Patient History
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Age/Gender: 23-year-old male
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Condition: Recurrent Anal Fistula (Bhagandara)
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History: The patient presented with a history of a previously operated anal fistula that had recurred, causing chronic perianal pain, intermittent swelling, and persistent pus discharge.
Clinical Presentation & Evaluation
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Chief Complaints: Continuous throbbing pain around the anal region, difficulty sitting for long periods, and recurrent foul-smelling discharge from an external opening.
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Clinical Findings: Physical examination revealed a trans-sphincteric fistula tract with an active external opening. Due to the failure of prior conventional surgical intervention, the patient opted for traditional Ayurvedic management to avoid further invasive surgeries and high recurrence risks.
Treatment Protocol & Management
The patient was managed under a comprehensive Ayurvedic protocol structured around Kshar Sutra therapy alongside supportive care:
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Kshar Sutra Application: A medicated alkaline thread (Kshar Sutra) was successfully maneuvered and tied through the fistula tract. The patient underwent weekly outpatient follow-ups for routine thread replacement, which progressively cut and healed the tract simultaneously.
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Duration of Therapy: The active Kshar Sutra cutting phase required 9 weeks to completely lay open and clear the fibrous tract.
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Wound Healing Phase: Following the removal of the thread, an additional 4 weeks were dedicated to complete epithelialization and absolute wound closure.
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Supportive Regimen Advised:
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Oral Ayurveda Medicines: Internal herbal formulations were prescribed to improve digestion (Agni), prevent constipation, and boost tissue healing.
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Sitz Bath: Warm water sitz baths were advised multiple times daily to maintain hygiene and relieve local discomfort.
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Local Dressing: Regular antiseptic and healing local dressings were maintained post-thread change.
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Dietary Precautions: A high-fiber diet, adequate hydration, and avoidance of spicy, processed, or heavy foods to ensure soft, regular bowel movements.
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Results & Conclusion
The patient showed steady, progressive recovery without any adverse events or impairment of sphincter control. The fistula tract was completely eliminated, and the wound achieved total anatomical closure by the end of the 13th week (9 weeks of active therapy + 4 weeks of secondary healing). At follow-up assessments, the patient remained completely symptom-free with no signs of recurrence.
This case study is contributed by Dr. Deepak Rathi, Kshar Sutra Therapy Expert in Delhi.
