Kshar Sutra is a para-surgical procedure in Ayurveda that utilizes a medicated alkaline thread for treating anal fistula (Bhagandara), hemorrhoids (Arsha), and other anorectal disorders. It is a safe, cost-effective, and minimally invasive approach that has been scientifically validated for its efficacy.
Kshar Sutra Therapy is an Ayurvedic Parasurgical Technique. Great Indian Surgeon Sushruta narrated in his teachings the use of Kshar for cure of fistula in ano and other anorectal diseases. The work of Sushruta was later compiled as “Sushrut Samhita” in the 5th century A.D. Acharya Chakrapani Datta (10-11 Century A.D.) and Acharya Bhav Mishra (16-18 century A.D.) have described in their classical Ayurvedic texts, the method of preparation and treatment of fistula in ano by use of Kshar Sutra (K.S.). It is being used for the successful treatment of anorectal Diseases from many years.
In this technique, a specially prepared thread (Kshar Sutra) is used to cure diseases. Kshar Sutra acts by “Herbal Chemical Cauterisation” and removes the disease from the body.
Many studies have been published by Ayurvedic doctors recently with encouraging results for treatment of fistula in ano and other anorectal diseases by use of Kshar Sutra.
Preparation of Kshar Sutra
Requirments:
- Thread : Surgical Linen thread of size 20.
- .Latex of Euphorbia neriifolia.
- .Haridra (Curcuma longa).
- .Apamarg Kshar (Achyranthus aspera).
Method of Preparation:
For the preparation of thread, surgical linen thread gauge number 20 was manually coated eleven times with the latex of Euphorbia neriifolia, followed by seven coatings of the latex and the alkaline powder of Achyranthus aspera alternatively, and dried. In the final phase, three coatings of latex and powder of Curcuma longa were given alternatively.
The thread thus prepared was sterilized by ultra violet radiation and placed in a polythene bag or glass tube.
Mode of Action of Kshar Sutra:
- The cut through of fistulous tract is effected by the pressure exerted on anorectal tissue by the moderately tight Kshar Sutra tied in the fistulous tract.
- The presence of Kshar Sutra in the fistulous tract does not allow the cavity to close down from either ends and there is a continuous drainage of pus along the Kshar Sutra itself.
- The Kshar Sutra slowly and gradually cuts through the fistulous tract from apex to the periphery. There is an ideal simultaneous cutting and healing of the tract and no pocket of pus is allowed to stay back.
- The kshar (Caustics) applied on the thread are anti-inflammatory, antislough agents and in addition, have property of chemical curetting. The Kshar Sutra remains in direct contact of the tract and therefore, it chemically curettes out the tract and sloughs out the epithelial lining, thereby allowing the fistulous tract to collapse and heal.
- The Kshar Sutra, due to its antibacterial property, does not allow bacteria to multiply in its presence.
- The pH of Kshar Sutra was towards the alkaline side and therefore it did not allow rectal pathogens to invade the cavity.
Post Kshar Sutra Therapy Instructions:
- Patients are allowed to take orally only liquid diet before six hours of operation.
- From next morning, warm Pancha Valkal Kwath sitz bath are advised to take at least thrice a day adding 5gm Sphatikadi yog for a minimum period of 3 weeks.
- Semi solid diet is allowed after 3-4 hours of the procedure.
- Tab. Triphala Guggulu – 500 mg TDS Haritaki Churna – 5-10 gm. once at bed time followed by warm water were prescribed.
- Jatyadi Tail Matrabasti (10 ml.) was prescribed twice a day for another two weeks.
- If the pain is there, some suitable analgesic was prescribed.
- Antibiotics were generally avoided.
General Advices after Kshar Sutra Therapy:
Patients are advised strictly:-
- To be ambulated (stay active like walking) during the period of treatment.
- To take normal food daily and avoid irritant spicy food.
- To take fibre containing diet & vegetables with plenty of water.
- To avoid such types of foods which cause constipation.
- To keep the bowel clear regularly by taking suitable and mild laxatives.
- To avoid prolonged sitting as well as standing during the treatment.
- To avoid long distance travelling and driving.
- To keep the anal region clean and do proper dressing.
Benefits of the Kshar Sutra Therapy:
- It is an Out Patient Treatment.
- Performed mostly under Local anesthesia.
- Only 30- 45 minutes is required for the procedure
- Hospital stay is usually minimum (5-6 hrs).
- Minimal bed rest is required after the procedure.
- Patient can resume his / her daily routine within 3 to 5 days.
- The recurrence rate is very less after Kshar Sutra ligation procedure
- Most important benefit of Kshar Sutra Therapy over Modern Surgeries is that the muscles that supports the Anus and helps in controlling the bowel movements are not dissected and hence the possibility of Anal Incontinence (loss of power to hold stools) is not there.
Kshar karma:
- Non surgical treatment
- No hospitalization.
- OPD procedure
- Single sitting
- No recurrence
- Cost effective
- Patient returns to his work soon
- No post procedure complications
Useful in following ailments :
- Nasal polyp
- Hypertrophied nasal turbinates
- First and second degree of Piles.
- Non healing ulcers
I. What is Kshar Sutra?
Kshar Sutra is a medicated alkaline thread prepared by coating surgical linen with Ayurvedic herbal extracts. When applied to an anorectal lesion, it provides chemical cauterization, antibacterial effects, and tissue regeneration.
✔️ Functions as a Seton – Gradually cuts and heals the fistulous tract.
✔️ Cauterizing Effect – Burns unhealthy tissue and prevents infection.
✔️ Antibacterial & Healing Properties – Reduces microbial load and promotes granulation tissue formation.
II. Preparation of Kshar Sutra
The Kshar Sutra is prepared using a specially coated thread with medicinal ingredients.
| Coating Material | Properties |
|---|---|
| Apamarga Kshara (Achyranthes aspera) | Alkali content for cauterization |
| Haridra (Curcuma longa) | Antimicrobial, anti-inflammatory |
| Snuhi Ksheera (Euphorbia neriifolia latex) | Proteolytic action, tissue penetration |
✅ The thread is coated 21 times with these ingredients and dried in a controlled environment to ensure uniformity.
III. Mechanism of Action
Kshar Sutra therapy follows a threefold mechanism:
1️⃣ Cauterization (Ksharana Karma) – The alkaline content gradually burns unhealthy tissue, leading to controlled chemical debridement.
2️⃣ Cutting (Chedana Karma) – The thread exerts a mechanical cutting action as it tightens and progresses through the tract.
3️⃣ Healing (Ropana Karma) – Promotes healthy granulation tissue formation and prevents recurrence.
IV. Clinical Applications of Kshar Sutra Therapy
| Condition | Mode of Action | Outcome |
|---|---|---|
| Anal Fistula (Bhagandara) | Gradual cutting & healing of the fistulous tract | 90-95% success rate, minimal recurrence |
| Hemorrhoids (Arsha) | Shrinks piles by cauterization | Less bleeding, faster healing |
| Pilonidal Sinus | Removes debris & promotes healing | Faster recovery, no recurrence |
| Perianal Abscess | Drains pus & prevents further infection | Avoids surgical excision |
| Rectal Polyps | Gradual excision | Minimal trauma, no surgical complications |
V. Procedure of Kshar Sutra Therapy
1. Pre-Procedural Assessment
🔹 Detailed history & proctological examination (Proctoscopy, MRI for fistula mapping).
🔹 Bowel preparation (Enema night before the procedure).
🔹 Local Anesthesia (2% Lignocaine infiltration) – Ensures painless insertion.
2. Procedure Steps
✅ For Anal Fistula (Bhagandara)
✔️ The Kshar Sutra is passed through the primary opening to the secondary opening using a probe.
✔️ It is tied loosely and kept in place.
✔️ The thread gradually cuts through the tract while healing follows behind.
✔️ The thread is replaced every 7 days until the entire fistula heals.
✅ For Hemorrhoids (Arsha)
✔️ The pile mass is ligated with Kshar Sutra at its base, leading to necrosis and sloughing.
✔️ Over 5-10 days, the pile mass shrinks and falls off naturally.
3. Post-Procedure Care
✔️ Sitz Baths – Promotes local hygiene and healing.
✔️ Herbal Ointments (Jatyadi Taila, Panchavalkala Kwatha) – Reduces inflammation.
✔️ Dietary Modifications – High-fiber diet to avoid constipation.
✔️ Follow-up every 7 days – Thread replacement until the tract heals completely.
VI. Scientific Evidence & Success Rate
🔹 Multiple clinical trials have reported >90% success rates with Kshar Sutra therapy, significantly reducing recurrence compared to conventional surgery.
🔹 MRI studies show complete tract obliteration with minimal fibrosis, leading to faster recovery.
🔹 Compared to fistulectomy (open surgery), Kshar Sutra is less invasive, requires no hospitalization, and has minimal postoperative complications.
VII. Advantages of Kshar Sutra Therapy
✔️ Minimally invasive – No major surgical intervention required.
✔️ No damage to sphincter function – Prevents incontinence, unlike fistulectomy.
✔️ Highly effective – Lower recurrence rate than traditional surgery.
✔️ Cost-effective – Requires minimal hospital stay.
✔️ Natural healing – Promotes granulation and tissue regeneration.
VIII. Modern Correlation & Comparative Analysis
| Parameter | Kshar Sutra Therapy | Conventional Surgery (Fistulectomy, LIS, etc.) |
|---|---|---|
| Invasiveness | Minimally invasive | Requires excision |
| Hospitalization | OPD-based | Requires admission |
| Recurrence Rate | Low (<5-10%) | Higher recurrence (20-30%) |
| Healing Time | 4-6 weeks | 2-3 months |
| Complications | Minimal pain, no incontinence | Possible incontinence, wound infection |
IX. Contraindications & Limitations
🔹 Complex, high-level fistulas (e.g., Suprasphincteric fistulas) may require MRI mapping before deciding on Kshar Sutra therapy.
🔹 Severe perianal infections & immunocompromised patients need antibiotic coverage.
🔹 Not suitable for malignant lesions – Requires biopsy before initiating therapy.