Arsha (haemorrhoids) is one of the most common anorectal disorders worldwide and is recognised in Ayurveda as one of the Ashta Mahagada (eight major diseases). While existing literature predominantly focuses on treatment, preventive approaches remain underexplored. This narrative review synthesises classical Ayurvedic Hetu (causative factors) with contemporary epidemiological evidence to develop an evidence-informed, non-pharmacological prevention framework. Literature was reviewed from major biomedical databases and eight classical Ayurvedic texts. Findings indicate strong convergence between classical Aharaja, Viharaja, Manasika, and bowel habit-related Hetu and modern risk factors such as constipation, prolonged sitting, obesity, pregnancy, diabetes, hypertension, and family history. Preventive measures including fibre-rich diet, adequate hydration, regular physical activity, weight management, proper toilet posture, and stress reduction closely correspond with the Ayurvedic principles of Nidana Parivarjana, Dinacharya, Ritucharya, and Sadvritta. Integrating these complementary perspectives may reduce the incidence, recurrence, and healthcare burden of Arsha, although further high-quality prospective and interventional studies are needed.