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

Introduction: Arsha (Haemorrhoids) is a common anorectal condition that causes significant discomfort and affects quality of life. While modern surgical options exist, they are often associated with postoperative complications. Case Presentation: A 52-year-old female patient presented with a 3-year history of prolapsed fourth-degree interno-external haemorrhoids at the 5 and 7 o’clock positions, accompanied by rectal bleeding and anal pain. The patient’s complaints were aggravated by her long-standing habit of consuming spicy foods. Conservative treatment failed to provide relief. The hemorrhoidal masses were subsequently treated with Ksharasutra (medicated caustic thread) ligation under spinal anaesthesia. Lessons Learned: This case demonstrates that Ksharasutra ligation is a safe, effective, and minimally invasive procedure for high-grade haemorrhoids. The technique combines chemical cauterization and mechanical pressure, leading to the sloughing of the pile mass and clean healing with minimal complications like pain, bleeding, or stricture. Outcome: The pile masses sloughed off by the 7th postoperative day, and the wounds healed completely by the 25th day without any complications such as anal spasm, stricture, or recurrence. The patient reported significant relief and a full recovery.