{ "slug": "epsom-salt-bath-hemorrhoids", "question": "Does an Epsom salt bath help hemorrhoids?", "shortTitle": "Epsom salt and sitz baths for hemorrhoids", "clinicalQuestion": "Do warm sitz baths, with or without Epsom salt, reduce pain, bleeding or other symptoms in adults with hemorrhoidal disease?", "pico": { "population": "Adults with symptomatic hemorrhoids", "intervention": "Warm sitz bath, with or without Epsom salt (magnesium sulfate)", "comparator": "No bath, usual care, or another topical measure", "outcomes": [ "Pain", "Bleeding", "Itching and irritation", "Swelling", "Healing" ] }, "category": "anorectal", "relatedConditions": [ "/hemorrhoids/" ], "relatedTreatments": [ "/treatments/hemorrhoidectomy/" ], "relatedEvidence": [], "bottomLine": { "verdict": "No study has tested whether an Epsom salt bath helps hemorrhoids.", "detail": "Every trial we found studied warm water sitz baths in people recovering from hemorrhoid surgery, not people managing hemorrhoids at home. The one trial that compared having a sitz bath against not having one found no difference in pain or painkiller use. None of them used Epsom salt.", "studyIds": [ "pmid:18380741", "pmid:40145987" ] }, "strength": { "level": "very-low", "why": "The 5 human studies found measure a related question rather than this one, so they can only be read indirectly.", "override": null }, "direction": { "level": "not-studied", "why": "No study has measured this outcome in people with this condition.", "override": null }, "counts": { "recordsRetrieved": 23, "recordsScreened": 23, "included": 5, "rcts": 5, "systematicReviews": 0, "observational": 0, "participants": 501, "yearFrom": 2008, "yearTo": 2025, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Pain from hemorrhoids", "status": "not-studied", "note": "Trials measured pain after surgery, not pain from untreated hemorrhoids.", "studyIds": [ "pmid:18380741", "pmid:40145987" ] }, { "name": "Bleeding", "status": "not-studied", "note": "No trial measured bleeding.", "studyIds": [] }, { "name": "Itching and irritation", "status": "not-studied", "note": "Measured once, after surgery, with no difference found.", "studyIds": [ "pmid:19337777" ] }, { "name": "Pain after hemorrhoid surgery", "status": "no-improvement", "note": "The only trial comparing a sitz bath with no sitz bath found no difference.", "studyIds": [ "pmid:18380741" ] }, { "name": "Whether Epsom salt adds anything", "status": "not-studied", "note": "No trial used Epsom salt. Every trial used plain warm water.", "studyIds": [] } ], "benefits": [ { "text": "Warm water is harmless and most people find it soothing, which is why it has been recommended for decades.", "studyIds": [ "pmid:18380741" ] }, { "text": "Starting a warm sitz bath sooner after hemorrhoid surgery lowered pain scores in one trial, so warmth may help a healing wound even if it does not treat hemorrhoids themselves.", "studyIds": [ "pmid:38642473" ] } ], "limitations": [ { "text": "Every trial enrolled people recovering from hemorrhoid surgery. None enrolled people with hemorrhoids who had not had an operation — which is who is usually asking.", "studyIds": [ "pmid:40145987", "pmid:39757160", "pmid:38642473", "pmid:19337777", "pmid:18380741" ] }, { "text": "Most trials compared a sitz bath with another active treatment such as a bidet, a water spray or an ice pack, so they cannot show whether either option helps.", "studyIds": [ "pmid:39757160", "pmid:19337777", "pmid:40145987" ] }, { "text": "Only one trial, in fifty patients, compared having a sitz bath with not having one at all.", "studyIds": [ "pmid:18380741" ] }, { "text": "No trial added Epsom salt to the water, so nothing is known about whether the salt itself does anything.", "studyIds": [ "pmid:18380741", "pmid:19337777" ] } ], "risks": [ { "text": "No trial reported harm from warm water baths. Water hot enough to burn is the practical risk, particularly for anyone with reduced sensation.", "studyIds": [ "pmid:40145987" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "It is cheap, available in any supermarket, and has been recommended by doctors and nurses for generations." }, { "text": "Warm water genuinely feels better on a sore area, which is easy to mistake for healing." }, { "text": "Epsom salt is widely marketed for aches and swelling, so people assume it draws down swollen tissue." } ], "keyStudies": [ "pmid:18380741", "pmid:40145987", "pmid:38642473", "pmid:19337777", "pmid:39757160" ], "studies": [ { "id": "pmid:40145987", "pmid": "40145987", "doi": "10.1097/DCR.0000000000003707", "nctId": null, "pmcid": null, "title": "Ice Packing Versus Warm Sitz Baths for Post-hemorrhoidectomy Pain Management: A Randomized Controlled Trial", "firstAuthor": null, "multipleAuthors": false, "journal": "Dis Colon Rectum", "year": 2025, "design": "rct", "n": 166, "nField": "reported", "population": "Adults undergoing Ferguson hemorrhoidectomy", "intervention": "Warm sitz bath", "comparator": "Ice packing", "primaryOutcome": "Postoperative pain and swelling", "result": "Ice packing beat the sitz bath on pain within 16 hours, swelling at 24 hours, wound healing at 7 days and morphine use.", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "Randomised and adequately sized, but single-centre with short follow-up and no validated hemorrhoid-specific wound measure, as the authors note.", "directness": "indirect", "limitations": "Single centre; short follow-up; ASA III patients excluded.", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40145987/", "sourceText": "BACKGROUND: Post-hemorrhoidectomy pain management remains challenging, with warm sitz baths being a common yet debated intervention. OBJECTIVE: To compare the efficacy of ice packing versus warm sitz baths in managing post-hemorrhoidectomy pain and wound healing. DESIGN: Randomized controlled trial. SETTINGS: Single-center study at E-DA Hospital in Taiwan. PATIENTS: A total of 166 patients undergoing Ferguson hemorrhoidectomy were included. INTERVENTIONS: Patients were randomly assigned to receive either ice packing (n = 82) or warm sitz bath (n = 84) for initial postoperative care. MAIN OUTCOME MEASURES: Primary outcomes were pain (visual analog scale) and swelling. Secondary outcomes included wound healing (Redness, Edema, Ecchymosis, Discharge, Approximation scale), analgesic consumption, and adverse events. RESULTS: The ice packing group showed lower pain scores within 16 hours postsurgery ( p < 0.01), reduced swelling at 24 hours (76.8% vs 56.0% with no or mild swelling, p = 0.03), superior wound healing at 7 days (Redness, Edema, Ecchymosis, Discharge, Approximation score: 2.56 ± 1.89 vs 3.27 ± 2.12, p = 0.02), and lower 24-hour morphine consumption (4.58 ± 2.56 vs 6.39 ± 2.7 mg, p < 0.01). LIMITATIONS: Single-center design, short follow-up period, lack of validated hemorrhoid-specific wound assessment tools, and exclusion of ASA III patients limit the present study's generalizability. CONCLUSIONS: Ice packing demonstrated superior efficacy in managing post-hemorrhoidectomy pain, reducing edema, and promoting wound healing, with a comparable safety profile and lower opioid requirements. See Video Abstract . COMPRESAS DE HIELO FRENTE A BAOS DE ASIENTO TIBIOS PARA EL TRATAMIENTO DEL DOLOR POSHEMORROIDECTOMA UN ENSAYO CONTROLADO ALEATORIZADO: ANTECEDENTES:El manejo del dolor posterior a una hemorroidectomía sigue siendo un desafío, y los baños de asiento tibios son una intervención común pero debatida.OBJETIVO:Comparar la eficacia de la aplicación de compresas de hielo frente a los baños de asiento tibios para el manejo del dolor posterior a una hemorroidectomía y la cicatrización de heridas.DISEÑO:Ensayo controlado aleatorizado.ESCENARIO:Estudio de un solo centro en el Hospital E-DA, Taiwán.PACIENTES:166 pacientes sometidos a una hemorroidectomía de Ferguson.INTERVENCIONES:Los pacientes fueron asignados aleatoriamente para recibir compresas de hielo (n = 82) o baños de asiento tibios (n = 84) para el cuidado posoperatorio inicial.PRINCIPALES MEDIDAS DE RESULTADOS:Los resultados primarios fueron el dolor (escala analógica visual) y la hinchazón. Los resultados secundarios incluyeron la cicatrización de heridas (escala REEDA), el consumo de analgésicos y los eventos adversos.RESULTADOS:El grupo que recibió compresas de hielo mostró puntuaciones de dolor más bajas dentro de las 16 horas posteriores a la cirugía (p < 0,01), una reducción de la hinchazón a las 24 horas (76,8 % frente a 56,0 % con hinchazón leve o nula, p = 0,03), una cicatrización superior de la herida a los 7 días (puntuación REEDA: 2,56 ± 1,89 frente a 3,27 ± 2,12, p = 0,02) y un menor consumo de morfina a las 24 horas (4,58 ± 2,56 mg frente a 6,39 ± 2,7 mg, p < 0,01).LIMITACIONES:El diseño de un solo centro, el corto período de seguimiento, la falta de herramientas validadas de evaluación de heridas específicas para hemorroides y la exclusión de pacientes ASA III limitaron la generalización.CONCLUSIONES:La compresa de hielo demostró una eficacia superior en el manejo del dolor posterior a la hemorroidectomía, la reducción del edema y la promoción de la cicatrización de la herida, con un perfil de seguridad comparable y menores necesidades de opioides. (Traducción-Dr. Felipe Bellolio ).", "provenance": [ { "field": "n", "quote": "A total of 166 patients undergoing Ferguson hemorrhoidectomy were included" }, { "field": "intervention", "quote": "warm sitz bath (n = 84) for initial postoperative care" }, { "field": "comparator", "quote": "randomly assigned to receive either ice packing (n = 82)" }, { "field": "population", "quote": "patients undergoing Ferguson hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Primary outcomes were pain (visual analog scale) and swelling" }, { "field": "result", "quote": "The ice packing group showed lower pain scores within 16 hours postsurgery" } ] }, { "id": "pmid:39757160", "pmid": "39757160", "doi": "10.1186/s12893-024-02737-0", "nctId": null, "pmcid": null, "title": "Comparison of warm sitz bath and electronic bidet with a lower-force water flow for postoperative management after hemorrhoidectomy (BIDLOW)", "firstAuthor": null, "multipleAuthors": false, "journal": "BMC Surg", "year": 2025, "design": "rct", "n": 101, "nField": "reported", "population": "Adults after hemorrhoidectomy", "intervention": "Warm sitz bath", "comparator": "Electronic bidet", "primaryOutcome": "Anal pain (VAS) at 7 days", "result": "Pain scores did not differ between the bidet and sitz bath groups, but non-inferiority was not demonstrated.", "resultDirection": "unclear", "quality": "low", "qualityWhy": "Twenty-six of 101 randomised patients dropped out before analysis, and the trial failed to show the non-inferiority it was designed to test.", "directness": "indirect", "limitations": "High attrition; both arms received an active treatment, so neither tests whether bathing helps at all.", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39757160/", "sourceText": "AIM: Electronic bidets can be a substitute for sitz baths, but no study has examined the use of electronic bidets to manage anal problems. METHODS: A randomized, controlled, single-blind, multicenter, parallel group trial was performed. Patients who underwent hemorrhoidectomy were randomly assigned (1:1) to use the electronic bidet or warm sitz baths for 7 days after hemorrhoidectomy. The primary endpoint was the difference in the anal pain VAS score for 7 days posthemorrhoidectomy. RESULTS: Patients were assigned to the electronic bidet (51) or sitz bath (50) groups. Twenty-six patients dropped out after randomization, and the final analysis included 34 patients in the electronic bidet group and 41 in the sitz bath group. The VAS score for anal pain 7 days posthemorrhoidectomy did not differ between the electronic bidet and sitz bath groups (38.3 ± 21.9 vs. 42.0 ± 21.1, p = 0.453). The upper limit of the 95% confidence interval of the VAS score in the electronic bidet group (81.22) was greater than the margin of noninferiority (46.20). CONCLUSION: The VAS scores after hemorrhoidectomy did not differ between the electronic bidet and sitz bath groups, but the noninferiority of the electronic bidet to sitz baths for anal pain 7 days posthemorrhoidectomy was not verified. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov (Registration number: NCT02353156, date: 02/02/2015).", "provenance": [ { "field": "n", "quote": "Patients were assigned to the electronic bidet (51) or sitz bath (50) groups" }, { "field": "intervention", "quote": "warm sitz baths for 7 days after hemorrhoidectomy" }, { "field": "comparator", "quote": "randomly assigned (1:1) to use the electronic bidet" }, { "field": "population", "quote": "Patients who underwent hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "The primary endpoint was the difference in the anal pain VAS score for 7 days posthemorrhoidectomy" }, { "field": "result", "quote": "The VAS score for anal pain 7 days posthemorrhoidectomy did not differ between the electronic bidet and sitz bath groups" } ] }, { "id": "pmid:38642473", "pmid": "38642473", "doi": "10.1016/j.ijnurstu.2024.104765", "nctId": null, "pmcid": null, "title": "Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial", "firstAuthor": null, "multipleAuthors": false, "journal": "Int J Nurs Stud", "year": 2024, "design": "rct", "n": 64, "nField": "reported", "population": "Adults after haemorrhoidectomy for grade III-IV haemorrhoids", "intervention": "Warm water sitz bath started 6 hours after surgery", "comparator": "Warm water sitz bath started the next day", "primaryOutcome": "Urinary retention and wound pain", "result": "Starting the sitz bath earlier lowered pain scores but did not change urinary retention. Both groups received sitz baths.", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "Randomised and double-blind, but small and single-ward.", "directness": "indirect", "limitations": "Tests the timing of a sitz bath, not whether sitz baths work: every participant had one.", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38642473/", "sourceText": "BACKGROUND: Haemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. OBJECTIVE: To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DESIGN: This was a longitudinal double-blind study with a permuted block randomization design. SETTING(S): This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. PARTICIPANTS: A total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) METHODS: Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. RESULTS: There was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = -0.81, 95 % CI: -1.44 to -0.18). CONCLUSIONS: Early warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. REGISTRATION: ClinicalTrials.gov ID: NCT04535765.", "provenance": [ { "field": "n", "quote": "A total of 64 participants (32 each in the experimental and control groups) were enrolled" }, { "field": "intervention", "quote": "The experimental group started warm-water sitz bath 6 h after the surgery" }, { "field": "comparator", "quote": "the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual" }, { "field": "population", "quote": "Patients who received haemorrhoidectomy for grade III or IV haemorrhoids" }, { "field": "primaryOutcome", "quote": "preventing urinary retention and reducing wound pain" }, { "field": "result", "quote": "There was no significant difference in the degree of change in the number of people with urinary retention between groups" } ] }, { "id": "pmid:34539803", "pmid": "34539803", "doi": "10.1155/2021/6473754", "nctId": null, "pmcid": null, "title": "Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications", "firstAuthor": null, "multipleAuthors": false, "journal": "Evid Based Complement Alternat Med", "year": 2021, "design": "rct", "n": 106, "nField": "reported", "population": "Patients after PPH hemorrhoid surgery", "intervention": "Warm water sitz bath (control arm)", "comparator": "Kangfuxin solution fumigation bath", "primaryOutcome": "Wound healing, pain, bleeding, oedema", "result": "Reported better outcomes in the herbal fumigation arm than the warm water sitz bath arm.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "Retracted by the journal. Listed here because it appears in the search and a reader should see that it was considered and discarded.", "directness": "indirect", "limitations": "Retracted publication — excluded from every count and from the conclusion.", "followUp": "", "plainFinding": "", "retracted": true, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34539803/", "sourceText": "Surgery is now the main clinical treatment for hemorrhoids, and the procedure for prolapse and hemorrhoids (PPH) is the commonly used procedure. The key to evaluating the efficacy of surgery includes the quality of postoperative wound healing and the occurrence of complications, so it is especially important to enhance the postoperative rehabilitation of hemorrhoids. This study investigates the method of postoperative treatment with Kangfuxin solution fumigation bath to explore the role of this method in the efficacy of patients after hemorrhoid PHH surgery and its effect on postoperative complications. It will accumulate some relevant information to improve the efficacy of hemorrhoid surgery and postoperative complications and open new ideas for further postoperative rehabilitation of other diseases in the anal area. A total of 106 patients with hemorrhoids were included in this study, all of whom were treated with PHH surgery. After surgery, they were randomly divided into a control group treated with warm water sitz bath and an observation group treated with Kangfuxin solution fumigation bath, with 53 cases in each group. We observed all patients' postoperative pain, bleeding, and perianal edema on a daily basis after surgery; we recorded the time of wound healing and hospital stay. The maximum anal squeeze pressure (MASP), anal defecation diastole pressure (ADDP), anal resting pressure (ARP), and the length of the high-pressure zone (HPZ) were used as observation indicators to evaluate the anal function of the patients before and after treatment. The results of the evaluation of the efficacy of patients after the treatment period showed that the total effective rate of treatment in the observation group (92.45%) was significantly higher than that of the control group (77.36%). The postoperative recovery showed that the wound healing time, hospitalization time, pain, bleeding, and edema scores at 3 and 5 days after surgery were lower in the observation group than in the control group; MASP and ARP increased in both groups after treatment compared to before treatment, with more increase in the observation group. The results suggest that patients with hemorrhoids after PPH should pay attention to postoperative care and rehabilitation. It also reveals that the application of Kangfuxin solution fumigation treatment has a significant effect, which can effectively reduce the patient's wound healing and hospital stay, while improving the patient's anal function and reducing postoperative complications, and is worthy of clinical promotion and application.", "provenance": [ { "field": "n", "quote": "A total of 106 patients with hemorrhoids were included in this study" }, { "field": "intervention", "quote": "a control group treated with warm water sitz bath" }, { "field": "comparator", "quote": "an observation group treated with Kangfuxin solution fumigation bath" }, { "field": "population", "quote": "patients with hemorrhoids were included in this study, all of whom were treated with PHH surgery" }, { "field": "primaryOutcome", "quote": "we recorded the time of wound healing and hospital stay" }, { "field": "result", "quote": "the total effective rate of treatment in the observation group (92.45%) was significantly higher than that of the control group (77.36%)" } ] }, { "id": "pmid:19337777", "pmid": "19337777", "doi": "10.1007/s11605-009-0876-9", "nctId": null, "pmcid": null, "title": "Comparison of clinical effects between warm water spray and sitz bath in post-hemorrhoidectomy period", "firstAuthor": null, "multipleAuthors": false, "journal": "J Gastrointest Surg", "year": 2009, "design": "rct", "n": 120, "nField": "reported", "population": "Adults after hemorrhoidectomy", "intervention": "Warm water sitz bath", "comparator": "Warm water spray", "primaryOutcome": "Pain, irritation, hygiene and satisfaction", "result": "No significant difference in pain, irritation or hygiene; patients found the spray more convenient and were more satisfied with it.", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "Randomised and reasonably sized, but both arms received an active treatment and outcomes were patient-reported on a visual analogue scale.", "directness": "indirect", "limitations": "Compares two ways of applying warm water, so it cannot show whether either helps.", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19337777/", "sourceText": "BACKGROUND: Warm water sitz bath is advised for a variety of anorectal disorders. However, preparation of the sitz bath is sometimes difficult for patients. As an alternative to the sitz bath, we have adapted a water spray method. A randomized, controlled study was conducted to determine if the water spray method has similar effects to the sitz bath in the post-hemorrhoidectomy period and it is easy to carry out. METHODS: A total of 120 patients were randomly assigned to water spray or sitz bath groups. All patients received analgesics and a fiber-rich diet after hemorrhoidectomy. Clinical parameters including pain, irritation (burning or itching sensations), hygiene, convenience, and overall satisfaction were evaluated by a visual analog scale to assess treatment outcome in both groups. RESULTS: There was no obvious difference in age, gender distribution, body mass index, or duration of disease between groups. There were no significant difference in scores for postoperative pain (p = 0.23), irritation (p = 0.48), or hygiene (p = 0.725) between groups. However, the water spray group reported significantly greater convenience (p < 0.05) and higher overall satisfaction (p < 0.05) compared with the sitz bath group. At the end of the 4-week postoperative follow-up period, 90% of patients in the watery spray group and 93% of patients in the sitz bath group showed complete wound healing. There were no significant differences in postoperative complications between groups. CONCLUSION: Our results demonstrate that the water spray method could provide a safe and reliable alternative to the sitz bath for post-hemorrhoidectomy care. Furthermore, the water spray method could be used instead of the sitz bath as a more convenient and satisfactory form of treatment.", "provenance": [ { "field": "n", "quote": "A total of 120 patients were randomly assigned to water spray or sitz bath groups" }, { "field": "intervention", "quote": "sitz bath groups" }, { "field": "comparator", "quote": "randomly assigned to water spray" }, { "field": "population", "quote": "in the post-hemorrhoidectomy period" }, { "field": "primaryOutcome", "quote": "Clinical parameters including pain, irritation (burning or itching sensations), hygiene, convenience, and overall satisfaction" }, { "field": "result", "quote": "There were no significant difference in scores for postoperative pain (p = 0.23), irritation (p = 0.48), or hygiene (p = 0.725) between groups" } ] }, { "id": "pmid:18380741", "pmid": "18380741", "doi": "10.1111/j.1445-2197.2008.04485.x", "nctId": null, "pmcid": null, "title": "Warm sitz bath does not reduce symptoms in posthaemorrhoidectomy period: a randomized, controlled study", "firstAuthor": null, "multipleAuthors": false, "journal": "ANZ J Surg", "year": 2008, "design": "rct", "n": 50, "nField": "reported", "population": "Adults after haemorrhoidectomy", "intervention": "Twice-daily warm sitz bath plus antibiotics and analgesics", "comparator": "Antibiotics and analgesics alone", "primaryOutcome": "Pain score, analgesic use and patient satisfaction", "result": "No difference in pain or analgesic use. The authors concluded there is no evidence to prescribe a sitz bath after haemorrhoidectomy.", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "Small, but it is the only trial that compared having a sitz bath against not having one, which is the comparison that answers the question.", "directness": "indirect", "limitations": "Fifty patients, single centre, and still the only controlled test of the question.", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18380741/", "sourceText": "BACKGROUND: Warm water sitz bath is routinely recommended after anal surgery. The aim of this study was to determine the influence of sitz bath with regards to pain scores, analgesic requirements and patient satisfaction ratings after haemorrhoidectomy. METHODS: Fifty patients were randomly assigned to receive antibiotics and analgesics alone (control patients) or a twice-daily sitz bath along with identical antibiotics and analgesics (sitz bath group). Weekly pain score and patient satisfaction score were evaluated on visual analogue scores. The number of analgesic tablets consumed in each week was also assessed. RESULTS: There was no significant difference in age, gender distribution and the number of excised haemorrhoid piles between the two groups. No significant difference in postoperative mean pain score between groups (P = 0.234) was noticed. Likewise, no relevant differences in analgesic requirements between sitz bath and no sitz bath group (P = 0.435) were seen. The satisfaction score was higher in the sitz bath group when compared with the control group; however, it did not reach a statistically significant level. CONCLUSIONS: This study shows that sitz bath does not offer pain relief, wound healing or reduction in consumption of analgesics and thus there is no evidence to prescribe sitz bath in the post-haemorrhoidectomy period.", "provenance": [ { "field": "n", "quote": "Fifty patients were randomly assigned" }, { "field": "intervention", "quote": "a twice-daily sitz bath along with identical antibiotics and analgesics" }, { "field": "comparator", "quote": "to receive antibiotics and analgesics alone (control patients)" }, { "field": "population", "quote": "after haemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "pain scores, analgesic requirements and patient satisfaction ratings" }, { "field": "result", "quote": "sitz bath does not offer pain relief, wound healing or reduction in consumption of analgesics" } ] } ], "faqs": [ { "q": "So should I stop taking sitz baths?", "a": "Not necessarily. There is no evidence they treat hemorrhoids, and no evidence they do harm. If a warm bath makes you more comfortable, that is a reasonable thing to do for comfort — just do not expect it to shrink a hemorrhoid or stop bleeding." }, { "q": "Does adding Epsom salt do anything?", "a": "Nobody has tested it for this. We searched PubMed for any study mentioning Epsom salt together with hemorrhoids or anal conditions and found none. Claims about Epsom salt drawing out swelling come from tradition and marketing, not from trials." }, { "q": "Why has my doctor recommended one?", "a": "Sitz baths have been standard advice for decades, mainly for comfort and hygiene after anal surgery. That is a reasonable use. It is different from saying a bath treats hemorrhoids." }, { "q": "What does have evidence?", "a": "For hemorrhoid symptoms the better-studied measures are fiber and fluid to soften stool, avoiding straining and long periods on the toilet, and office procedures or surgery when symptoms persist. Bleeding should always be examined rather than assumed to be hemorrhoids." } ], "patientTakeaway": "A warm bath is fine if it makes you more comfortable — it is not going to harm you. But no study has shown that it treats hemorrhoids, and adding Epsom salt has never been tested at all. If you want something that works on the problem rather than the feeling, start with softening your stool and not straining. And get bleeding looked at rather than assuming it is hemorrhoids.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(sitz bath[tiab] OR \"warm water bath\"[tiab] OR epsom[tiab] OR \"magnesium sulfate\"[tiab]) AND (hemorrhoid*[tiab] OR haemorrhoid*[tiab] OR \"Hemorrhoids\"[MeSH Terms])", "pubmed-epsom-check": "(epsom[tiab]) AND (hemorrhoid*[tiab] OR anal[tiab] OR fissure[tiab])" }, "pubmedQueryTranslation": "(\"sitz bath\"[Title/Abstract] OR \"warm water bath\"[Title/Abstract] OR \"epsom\"[Title/Abstract] OR \"magnesium sulfate\"[Title/Abstract]) AND (\"hemorrhoid*\"[Title/Abstract] OR \"haemorrhoid*\"[Title/Abstract] OR \"Hemorrhoids\"[MeSH Terms])", "searchedOn": "2026-10-04", "inclusion": [ "Human studies reporting a clinical outcome", "Any study of a warm water or salt bath for hemorrhoidal disease or after hemorrhoid surgery" ], "exclusion": [ "Studies of herbal or medicated baths where the bath itself was the comparator, not the question", "Retracted publications, which are listed but excluded from every count", "Studies not reporting an outcome relevant to the question" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.", "The epsom-specific search returned zero records, which is the basis for saying Epsom salt itself is untested." ] }, "seo": { "title": "Does an Epsom salt bath help hemorrhoids?", "description": "No trial has ever tested Epsom salt for hemorrhoids. We searched PubMed: five randomised trials of warm sitz baths, all after surgery. Here is what they found." }, "lastChecked": "2026-10-04", "lastChanged": "2026-10-04", "nextCheckDue": "2026-11-04", "history": [], "pipeline": { "screenModel": "hand-built fixture", "extractModel": "hand-built fixture", "composeModel": "hand-built fixture", "promptVersion": "fixture-1", "ranOn": "2026-10-04" }, "status": "published" }