Bhagandara (Fistula-in-Ano) - A Review of Literature

Bhagandara is one of the most important anorectal disorders described in Ayurvedic literature and is included among the Ashta Mahagada (eight grave diseases) by Acharya Sushruta. The disease is characterized by the formation of a chronic tract in the perianal region associated with pain, discharge, and recurrent inflammation. Owing to its clinical features and pathological course, Bhagandara can be closely correlated with Fistula-in-Ano described in modern surgery. The present review was undertaken through a systematic analysis of classical Ayurvedic texts including Sushruta Samhita, Charaka Samhita, Astanga Hridaya, Astanga Samgraha, Madhava Nidana, Sarangadhara Samhita, and Bhavaprakasha, along with contemporary surgical literature and research publications related to Fistula-in-Ano. Relevant information regarding etiology, pathogenesis, classification, clinical manifestations, diagnosis, prognosis, and management was critically reviewed and compiled. Classical Ayurvedic literature describes Bhagandara as a disease originating from Bhagandara Pidika due to vitiation of Doshas, predominantly Vata, involving Rakta and Mamsa Dhatu in the Guda Pradesh. Various types such as Sataponaka, Ustragreva, Parisravi, Shambukavarta, and Unmargi have been described based on Doshic predominance and clinical presentation. Modern medicine recognizes Fistula-in-Ano as an abnormal communication between the anal canal and perianal skin, most commonly arising secondary to cryptoglandular infection and anorectal abscess. Both systems describe chronic discharge, pain, recurrent infection, and tract formation as key pathological features. The review reveals significant conceptual similarities between Bhagandara and Fistula-in-Ano with respect to etiology, pathogenesis, clinical manifestations, and principles of management. Ksharasutra therapy, one of the unique contributions of Ayurveda, has gained global recognition due to its effectiveness, low recurrence rate, and preservation of anal continence. An integrative understanding of Ayurvedic and contemporary surgical concepts may provide a comprehensive approach for the management of this challenging anorectal disorder.