Ayurveda management of Bhagandara (~Fistula-in-ano) with coexisting Arsha (~Hemorrhoids)

Infection of the anal glands may manifest in anal fistula formation and thus becomes annoying for the patients because of its recurring nature. Symptomatic hemorrhoids are another most common anorectal disorder which when presented in a complicated state, become a troublesome entity. Coexistence of both the disease with supralevator extension of the fistulous tract is infuriating for the operating surgeon. Management approach in such a complex case with uncertain prognosis and outcome is a point of concern. Since the management principle is only through surgical intervention, a surgeon is expected to choose a sphincter-saving technique to preserve the sphincter mechanism. This is a clinical representation of a long-standing case of a 48-year-old male patient diagnosed as complex Fistula-in-ano with Hemorrhoids for the last five years. This case was dealt surgically with utmost care to save sphincter tissue, and the wound management was done using Ayurveda interventions. Within seven weeks of management, complete wound healing was achieved, and no recurrence has been noticed till date. Thus, the surgical approach with Ayurveda management principle showed good clinical outcomes in the management of complex case of Anal fistula with Hemorrhoids.