Bhagandara (Fistula-in-Ano)

Bhagandara: Fistula-in-Ano

Bhagandara arises when neglected anal abscesses (guda pidaka) burst, forming a tubular tract connecting anorectal canal to perianal skin, often from Apana Vata vitiating mamsa and rakta dhatus. Classified into five types—Vataja (dry, painful, black tract), Pittaja (suppurating, burning yellow), Kaphaja (thick pus, sluggish), Raktaja (bloody), and Sannipataja (mixed)—it ranks among Ashtamahagada for recurrence.

Symptoms include perianal swelling, chronic pus discharge (piya malashrava), pain (vedana), itching (kandu), incomplete evacuation, and fistula-in-ano tracts extending 2 angulas around guda; complications like multiple openings (unmargi) or sphincter damage ensue. Pathogenesis starts with cryptoglandular infection or injury, doshas drilling deep (krimi invasion), correlating to modern complex fistulas with high relapse post-surgery.

Chikitsa emphasizes Ksharasutra (medicated seton ligation) for minimal recurrence, preceded by Shodhana (Vamana, Virechana, Basti) and Snehana; Apamarga kshara excels in cutting/excising tracts. Shamana uses Arsha hita like Triphala guggulu; Pathya avoids constipation-inducing foods. Prognosis favors single-tract early cases; complex Sannipataja resists cure.