Management of Bhagandara (Fistula-in-Ano) Using Gunja Kshar Sutra

Abstract

Bhagandara (fistula-in-ano) is a chronic, recurrent, and challenging ano-rectal disorder described in Ayurveda as one of the Ashta Mahagada due to its grave prognosis and tendency for recurrence. Conventional surgical management often carries risks of recurrence, prolonged healing, and sphincter-related complications, whereas Kshar Sutra therapy offers a minimally invasive Ayurvedic parasurgical alternative. This case study evaluates the efficacy of Gunja Kshar Sutra therapy in a 35-year-old male patient presenting with persistent perianal pain, intermittent pus discharge, and occasional constipation for six months, with a prior history of fistula-in-ano one year earlier. Clinical examination confirmed Bhagandara with an external opening at the 4 o’clock position and a single indurated fistulous tract. Following standard pre-operative investigations, Gunja Kshar Sutra was applied under spinal anesthesia using a systematic parasurgical procedure, followed by weekly thread changes, local hygiene measures, sitz baths, bowel regulation, and dietary modifications. The patient demonstrated significant pain reduction within the first week, decreased discharge by the second week, progressive tract cutting during the third and fourth weeks, and complete healing by day 45. The tract length measured 3.7cm with a satisfactory Unit Cutting Rate (UCR) of approximately 0.58cm/week. Complete symptomatic relief was achieved without recurrence or major complications. The findings suggest that Gunja Kshar Sutra therapy is a safe, effective, economical, and sphincter-preserving treatment modality for recurrent Bhagandara, validating classical Ayurvedic management principles while offering substantial relevance in modern ano-rectal surgical care.