A fistula is a small tunnel between the anal canal and the skin. It does not heal on its own, and it is the condition Kshara Sutra treats best.
Also known as: Fistula-in-ano · Anal fistula · Bhagandara (Ayurveda)
An anal fistula is a small tunnel that forms between the inside of the anal canal and the skin near the anus. It usually begins as an infection in one of the small glands inside the anal canal. That infection forms an abscess; when the abscess drains — either on its own or after being opened — a tract can remain behind.
That remaining tract is the fistula. Because it is lined with tissue, it does not close spontaneously.
Many people describe the same cycle: a painful swelling near the anus, which bursts or is drained, followed by relief, followed weeks or months later by the same thing again.
That cycle is the signature of a fistula. Each episode is the tract becoming blocked, building up, and discharging again. Antibiotics settle the infection but leave the tunnel intact, so the pattern repeats.
The treatment plan depends on where the tract runs in relation to the anal sphincter muscles — the muscles that control continence.
This distinction is the entire reason fistula treatment should not be rushed. Dividing a tract without knowing how much sphincter it crosses is what causes incontinence.
A thread is coated in repeated layers of herbal alkaline medication and passed through the fistula tract, then tied. Over the following week, the medicated thread does two things at once:
Because the division is gradual, the sphincter muscle heals progressively rather than being cut across in one action. That is what preserves continence.
The thread is replaced weekly in the outpatient clinic. Each change takes a few minutes. Treatment continues until the tract is fully divided and the wound has healed.
Most patients continue working, driving and living normally throughout.
Proctology is Dr Neelambika’s principal area of practice, and Kshara Sutra is a technique that depends heavily on how often the operator performs it — the quality of the thread, the judgement about tract mapping, and the weekly management all improve with volume. Ano-rectal conditions are a core part of what this hospital does rather than an occasional case.
Kshara Sutra is a medicated thread, coated in successive layers of herbal alkaline preparations, that is threaded through the fistula tract. It cuts through the tract slowly while simultaneously healing behind itself. The thread is changed at weekly intervals in the outpatient clinic until the tract is fully divided and healed. It is a classical Ayurvedic technique described in the Sushruta Samhita and is recognised as a standard treatment for fistula-in-ano.
Two reasons. Recurrence after conventional fistulotomy can be significant, particularly with high or complex tracts. And because Kshara Sutra divides the tract gradually rather than in one cut, the anal sphincter has time to heal alongside it, which reduces the risk of incontinence — the complication patients worry about most. It is also done as an outpatient procedure, so most people keep working through treatment.
It depends on the length and complexity of the tract. The thread cuts through at roughly 0.5 to 1 cm per week, so a simple low fistula may take 4 to 6 weeks, while a long or branching tract can take several months. You attend weekly for a thread change, which takes a few minutes. We give you an estimate after examining and, where needed, imaging the tract.
There is discomfort, particularly in the first day or two after each thread change, and this is manageable with ordinary pain relief. It is not comparable to the pain of an untreated abscess. Most patients continue their normal work and routine throughout.
No. A fistula is an epithelialised tract, and it does not close by itself. Antibiotics may settle an episode of infection and the discharge may stop for a while, but the tract remains and the problem returns. Delaying treatment tends to make tracts longer and more branched, which then takes longer to treat.
Not always. Simple, low fistulas can often be assessed clinically. For recurrent fistulas, suspected high or complex tracts, or where there is a history of previous surgery, an MRI fistulogram maps the tract properly and materially changes the plan. We will tell you if you need one and why.
Proctology & General surgery - (Shalya Tantra)
BAMS, MS(Ayurveda), PhD
Dr. NEELAMBIKA G. B. is an Ayurvedic Surgeon with special emphasis on Management of Surgical conditions through Ayurvedic approach and makes the best use of conventional clinical and diagnostic evaluations for the diagnosis and outcomes assessment.
Reg. 88606/15180 KAUP Board
