Anorectal abscesses are one of the potentially debilitating diseases among them perianal abscess and ischiorectal abscess are common. Lateral spread of the ischiorectal abscess through the conjoint tendon leads to a horseshoe abscess. Surgical treatment is incision and drainage. Complications include sepsis, faecal incontinence, and fistula in ano. Kshara sutra is proved effective for fistula in ano, which helps in preventing recurrence. Here we report a case of ischiorectal abscess with horseshoe connection came with swelling and pain over the right perianal region. The condition was diagnosed as guda vidradi (perianal abscess) as per Ayurveda classics, and Bhedana karma is considered as primary treatment. Considering the recurrence and chronicity, kshara sutra ligation was planned after Bhedana karma. The case was completely cured with minimal follow-ups. Post-operative wounds healed with minimal scar formation. Adoption of the treatment has given successful results in the management of ischiorectal abscess with horseshoe connectio
