HOLISTIC MANAGEMENT OF ARSHA (HAEMORRHOIDS) WITH SPECIAL REFERENCE TO MOOLA BANDHA ABHYASA AND PELVIC FLOOR EXERCISES: A CRITICAL REVIEW

Abstract

Hemorrhoids, referred to in Ayurvedic classical literature as Arsha, constitute one of the most prevalent and clinically significant anorectal conditions encountered across all age groups and geographic populations. The disease is characterised by abnormal engorgement, hypertrophy, or prolapse of the normal vascular cushions at the ano-rectal junction, producing a spectrum of symptoms ranging from painless rectal bleeding and perianal discomfort to acute thrombosis and irreducible prolapse. In the Ayurvedic theoretical framework, Arsha arises primarily from the vitiation of Apana Vata, the downward-acting subdivision of Vata Dosha that governs all evacuatory and reproductive pelvic functions, compounded by the derangement of Pitta and Kapha in varying proportions according to the individual's constitution (Prakriti). Contemporary biomedical understanding attributes the condition to deterioration of the connective tissue and smooth muscle of the haemorrhoidal supporting apparatus, venous stasis within the inferior haemorrhoidal plexus, and cumulative mechanical trauma from straining. This review examines the scientific and classical rationale for integrating two non-pharmacological conservative modalities Moola Bandha Abhyasa (a classical yogic perineal lock technique) and pelvic floor muscle training (PFMT) in the management of Arsha. Evidence is drawn from primary Ayurvedic texts including the Charaka Samhita, Sushruta Samhita, and Ashtanga Hridayam, as well as peer-reviewed biomedical literature on anorectal physiology, yoga therapy, and pelvic rehabilitation. The review proposes a mechanistic framework, describes an integrated clinical protocol, and outlines future research directions.