Piles / Fistula

In Ayurveda four types of treatment are prescribed for Piles/Fistula:-

Agnikarma (heat therapy / cauterization)
Ksharsutra (medicinal tread)
Surgical products

As per the stage of the disease one of the above procedure is selected. Among all Ksharsutra is said to be one of the best, characteristic and useful therapy. With in very short time, with less pain and bleeding this procedure can be carried out by one day stay in the hospital. For the patients of Piles as well as Fistula, Ksharsutra is better than surgical procedure.

Piles is a disease in which eruptions or elongation of the walls of rectal veins are seen in the peripheri of the anus. It is called as ‘Moolavyadha’ in Marathi,’ Beek in Konkani and Piles or Haemorrhoids in English. Now a days, due to busy life, man is not punctual about food. Due to uneven food timings/habits, symptoms like indigestion, gas formation, burning sensation are seen, which can be responsible for the disease manifestation especially Piles. If the same food habits are continued further then along with the above symptoms, other symptoms like pain in anal region, burning sensation in that area, bleeding etc, may produce, which are called as predisposing symptoms.

This disease can be congenital or can occur after birth. This can also be hereditary one i.e. if the parents are having, the child is prone to get the same. The main causes of piles are - uneven timings of food, extra pungent, extra spicy food items, non-vegetarian diet like chicken, mutton, fish etc. in more quantity, use of potato, peas in food in large amount, frequent eating, drinking liquor, smoking, tobacco, constant sitting, sitting on hard surface, frequent traveling in vehicles, afternoon sleep, remaining awake till late night, unnecessary forceful defecation, constipation etc.

The main types of Piles are
1. Internal Piles
2. External Piles.

Above two types of Piles have different symptoms.

In case of internal piles due to hare stools, rectal veins are stretched and ruptured and bleeding occurs through them. After passing stool 10 ml - 30 ml blood flows out through anus. After few days, some fleshy part descends down which is reddish in colour and it goes in automatically. Day by day if the medicine is not taken and hard stools continue then the fleshy part descends down and one has to push it inside since it does not go automatically. This condition is very painful. One can not walk properly due to stretching pain. In some cases while sitting also, the piles descend down from the rectum. If still proper treatment is not taken, then the next complicated stage is seen where in piles which come out, become swollen and gets blocked in the anal sphincter. In this condition the person perspires very much, can not sit, can not move, feels giddiness, external thirsty and uneasy. If proper measures are not taken in this condition, it could be fatal. This condition is called as ‘Strangulated Piles’.

External piles have different symptoms. In this bleeding is not seen but fleshy out growth is seen in the periphery of the anus which is of skin colour or black. After sitting for long time or having non veg diet, this growth swells and pains and itching occurs. The person cannot walk properly. These piles can be one or more in number.

First of all one should take care to avoid piles totally. For that regular, limited food should be taken along with sufficient exercises and one should follow the daily regimens as well as seasonal regimens explained in Ayurveda. Strong emphasis should be given on digestion, constipation, gas formation, indigestion should be avoided as much as possible.

If the piles are seen, then one has to have control over diet. Non-veg., extra pungent, oily, spicy, fried, items of food should be avoided. Fish, eggs, chicken, pork, flesh of cow (beef), bread, peas, bakery products, Idili-dosa, fermented products etc., should not be taken. Drinks, smoking, tobacco, lentel should be avoided. In addition to this proper care of ‘Agni’ (digestion power) is must. Food items increasing this digestion power (Agni) and adding fibres to stools are best. In this light food like Moong, rice, chapatti, jawar, green vegetables are to be used on large quantity. Butter, milk and rice is one of the best diet for the patient of piles.

One should stop sitting on hard surfaces, sitting at one place for longer duration or riding a bike continuosly. Medicines which regularize and facilitates the passing of stool, like Haritaki, Triphala, Isabgol should be taken at night. If the condition is worst and bleeding is more then the doctor should be approached as soon as possible.


Treatment for Fistula in ano and piles :
Kshara-sutra is a medicated thread which is prepared by applying the coatings of apamarg kshara, haridra churna etc. with snuhi ksheer as binding agent. The thread is then sterilized by U.V. Radiation. The cumulative effect of the above-mentioned three drugs exerts a powerful debridement effect on the fistula tract & induces healing by the resultant fresh & healthy granulation tissues. The sutra is the drug delivery mechanism precisely at the tissues involved.

The patient is routinely investigated with special reference to other associated disorders like hypertension, diabetes mellitus, tuberculosis etc. The next step lies in the proper identification & evaluation of the fistulous tract. This is achieved by careful probing with malleable probes. However, USG or fistulogram may be required in a few cases like high anal fistula, recurrent fistula, fistula with multiple openings & branching patterns. Once the tract has been accurately defined, it has to be legated with kshara-sutra, as an OPD procedure. Every seventh day, the old sutra is replaced with a new KS till there is a finale cut through.

It has been observed that the length of the tract reduces @ 1cm per week. But there are several factors which modify this cutting rate of the thread, for example, in the patient of post surgical recurrence, there is abundance of fibrous tissues which reduces the cutting rate.

Kshara sutra was the novel idea of drug delivery along the whole length of the fistulous tract by the Ayurvedic Surgeons. During kshar-sutra therapy, there is debridement & cutting of the tissues followed by healing. The kshara acts as powerful debriding agent & selectively acts on the unhealthy tissues, pus pockets etc. This process of debridement & healing starts from deeper tissues & travels towards periphery in stages.

The postoperative complications like recurrence of the disease, fecal incontinence, bleeding are not seen with kshara sutra treatment. Further this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization are required patient maintains his normal routine activities as usual during treatment period. Ayurveda specialist offers better cure rates for fistula in ano as compared to modern surgery.

The incidence of ano rectal diseases is increasing day by day due to fast food culture, Low fibre diet, sedentary life style etc. Most of these diseases are treated surgically, which is usually associated with post operative pain, bleeding, decrease in sphincter strength & some times recurrence of the disease. After extensive research using ayurvedic treatment methodologies with modern equipments & technology, certain treatment modalities have been formulated. These methods are non surgical or parasurgical. Hence, more convenient & have better results as compared to modern surgery in certain diseases.

Sushrut Ayurveda Speciality Center is a pioneer center for treating ano-rectal diseases, ie. Fistula, piles, fissure etc using graded Kshar sutra therapy-a concept of Ayurvedic surgery. The technique has been scientifically developed & clinically evaluated by the Indian Council Of Medical Research, the apex body of medical research in India. It has conducted clinical trials of Kshar sutra therapy in the disease FISTULA-IN-ANO, at four centers including AIIMS.

The results of this clinical trial have been officially released. It has been proved that ksharsutra is a more effective & more suitable treatment as compared to surgery for treating fistula in ano.


1. Ayurvedic treatment for various ano rectal diseases –

2. Khsarsutra ligation – Famous and result oriented medicated alkaline setone technique for fistula in ano and internal piles (Hemorrhoids).

3. Kshara Varti & Kshara Pichu Technique – Very effective in Non Healing ulcers, sinuses, fistula and fissure in ano.

4. Vrana Upakrama (wound management) – Various ancient wound management for non healing, varicose, diabetic wounds and very effective management for fistula in ano as well as for abscess also.

5. Kshara karma – Chemical couterization for Hemorrhoids.

6. Basti (Medicated Enema) – Basti is very effective for Chronic constipation, IBS & U and Colitis.

7. Chemical Cauterization through Ayurvedic Drugs

8. Conservative Management – Shaman chikitsa for Ano-Rectal disorders

9. Surgery according to Ayurveda Principles-

10. Surgery according to Modern Science-

11. Jalouka – Leach application technique-

12. IRC_ (Infra Red Coagulation ) - For Hemorrhoids.

13. Fistulectomy &Fistulotomy - Radio Frequency Cauterization