali cauterization), and Bheshaja Chikitsa (medicinal management) as treatment modalities.1 This paper reports a case of a 33-year-old male patient diagnosed with fistula-in-ano in the Shalya OPD. The patient was treated with the Ksharasutra procedure, which is considered an ideal treatment for Bhagandara as it simultaneously cuts and curettes the unhealthy tissue within the fistulous tract, promoting healing.