Ksharasutra Ligation in the Management of Fourth-Degree Hemorrhoids (Arsha): A Case Report

Background: Fourth-degree hemorrhoids represent an advanced stage of Arsha, often requiring surgical intervention. Conventional hemorrhoidectomy is associated with postoperative pain and complications. Ksharasutra therapy, a parasurgical procedure in Ayurveda, offers a minimally invasive alternative. Case Presentation: A 36-year-old male presented with irreducible prolapsed hemorrhoids, bleeding per rectum, and pain during defecation for 6 months. Clinical and proctoscopic examination confirmed fourth-degree internal hemorrhoids. Intervention: Ksharasutra ligation was performed under local anesthesia. Postoperative management included Ayurvedic internal medications, sitz bath with panchwalkal Kwatha, and local application of Jatyadi Taila. Results: Progressive reduction in symptoms was observed. Sloughing of the hemorrhoidal mass occurred within 2–3 weeks, followed by complete healing by the fourth week. No complications or recurrence were noted during follow-up. Conclusion: Ksharasutra ligation is a safe, effective, and minimally invasive approach for managing advanced hemorrhoids. Larger studies are recommended to validate these findings.