{ "slug": "sitz-bath-for-hemorrhoids", "question": "Do sitz baths help hemorrhoids?", "shortTitle": "Sitz Baths for Hemorrhoids", "clinicalQuestion": "In patients with symptomatic hemorrhoids (including internal and bleeding hemorrhoids), does the use of sitz baths improve symptoms, reduce hemorrhoid size, or reduce bleeding compared with no sitz bath use?", "pico": { "population": "Adults with symptomatic hemorrhoids (internal, external, or bleeding)", "intervention": "Sitz bath (warm water soak of the perianal area), with or without added salt or other additives", "comparator": "No sitz bath, usual care, or other conservative measures", "outcomes": [ "Symptom score (pain, itching, discomfort)", "Bleeding frequency or severity", "Hemorrhoid size or grade on examination", "Time to symptom resolution", "Need for further medical or surgical treatment", "Recurrence of symptoms" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids", "anal-fissure" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "No trial has shown that a sitz bath reduces hemorrhoid pain, bleeding, or size better than not doing one.", "detail": "The only randomized trial that directly tested adding a warm sitz bath to standard care, versus standard care without one, found no difference in pain, pain-medicine use, or satisfaction — and that trial was done in people recovering from hemorrhoid surgery, not people with untreated hemorrhoids. Most other studies compared different ways of doing a sitz bath (hot vs cold water, plain vs herbal, bath vs bidet) or gave everyone a sitz bath as background care, so they cannot show whether sitz baths help at all compared with doing nothing.", "studyIds": [ "pmid:18380741", "pmid:40145987", "pmid:39757160", "pmid:20580349", "pmid:19337777" ] }, "strength": { "level": "low", "why": "The randomised evidence here is small or at risk of bias (1 trial).", "override": null }, "direction": { "level": "no-meaningful-benefit", "why": "Most of the evidence found no meaningful difference.", "override": null }, "counts": { "recordsRetrieved": 57, "recordsScreened": 57, "included": 38, "rcts": 14, "systematicReviews": 2, "observational": 10, "participants": 4039, "yearFrom": 1986, "yearTo": 2026, "registeredTrialsWithoutResults": 2 }, "excluded": [], "outcomes": [ { "name": "Symptom score (pain, itching, discomfort)", "status": "no-improvement", "note": "In one trial, adding a sitz bath to standard post-surgery care (antibiotics and painkillers) made no difference in pain scores, pain-medicine use, or satisfaction compared with the same care without a sitz bath. Trials comparing a sitz bath against other approaches mostly found no consistent difference in pain either: no difference versus an electronic bidet, no difference between cold-water and hot-water sitz baths, and no difference versus a warm water spray (though the spray group reported more convenience and satisfaction). One trial found that ice packing gave lower pain scores and less pain-medicine use than a warm sitz bath after hemorrhoid surgery.", "studyIds": [ "pmid:18380741", "pmid:40145987", "pmid:39757160", "pmid:20580349", "pmid:19337777" ] }, { "name": "Bleeding frequency or severity", "status": "not-studied", "note": "No study has compared sitz baths with no treatment for hemorrhoid bleeding. A couple of post-surgery trials measured bleeding, but every patient in those trials got a sitz bath, so the bath's own effect on bleeding can't be judged from them.", "studyIds": [ "pmid:41508088", "pmid:27097430" ] }, { "name": "Hemorrhoid size or grade on examination", "status": "not-studied", "note": "No study measured whether a sitz bath alone shrinks a hemorrhoid compared with no treatment. One small study found a smaller hemorrhoid diameter when a sitz bath was combined with a medicated ointment, but the ointment's own contribution can't be separated out.", "studyIds": [ "pmid:41357914" ] }, { "name": "Time to symptom resolution", "status": "insufficient", "note": "One case series of people with painful thrombosed hemorrhoids found pain was mostly gone by day 5 and fully gone by day 10 using sitz baths plus pain medicine, but there was no comparison group, so it can't say the sitz bath was what resolved it.", "studyIds": [ "pmid:35064300" ] }, { "name": "Need for further medical or surgical treatment", "status": "not-studied", "note": "No study has tracked whether using sitz baths changes the chance that someone later needs a procedure or surgery for their hemorrhoids.", "studyIds": [] }, { "name": "Recurrence of symptoms", "status": "insufficient", "note": "A case series reported about 6 in 100 people had symptoms come back after conservative treatment that included sitz baths, but with no comparison group this can't show the bath itself affected recurrence.", "studyIds": [ "pmid:35064300" ] } ], "benefits": [], "limitations": [ { "text": "Most studies were done in people recovering from hemorrhoid surgery, not people with ordinary, untreated hemorrhoids — so the findings may not carry over to everyday hemorrhoid symptoms.", "studyIds": [ "pmid:40145987", "pmid:39757160", "pmid:38642473", "pmid:18380741" ] }, { "text": "Many trials compared one version of a sitz bath against another — hot water versus cold, plain water versus ozonated or herbal water — rather than comparing a sitz bath with no sitz bath at all.", "studyIds": [ "pmid:32421480", "pmid:28176917", "pmid:27097430", "pmid:20580349" ] }, { "text": "In several studies everyone in the trial received a sitz bath as routine background care, so the specific effect of the bath could not be pulled apart from the other treatment being tested.", "studyIds": [ "pmid:41508088", "pmid:38380823", "pmid:12368938", "pmid:8843260", "pmid:1661696", "pmid:3463834" ] }, { "text": "Only one randomized trial directly tested adding a sitz bath versus not adding one, and it was small — 50 people — and limited to post-surgery patients.", "studyIds": [ "pmid:18380741" ] } ], "risks": [], "whyPeopleTryIt": [ { "text": "Warm water feels immediately soothing on itchy, sore skin." }, { "text": "It's a remedy doctors and pharmacists have recommended for generations, so it feels like a trusted, established habit." }, { "text": "It's cheap, easy to do at home, and needs no prescription or appointment." }, { "text": "People hope soaking will reduce swelling the way warmth seems to help other sore or swollen body parts." } ], "keyStudies": [ "pmid:18380741", "pmid:35685735", "pmid:29055673", "pmid:42067175", "pmid:40145987", "pmid:19337777", "pmid:38642473", "pmid:20580349" ], "studies": [ { "id": "pmid:42746097", "pmid": "42746097", "doi": "10.1002/hsr2.73214", "nctId": null, "pmcid": "PMC13575336", "title": "Evaluating the Timing of Sitz Baths After Laser Hemorrhoidoplasty: An Exploratory Study", "firstAuthor": "Liao", "multipleAuthors": true, "journal": "Health Sci Rep", "year": 2026, "design": "retrospective", "n": 310, "nField": "reported", "population": "patients with grade I-IV hemorrhoids who had laser hemorrhoidoplasty surgery", "intervention": "starting sitz baths early (on operation day or day 1 after surgery)", "comparator": "starting sitz baths later, after hospital discharge", "primaryOutcome": "pain scores (VAS) and change in pain scores after surgery", "result": "starting sitz baths earlier was linked to higher pain scores, while delayed sitz baths were linked to lower pain scores on day 1 and after discharge; complication rates were similar across groups", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this was a retrospective study (not randomized), so timing of sitz baths was not controlled and other factors could explain the pain differences.", "directness": "indirect", "limitations": "Retrospective design; patients were not randomly assigned to sitz bath timing; studied only after a specific laser surgery, not for hemorrhoids in general.", "followUp": "", "plainFinding": "Early sitz baths showed no pain benefit.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42746097/", "sourceText": "BACKGROUND: Laser hemorrhoidoplasty (LHP) is a minimally invasive procedure for the treatment of hemorrhoids. Early sitz baths are recommended after conventional hemorrhoidectomy; however, their effectiveness following LHP has not been evaluated. AIM: This study aimed to evaluate the timing of sitz baths for postoperative recovery in patients undergoing LHP. METHODS: A retrospective analysis was conducted on patients with grade I-IV hemorrhoids who underwent LHP between March 2023 and December 2025. Patients were grouped by sitz bath timing: operation day, postoperative day 1, or after discharge. Primary outcomes were maximum and mean visual analog scale (VAS) pain scores and change in VAS scores (ΔVAS) between operation day and postoperative day 1. Secondary outcomes included intraoperative parameters, recovery outcomes, and complications (urinary retention and bleeding). RESULTS: Of 310 patients, 92 began sitz baths on operation day, 146 on postoperative day 1, and 72 after discharge. Mean initiation times were 6.6 and 21.0 h for the operation-day and postoperative-day-1 groups (p < 0.0001). The operation-day group had significantly higher mean VAS pain score (1.31 ± 0.77 vs. 0.91 ± 0.57 vs. 0.93 ± 0.6, p = 0.0022) on the operation day and △VAS pain score (mean) (-0.27 ± 0.67 vs. 0.12 ± 0.63 vs. 0.14 ± 0.56, p = 0.0018) compared with other groups. Complication rates did not differ among groups. Multivariable analysis showed that delayed sitz bath was independently associated with lower mean VAS pain score on postoperative Day 1 (β = -0.374, 95% CI: -0.551 to -0.196, p < 0.001) and after discharge (β = -0.364, 95% CI: -0.572 to -0.156, p < 0.001). CONCLUSIONS: Although this study failed to show advantages of early sitz baths, it does not exclude potential benefits for sitz baths after LHP. Prospective studies with larger cohorts are warranted.", "provenance": [ { "field": "n", "quote": "Of 310 patients, 92 began sitz baths on operation day, 146 on postoperative day 1, and 72 after discharge." }, { "field": "population", "quote": "patients with grade I-IV hemorrhoids who underwent LHP" }, { "field": "intervention", "quote": "Patients were grouped by sitz bath timing: operation day, postoperative day 1, or after discharge." }, { "field": "comparator", "quote": "after discharge" }, { "field": "primaryOutcome", "quote": "Primary outcomes were maximum and mean visual analog scale (VAS) pain scores and change in VAS scores (ΔVAS) between operation day and postoperative day 1." }, { "field": "result", "quote": "The operation-day group had significantly higher mean VAS pain score (1.31 ± 0.77 vs. 0.91 ± 0.57 vs. 0.93 ± 0.6, p = 0.0022) on the operation day and △VAS pain score (mean) (-0.27 ± 0.67 vs. 0.12 ± 0.63 vs. 0.14 ± 0.56, p = 0.0018) compared with other groups. Complication rates did not differ among groups." }, { "field": "result", "quote": "Although this study failed to show advantages of early sitz baths, it does not exclude potential benefits for sitz baths after LHP." } ] }, { "id": "pmid:42245301", "pmid": "42245301", "doi": "10.3389/fsurg.2026.1738476", "nctId": null, "pmcid": "PMC13231432", "title": "Traditional Chinese medicine fumigation combined with Musk hemorrhoid suppository for wound healing and inflammation control in patients with mixed hemorrhoids after Milligan-Morgan hemorrhoidectomy", "firstAuthor": "Zhao", "multipleAuthors": true, "journal": "Front Surg", "year": 2026, "design": "rct", "n": 160, "nField": "reported", "population": "patients with mixed hemorrhoids after surgery to remove them", "intervention": "Chinese medicine herbal fumigation plus Musk hemorrhoid suppository", "comparator": "potassium permanganate sitz bath alone", "primaryOutcome": "complete wound healing by day 14 after surgery", "result": "the combined herbal treatment healed wounds faster and worked better than sitz bath alone", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a postoperative healing study in surgery patients, not general hemorrhoid sufferers, so it does not directly answer whether sitz baths help hemorrhoids.", "directness": "indirect", "limitations": "the abstract does not describe blinding, and the sitz bath group used medicated (potassium permanganate) water rather than plain water, which differs from typical sitz bath use.", "followUp": "4 weeks postoperatively", "plainFinding": "Herbal combo beat sitz bath after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42245301/", "sourceText": "OBJECTIVE: To evaluate the efficacy, safety, and underlying mechanism of traditional Chinese medicine (TCM) fumigation combined with Musk hemorrhoid suppository for postoperative recovery in patients with mixed hemorrhoids undergoing Milligan-Morgan Hemorrhoidectomy (MMH). METHODS: A prospective, stratified randomized controlled study enrolled 160 patients, who were stratified by hemorrhoid grade and randomized into four groups (40 cases each): combined (TCM fumigation + Musk suppository), fumigation alone, suppository alone, and control (1:5,000 potassium permanganate sitz bath). An internal validation cohort (40 cases, 25% of the main trial size) was included to confirm result consistency. The primary endpoint was complete wound epithelialization rate at postoperative day (POD) 14, with secondary endpoints including wound healing time, total effective rate at 4 weeks postoperatively, anal function, serum inflammatory factors (IL-6, TNF-α, CRP) and tissue NF-κB p65 protein, complication incidence, and quality of life (GQOL-30). Statistical analyses used Bonferroni correction for multiple comparisons to control Type I error (α = 0.0125). Safety was evaluated via adverse events (AEs) and liver/kidney function tests. RESULTS: All groups had balanced baseline characteristics (all P > 0.05). The combined group achieved the highest POD14 complete epithelialization rate, with the shortest wound healing time (5.15 ± 0.60 days, a 2.30-day reduction vs. control group's 7.45 ± 0.75 days, P < 0.001) and the highest 4-week total effective rate (97.50% vs. control's 65.00%, P < 0.001). Additionally, the combined group showed significantly improved anal function, marked reductions in inflammatory markers (relative reduction: NF-κB p65 51.5%, IL-6 33.0%, all P < 0.001), fewer Grade I/II complications (7.50% vs. control's 22.50%, P = 0.032), and higher GQOL-30 scores (P < 0.001). Efficacy was consistent between the main trial and validation cohort (P = 0.618). No severe AEs were reported. CONCLUSION: The combined TCM regimen safely accelerates postoperative recovery after MMH, reduces inflammation and complications, and improves patient quality of life.", "provenance": [ { "field": "n", "quote": "enrolled 160 patients" }, { "field": "population", "quote": "patients with mixed hemorrhoids undergoing Milligan-Morgan Hemorrhoidectomy (MMH)" }, { "field": "intervention", "quote": "combined (TCM fumigation + Musk suppository)" }, { "field": "comparator", "quote": "control (1:5,000 potassium permanganate sitz bath)" }, { "field": "primaryOutcome", "quote": "The primary endpoint was complete wound epithelialization rate at postoperative day (POD) 14" }, { "field": "result", "quote": "the shortest wound healing time (5.15 ± 0.60 days, a 2.30-day reduction vs. control group's 7.45 ± 0.75 days, P < 0.001) and the highest 4-week total effective rate (97.50% vs. control's 65.00%, P < 0.001)" } ] }, { "id": "pmid:42163169", "pmid": "42163169", "doi": "10.1186/s12906-026-05410-6", "nctId": null, "pmcid": "PMC13366706", "title": "Assessment of the perceptions and practices of traditional hemorrhoid healers in the North Gondar Zone, Ethiopia", "firstAuthor": "Alula", "multipleAuthors": true, "journal": "BMC Complement Med Ther", "year": 2026, "design": "case-series", "n": 15, "nField": "reported", "population": "traditional healers who treat hemorrhoids in North Gondar Zone, Ethiopia", "intervention": "traditional hemorrhoid treatments including herbal topical applications, fumigation, and sitz baths", "comparator": "none reported", "primaryOutcome": "healers' perceived effectiveness of their treatments for hemorrhoids", "result": "healers reported strong confidence in effectiveness for early-stage hemorrhoids but limited effectiveness for severe cases", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a small qualitative interview study of healers' own beliefs, with no patients tested, no control group, and no objective measurement of whether sitz baths actually worked.", "directness": "indirect", "limitations": "qualitative design based on self-reported perceptions of healers rather than measured patient outcomes; no comparison group or objective diagnosis", "followUp": "", "plainFinding": "Healers say it helps mild cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42163169/", "sourceText": "BACKGROUND: Hemorrhoids are a common but often under-reported health problem in Ethiopia, particularly in rural areas where access to biomedical services is limited. In such contexts, traditional healers play an important role in providing care for sensitive conditions, including hemorrhoids. However, empirical evidence on their practices remains limited. This study aimed to explore the diagnostic methods, treatment approaches, perceived effectiveness, and sustainability challenges of traditional hemorrhoid healers in the North Gondar Zone. METHODS: A qualitative cross-sectional study design was employed. In-depth semi-structured interviews were conducted with 15 purposively selected traditional healers. Data were analyzed using thematic analysis to identify key themes related to diagnosis, treatment, and challenges. RESULTS: The findings showed that hemorrhoids were primarily diagnosed through direct physical examination and patient-reported symptoms, without the use of biomedical diagnostic tools. Treatments mainly involved locally sourced medicinal plants, often combined with substances such as butter or honey, and administered through topical applications, herbal fumigation, or sitz baths. Participants reported strong confidence in the effectiveness of these treatments for early-stage hemorrhoids, while acknowledging limited effectiveness in severe cases. Key challenges included lack of legal recognition, environmental degradation affecting medicinal plant availability, social stigma, and weak collaboration with the biomedical sector. CONCLUSION: Traditional healers play a significant role as primary healthcare providers in underserved communities. Strengthening their role through formal recognition, promoting sustainable use of medicinal plants, and fostering collaboration with biomedical services may improve healthcare delivery.", "provenance": [ { "field": "population", "quote": "In-depth semi-structured interviews were conducted with 15 purposively selected traditional healers." }, { "field": "n", "quote": "15 purposively selected traditional healers" }, { "field": "intervention", "quote": "Treatments mainly involved locally sourced medicinal plants, often combined with substances such as butter or honey, and administered through topical applications, herbal fumigation, or sitz baths." }, { "field": "comparator", "quote": "Participants reported strong confidence in the effectiveness of these treatments for early-stage hemorrhoids, while acknowledging limited effectiveness in severe cases." }, { "field": "primaryOutcome", "quote": "explore the diagnostic methods, treatment approaches, perceived effectiveness, and sustainability challenges of traditional hemorrhoid healers" }, { "field": "result", "quote": "Participants reported strong confidence in the effectiveness of these treatments for early-stage hemorrhoids, while acknowledging limited effectiveness in severe cases." } ] }, { "id": "pmid:42067175", "pmid": "42067175", "doi": "10.1016/j.cgh.2026.04.008", "nctId": null, "pmcid": null, "title": "AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review", "firstAuthor": "Qureshi", "multipleAuthors": true, "journal": "Clin Gastroenterol Hepatol", "year": 2026, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with symptomatic hemorrhoids", "intervention": "sitz baths along with fiber and lifestyle changes", "comparator": "no direct comparator specified", "primaryOutcome": "symptom improvement in hemorrhoids", "result": "sitz baths are often recommended for symptom relief but the evidence supporting them is limited", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an expert opinion guideline without a systematic review of evidence, and it explicitly states data on sitz baths is limited.", "directness": "direct", "limitations": "No systematic review was performed; statements are based on expert opinion rather than graded evidence.", "followUp": "", "plainFinding": "Often advised, but evidence is thin.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42067175/", "sourceText": "DESCRIPTION: Hemorrhoids are a common problem. The diagnosis and treatment can be challenging. Gastroenterologists have much to offer these patients. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease. METHODS: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These BPA statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BPA 1: The diagnosis and treatment of hemorrhoids is within the purview of the gastroenterologist. The diagnosis and grading of hemorrhoids is easily made by taking a history from the patient and examining the patient. Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse. Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure. BPA 2: Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet, are reasonable first-line therapies for symptomatic hemorrhoids. The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised, but scientific data is limited. BPA 3: Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids, and vasoactive agents, can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy. Topical steroids should not be used for more than 2 weeks at a time. BPA 4: Anoscopy should be performed, whenever possible, on every new patient with suspected hemorrhoids, prior to treatment, to ensure accurate diagnosis. BPA 5: Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting. Infrared coagulation and rubber band ligation have similar benefits in the short term. Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding. Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids. BPA 6: As part of informed consent for hemorrhoid therapies, the patient must be made aware of the small possibility of pelvic sepsis as a complication. Patients should be counseled about the risk and instructed to present to the emergency department immediately for evaluation, if indicated. BPA 7: In patients with active Crohn's disease or ulcerative colitis, hemorrhoid disease management should be delayed until complete remission is achieved. BPA 8: Hemorrhoids occur in up to two-thirds of women during pregnancy. Treatment should generally involve conservative management, including fiber, treatment of constipation, and topical ointments. If symptoms persist postpartum, or if a woman is planning further pregnancies, standard treatment such as banding or infrared coagulation can be considered. BPA 9: Acute thrombosed hemorrhoids are often extremely painful. They are best treated surgically with incision and drainage. BPA 10: Consultation with a surgeon should be offered to patients with grade 3 internal hemorrhoids who fail banding procedures or have associated external hemorrhoids. Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids. Grade 4 internal hemorrhoids require surgical hemorrhoidectomy. BPA 11: Patients with cirrhosis and hemorrhoids should be carefully examined so as not to confuse hemorrhoids with rectal varices. Hemorrhoids in patients with cirrhosis can be treated with banding or infrared coagulation. In patients with significant coagulopathy, infrared coagulation is preferred to banding. Concomitant portal hypertension should not alter this approach. For most clinicians, significant coagulopathy means a platelet count of less than 50,000 per microliter or international normalized ratio greater than 2.0. The presence of concomitant portal hypertension should not alter this approach.", "provenance": [ { "field": "population", "quote": "symptomatic hemorrhoids" }, { "field": "intervention", "quote": "The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised, but scientific data is limited." }, { "field": "result", "quote": "The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised, but scientific data is limited." }, { "field": "primaryOutcome", "quote": "symptom improvement" }, { "field": "comparator", "quote": "Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet, are reasonable first-line therapies" } ] }, { "id": "pmid:41508088", "pmid": "41508088", "doi": "10.19540/j.cnki.cjcmm.20250724.501", "nctId": null, "pmcid": null, "title": "[Multicenter, randomized, open-label, and positive-controlled clinical trial of Pien Tze Huang Capsules combined with Compound Pien Tze Huang Hemorrhoid Ointment in postoperative management of mixed hemorrhoids]", "firstAuthor": "Han", "multipleAuthors": true, "journal": "Zhongguo Zhong Yao Za Zhi", "year": 2025, "design": "rct", "n": 240, "nField": "reported", "population": "patients who had surgery to remove mixed hemorrhoids", "intervention": "Pien Tze Huang Capsules taken orally plus Compound Pien Tze Huang Hemorrhoid Ointment applied topically, on top of sitz baths", "comparator": "Mayinglong Shexiang Hemorrhoid Ointment applied topically, on top of sitz baths", "primaryOutcome": "wound fluid discharge, wound bleeding, and new tissue growth scores after surgery", "result": "Less wound discharge with the herbal capsule-plus-ointment combination by day 7, but no significant difference in bleeding, tissue growth, swelling, or pain scores", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was an open-label trial without a placebo group, both arms got sitz baths, and most of the measured outcomes showed no significant difference.", "directness": "indirect", "limitations": "Open-label design, positive-control rather than placebo comparison, and the trial tested an added herbal medicine rather than sitz baths themselves since all patients received sitz baths as baseline care", "followUp": "postoperative day 7", "plainFinding": "Herbal add-on reduced wound oozing only.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41508088/", "sourceText": "Pien Tze Huang has the efficacy of clearing heat, removing toxins, cooling the blood, removing blood stasis, subduing swelling, and relieving pain. It is widely used in the treatment of acute viral hepatitis, carbuncles and furuncles, unidentified swelling and poison, blunt trauma, and various inflammations. To investigate the clinical efficacy and safety of Pien Tze Huang Capsules combined with Compound Pien Tze Huang Hemorrhoid Ointment in controlling the postoperative inflammatory response of wounds in patients undergoing surgery for mixed hemorrhoids, a multicenter, randomized, open-label, and positive-controlled clinical trial was conducted at 12 tertiary medical institutions in China. A total of 240 patients who underwent Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids were enrolled and randomly assigned to the treatment or control group(1∶1). Both groups received sitz baths with Compound Jingjie for Fumigation and Washing as basic treatment. The treatment group additionally received Pien Tze Huang Capsules orally(2 capsules per dose, 3 times per day) and topical application of Compound Pien Tze Huang Hemorrhoid Ointment(2.5 g, twice per day), while the control group received topical Mayinglong Shexiang Hemorrhoid Ointment(2.5 g, twice per day). The treatment duration was 7 days. Primary efficacy endpoints included wound exudation scores, wound bleeding scores, and wound granulation tissue formation scores, and secondary endpoints included perianal edema scores, pain score using pain visual analogue scale(VAS) scores, postoperative analgesic use, and adverse events. RESULTS:: showed that in the full analysis set(FAS), the wound exudation scores on postoperative day 7 was significantly lower in the treatment group compared to that in the control group(P<0.05). In the per-protocol set(PPS), the wound exudation scores on postoperative days 3 and 7 was also significantly lower in the treatment group(P<0.05). While the treatment group showed lower perianal edema scores and pain VAS scores than the control group, the differences were not statistically significant. No statistically significant differences were observed between the two groups in wound bleeding scores, wound granulation tissue formation scores, analgesic use rate or amount, or incidence of adverse reactions. A total of 56 adverse events were observed, with 25 in the treatment group and 31 in the control group. The incidence of adverse reactions was comparable between groups, with no statistically significant difference. No serious drug-related adverse events were observed in either group. The results suggest that the Pien Tze Huang Capsules combined with Compound Pien Tze Huang Hemorrhoid Ointment can reduce wound exudation after surgery for mixed hemorrhoids, playing a beneficial role in controlling postoperative inflammation. The treatment offers good safety and tolerability, showing great potential as a postoperative adjunctive therapy integrating traditional Chinese medicine and western medicine.", "provenance": [ { "field": "n", "quote": "A total of 240 patients who underwent Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids were enrolled" }, { "field": "population", "quote": "patients undergoing surgery for mixed hemorrhoids" }, { "field": "intervention", "quote": "The treatment group additionally received Pien Tze Huang Capsules orally(2 capsules per dose, 3 times per day) and topical application of Compound Pien Tze Huang Hemorrhoid Ointment(2.5 g, twice per day)" }, { "field": "comparator", "quote": "the control group received topical Mayinglong Shexiang Hemorrhoid Ointment(2.5 g, twice per day)" }, { "field": "primaryOutcome", "quote": "Primary efficacy endpoints included wound exudation scores, wound bleeding scores, and wound granulation tissue formation scores" }, { "field": "result", "quote": "the wound exudation scores on postoperative day 7 was significantly lower in the treatment group compared to that in the control group(P<0.05)" }, { "field": "result", "quote": "No statistically significant differences were observed between the two groups in wound bleeding scores, wound granulation tissue formation scores, analgesic use rate or amount, or incidence of adverse reactions." }, { "field": "directness", "quote": "Both groups received sitz baths with Compound Jingjie for Fumigation and Washing as basic treatment." } ] }, { "id": "pmid:41357914", "pmid": "41357914", "doi": "10.5498/wjp.v15.i12.111180", "nctId": null, "pmcid": "PMC12679078", "title": "Effects of Tongyangxiao lotion bidet therapy combined with Ziyu ointment on postpartum hemorrhoidal pain, oedema, anxiety, and depression", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "World J Psychiatry", "year": 2025, "design": "retrospective", "n": 268, "nField": "reported", "population": "women with hemorrhoids after childbirth", "intervention": "Tongyangxiao lotion sitz bath therapy combined with Ziyu ointment", "comparator": "magnesium sulfate wet compress combined with Ziyu ointment", "primaryOutcome": "hemorrhoid pain, swelling, comfort, compliance, and psychological state", "result": "Hemorrhoid diameter and edema were smaller, comfort scores and treatment compliance were higher in the sitz bath group after 14 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study comparing two combined treatments rather than a randomized trial of sitz baths alone, so it can't clearly isolate the effect of the sitz bath itself.", "directness": "indirect", "limitations": "Retrospective design; both groups received an ointment alongside their respective soak/compress, so the lotion's specific contribution versus the ointment is unclear.", "followUp": "14 days", "plainFinding": "Herbal sitz bath eased swelling and pain", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41357914/", "sourceText": "BACKGROUND: Postpartum hemorrhoids are common complications in women after childbirth, with an incidence rate of 37.9%. Progesterone levels increase during pregnancy, which can lead to constipation. Abdominal pressure surges sharply during delivery, which can block the venous return of the rectum and result in hemorrhoids, pain, and edema. Tongyangxiao lotion and Ziyu ointment, traditional Chinese medicinal preparations, have the efficacy of subduing swelling, relieving itching, and promoting healing; however, their combined application in treating postpartum hemorrhoids is less studied. AIM: To investigate effects of Tongyangxiao lotion sitz bath therapy combined with Ziyu ointment on postpartum hemorrhoidal pain, edema, anxiety, and depression. METHODS: A retrospective analysis was conducted at Hebei Hospital of Traditional Chinese Medicine on 268 patients with hemorrhoids (September 2023 to February 2025). They were divided according to treatment method into control (wet compress with magnesium sulfate + Ziyu ointment) and observation (Tongyangxiao lotion sitz bath therapy + Ziyu ointment) groups (n = 134 in each group). Degree of pain, comfort level, compliance behavior with medical care, psychological state, therapeutic effect, hemorrhoid edema score, incidence of adverse reactions, and hemorrhoid diameter were compared. RESULTS: No statistically significant difference was observed in the diameter of the hemorrhoids or edema between the two groups before treatment. Hemorrhoid diameter and degree of edema were significantly smaller in the observation group than those in the control group 14 days post treatment. No statistically significant difference was observed in the scores of the General Comfort Questionnaire (GCQ) dimensions and participants' compliance before treatment. All GCQ dimension scores were significantly higher in the observation group than those in the control group 7 and 14 days post treatment. The compliance rate was significantly higher in the observation group than that of the control group. No statistically significant difference was observed in the incidence of adverse reactions between the two groups (P > 0.05). CONCLUSION: Tongyangxiao lotion combined with Ziyu ointment can improve patients' surface edema, postpartum hemorrhoid pain, treatment adherence, and comfort, reducing negative emotions. This is relatively safe and worthy of clinical promotion.", "provenance": [ { "field": "n", "quote": "n = 134 in each group" }, { "field": "population", "quote": "patients with hemorrhoids" }, { "field": "intervention", "quote": "Tongyangxiao lotion sitz bath therapy + Ziyu ointment" }, { "field": "comparator", "quote": "wet compress with magnesium sulfate + Ziyu ointment" }, { "field": "primaryOutcome", "quote": "Degree of pain, comfort level, compliance behavior with medical care, psychological state, therapeutic effect, hemorrhoid edema score, incidence of adverse reactions, and hemorrhoid diameter were compared." }, { "field": "result", "quote": "Hemorrhoid diameter and degree of edema were significantly smaller in the observation group than those in the control group 14 days post treatment." } ] }, { "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": "Chen", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2025, "design": "rct", "n": 166, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids (Ferguson hemorrhoidectomy)", "intervention": "ice packing after surgery", "comparator": "warm sitz baths after surgery", "primaryOutcome": "pain and swelling after surgery", "result": "ice packing gave lower pain scores, less swelling, better wound healing, and less morphine use than warm sitz baths", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but from only one hospital, with a short follow-up and no validated wound-scoring tool for hemorrhoids.", "directness": "indirect", "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.", "followUp": "7 days", "plainFinding": "Ice packs beat warm sitz baths after surgery", "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": "population", "quote": "PATIENTS: A total of 166 patients undergoing Ferguson hemorrhoidectomy were included." }, { "field": "intervention", "quote": "Patients were randomly assigned to receive either ice packing (n = 82) or warm sitz bath (n = 84) for initial postoperative care." }, { "field": "comparator", "quote": "Patients were randomly assigned to receive either ice packing (n = 82) or warm sitz bath (n = 84) for initial postoperative care." }, { "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 ( 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)." } ] }, { "id": "pmid:39757160", "pmid": "39757160", "doi": "10.1186/s12893-024-02737-0", "nctId": null, "pmcid": "PMC11702218", "title": "Comparison of warm sitz bath and electronic bidet with a lower-force water flow for postoperative management after hemorrhoidectomy (BIDLOW)", "firstAuthor": "Kwon", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "rct", "n": 75, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids", "intervention": "electronic bidet with lower-force water flow", "comparator": "warm sitz bath", "primaryOutcome": "anal pain score over 7 days after surgery", "result": "no significant difference in pain scores between electronic bidet and sitz bath groups", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small trial with many dropouts after randomization and failed to prove the alternative device was as good as sitz baths.", "directness": "indirect", "limitations": "Twenty-six patients dropped out after randomization; noninferiority of electronic bidet not verified.", "followUp": "7 days", "plainFinding": "No difference in pain after surgery.", "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": "the final analysis included 34 patients in the electronic bidet group and 41 in the sitz bath group" }, { "field": "population", "quote": "Patients who underwent hemorrhoidectomy" }, { "field": "intervention", "quote": "use the electronic bidet" }, { "field": "comparator", "quote": "warm sitz baths for 7 days after 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 (38.3 ± 21.9 vs. 42.0 ± 21.1, p = 0.453)." } ] }, { "id": "pmid:38868538", "pmid": "38868538", "doi": "10.1002/hsr2.2192", "nctId": null, "pmcid": "PMC11168280", "title": "Myrrh sitz bath for wound healing after hemorrhoidectomy: A retrospective study of adverse effects and treatment outcomes", "firstAuthor": "Al Amri", "multipleAuthors": false, "journal": "Health Sci Rep", "year": 2024, "design": "retrospective", "n": 67, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids", "intervention": "Myrrh-based sitz bath used as self-treatment for wound care after hemorrhoid surgery", "comparator": "standard wound care after hemorrhoid surgery", "primaryOutcome": "wound healing grade and complication rate after hemorrhoidectomy", "result": "Myrrh group had more higher-grade healing but also more complications than standard care", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small retrospective study where patients chose their own treatment, so differences could be due to the older, sicker patients in the Myrrh group rather than the Myrrh itself.", "directness": "indirect", "limitations": "Retrospective design, self-selected treatment without medical advice, Myrrh group was significantly older with more comorbidities, small sample size in Myrrh group (15 patients)", "followUp": "", "plainFinding": "Faster healing but more complications", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38868538/", "sourceText": "BACKGROUND AND AIM: Hemorrhoids affect 75% of people worldwide. surgical hemorrhoidectomy remains the definitive intervention for severe cases. Postoperative wound care is critical, and alternative treatments, like Myrrh, are of growing interest due to their potential wound-healing properties. This study aimed to compare the safety, efficacy, and treatment outcomes of Myrrh sitz baths with standard clinical care in promoting wound healing after hemorrhoidectomy. METHODS: A retrospective cohort study was carried out using medical records from Abha Private Hospital for the period of January-December 2022. The data of patients who underwent hemorrhoidectomy were collected and categorized based on postoperative wound care into two groups: Group A for Myrrh-based wound care as a self-medication and Group B for standard wound care. RESULTS: The study included 67 patients who underwent hemorrhoidectomy. Out of these patients, 52 had standard wound care, while 15 used Myrrh-based wound care as self-treatment without medical advice. The Myrrh group patients were significantly older with more comorbidities. The Myrrh group had significant Grade III wound healing outcomes 9/15 (60%) compared to the standard care group 2/52 (3.8%) (p < 0.001). However, despite the better healing outcomes, the Myrrh group had a significantly higher complication rate 7/15(46.7%) than the standard care group 1/52 (1.9%) (p < 0.001). These results indicate that despite the good healing capacity of Myrrh, cautious usage must be considered. CONCLUSION: Myrrh sitz baths appear more effective than standard wound care in enhancing healing after hemorrhoidectomy. However, increased complications suggest the necessity for comprehensive evaluation and research on its safety profile. These findings can guide future research and clinical practices related to postoperative wound care.", "provenance": [ { "field": "n", "quote": "The study included 67 patients who underwent hemorrhoidectomy." }, { "field": "population", "quote": "The data of patients who underwent hemorrhoidectomy were collected" }, { "field": "intervention", "quote": "Group A for Myrrh-based wound care as a self-medication" }, { "field": "comparator", "quote": "Group B for standard wound care" }, { "field": "primaryOutcome", "quote": "compare the safety, efficacy, and treatment outcomes of Myrrh sitz baths with standard clinical care in promoting wound healing after hemorrhoidectomy" }, { "field": "result", "quote": "The Myrrh group had significant Grade III wound healing outcomes 9/15 (60%) compared to the standard care group 2/52 (3.8%) (p < 0.001). However, despite the better healing outcomes, the Myrrh group had a significantly higher complication rate 7/15(46.7%) than the standard care group 1/52 (1.9%) (p < 0.001)." } ] }, { "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": "Liao", "multipleAuthors": true, "journal": "Int J Nurs Stud", "year": 2024, "design": "rct", "n": 64, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids (grade III or IV)", "intervention": "warm water sitz bath started 6 hours after hemorrhoid surgery", "comparator": "warm water sitz bath started the standard way, on day 1 after surgery", "primaryOutcome": "urinary retention and wound pain after surgery", "result": "no difference in urinary retention, but lower pain scores with early sitz bath", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial but small and looked at post-surgical patients, not people with untreated hemorrhoids using sitz baths as a primary treatment", "directness": "indirect", "limitations": "small sample of 64 patients, single surgical ward, and the question studied was timing of sitz baths after surgery rather than sitz baths as treatment for hemorrhoids themselves", "followUp": "until hospital discharge", "plainFinding": "Less pain, no change in retention", "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": "population", "quote": "Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 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": "primaryOutcome", "quote": "To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on 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. 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)." }, { "field": "n", "quote": "A total of 64 participants (32 each in the experimental and control groups) were enrolled." } ] }, { "id": "pmid:38380823", "pmid": "38380823", "doi": "10.1097/DCR.0000000000003211", "nctId": null, "pmcid": null, "title": "Efficacy of Micronized Purified Flavonoid Fraction in the Posthemorrhoidectomy Period Trial: Open-Label Randomized Controlled Trial", "firstAuthor": "Medkova", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2024, "design": "rct", "n": 50, "nField": "reported", "population": "adults who had surgery to remove hemorrhoids (grade III-IV)", "intervention": "standard post-surgery care (pain relievers, topical steroids, fiber, warm sitz baths, nifedipine gel) plus a flavonoid drug (micronized purified flavonoid fraction)", "comparator": "standard post-surgery care alone, which already included warm sitz baths", "primaryOutcome": "swelling or clotting of the skin bridges left after surgery, pain levels, quality of life, and patient-rated treatment effect", "result": "the flavonoid drug reduced swelling/clotting and skin tag formation and patients rated it better, but there was no difference in pain scores between groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small, single-center, open-label trial that tested an add-on drug, not sitz baths themselves, since both groups already received sitz baths as part of standard care.", "directness": "indirect", "limitations": "Unicenter open-label design.", "followUp": "60 days", "plainFinding": "Added flavonoid drug reduced swelling, no extra pain relief; doesn't test sitz baths.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38380823/", "sourceText": "BACKGROUND: Frequent early postoperative complications of hemorrhoidectomy are thrombosis and edema of mucocutaneous \"bridges.\" OBJECTIVE: This study aimed to investigate the efficacy of micronized purified flavonoid fraction in preventing complications after elective hemorrhoidectomy. DESIGN: Prospective unicentral open-label randomized controlled trial. SETTINGS: 2021-2022 at the Clinic of Colorectal and Minimally Invasive Surgery at Sechenov University (Moscow, Russia). PATIENTS: Patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids. INTERVENTIONS: After hemorrhoidectomy, patients were randomly assigned either to standard treatment (peroral nonsteroid anti-inflammatory drugs and local anesthetics, topical steroids, psyllium, warm sitz baths, and nifedipine gel), referred to as the control group, or to standard treatment with micronized purified flavonoid fraction, referred to as the study group, and followed up for 60 days. MAIN OUTCOME MEASURES: Thrombosis or edema of mucocutaneous bridges and pain intensity on a visual analog scale оn postoperative days 1-7, 14, 21, and 30; quality of life and patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30; and perianal skin tags оn postoperative day 60. RESULTS: The data from 50 patients were analyzed (25 in each group). The visual analog scale demonstrated no differences between groups in each follow-up point. Compared to the control group, the patients in the study group had a significantly higher patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30 and a significantly lower rate of thrombosis or edema of mucocutaneous bridges оn postoperative days 1-7 and 14. Patients in the study group had significantly lower rates of perianal skin tags. LIMITATIONS: Unicenter open-label design. CONCLUSIONS: Micronized purified flavonoid fraction in the posthemorrhoidectomy period is an effective adjunct to standard treatment that helps reduce the rate of thrombosis and edema of mucocutaneous bridges, improves patient-assessed treatment effect, and prevents postoperative perianal skin tags formation. Micronized purified flavonoid fraction in the posthemorrhoidectomy period is not associated with additional pain relief in comparison with nonmicronized purified flavonoid fraction standard treatment. See Video Abstract . EFICACIA DE LA FRACCIN DE FLAVONOIDES PURIFICADA MICRONIZADA EN EL PERODO POSTERIOR A LA HEMORROIDECTOMA ENSAYO MOST ENSAYO CONTROLADO, ALEATORIZADO, ABIERTO: ANTECEDENTES:Una complicación postoperatoria temprana frecuente de la hemorroidectomía es la trombosis y el edema de los \"puentes\" mucocutáneos.OBJETIVO:Investigamos la eficacia de la fracción de flavonoides purificada micronizada en la prevención de complicaciones después de una hemorroidectomía electiva.DISEÑO:Ensayo controlado aleatorio, prospectivo, unicentral, abierto.AJUSTES:2021-2022 Clínica de Cirugía Colorrectal y Mínimamente Invasiva Universidad Sechenov (Moscú, Rusia).PACIENTES:Pacientes después de hemorroidectomía, que se realizó para hemorroides de grado III-IV.INTERVENCIONES:Después de la hemorroidectomía, los pacientes fueron asignados aleatoriamente al tratamiento estándar (antiinflamatorios no esteroides perorales y anestésicos locales, esteroides tópicos, psyllium, baños de asiento tibios, gel de nifedipina) - grupo de control, o al tratamiento estándar con flavonoide purificado micronizado. fracción (grupo de estudio) y seguido durante 60 días.RESULTADOS DE MEDIDAS PRINCIPALES:Trombosis o edema de puentes mucocutáneos e intensidad del dolor en una escala analógica visual entre el 1.º, 7.º, 14.º, 21.º y 30.º día postoperatorio; calidad de vida y efecto del tratamiento evaluado por el paciente el día 1, 3, 7, 21 y 30 del postoperatorio; Marcas cutáneas perianales en el día 60 del postoperatorio.RESULTADOS:Se analizaron los datos de 50 pacientes (25 en cada grupo). La escala analógica visual no demostró diferencias entre grupos en cada punto de seguimiento. En comparación con el grupo de control, los pacientes en el grupo de estudio tuvieron un efecto del tratamiento evaluado por el paciente significativamente mayor en los días 1, 3, 7, 21 y 30 después de la operación, una tasa significativamente menor de trombosis o edema de los puentes mucocutáneos en los días 1, 7 y 14.. Los pacientes del grupo de estudio tuvieron tasas significativamente más bajas de marcas en la piel perianal.LIMITACIONES:Diseño Unicenter de etiqueta abierta.CONCLUSIONES:La fracción de flavonoides purificada micronizada en el período posterior a la hemorroidectomía es un complemento eficaz del tratamiento estándar que ayuda a reducir la tasa de trombosis y edema de los puentes mucocutáneos, mejora el efecto del tratamiento evaluado por el paciente y previene la formación de marcas cutáneas perianales posoperatorias. La fracción de flavonoides purificados micronizados en el período posterior a la hemorroidectomía no se asocia con un alivio adicional del dolor en comparación con el tratamiento estándar con la fracción de flavonoides purificados no micronizados. (Traducción-Yesenia Rojas-Khalil ).", "provenance": [ { "field": "n", "quote": "The data from 50 patients were analyzed (25 in each group)." }, { "field": "population", "quote": "Patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids." }, { "field": "intervention", "quote": "standard treatment with micronized purified flavonoid fraction, referred to as the study group" }, { "field": "comparator", "quote": "standard treatment (peroral nonsteroid anti-inflammatory drugs and local anesthetics, topical steroids, psyllium, warm sitz baths, and nifedipine gel), referred to as the control group" }, { "field": "primaryOutcome", "quote": "Thrombosis or edema of mucocutaneous bridges and pain intensity on a visual analog scale оn postoperative days 1-7, 14, 21, and 30; quality of life and patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30; and perianal skin tags оn postoperative day 60." }, { "field": "result", "quote": "The visual analog scale demonstrated no differences between groups in each follow-up point. Compared to the control group, the patients in the study group had a significantly higher patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30 and a significantly lower rate of thrombosis or edema of mucocutaneous bridges оn postoperative days 1-7 and 14." } ] }, { "id": "pmid:36398208", "pmid": "36398208", "doi": null, "nctId": null, "pmcid": "PMC9641488", "title": "Effects of Huhuang Burn Liniment on wound healing and changes in IL-10 and MMP-9 levels in patients with mixed hemorrhoids", "firstAuthor": "Sha", "multipleAuthors": true, "journal": "Am J Transl Res", "year": 2022, "design": "retrospective", "n": 113, "nField": "reported", "population": "patients with mixed hemorrhoids who had surgery to remove them", "intervention": "Huhuang Burn Liniment applied after surgery", "comparator": "potassium permanganate sitz bath after surgery", "primaryOutcome": "wound healing time and overall treatment effectiveness", "result": "the liniment group healed faster, had less pain, swelling and leaking, and fewer complications than the sitz bath group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective, non-randomized single-center study, so differences between groups could be due to factors other than the treatment itself", "directness": "indirect", "limitations": "retrospective design, single hospital, no randomization mentioned, and sitz bath is only used as a comparison treatment rather than being the main therapy studied", "followUp": "", "plainFinding": "Herbal liniment healed better than sitz bath.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36398208/", "sourceText": "OBJECTIVE: To explore the effects of Huhuang Burn Liniment on wound healing and levels of interleukin-10 (IL-10) and matrix metalloproteinase-9 (MMP-9) in patients with mixed hemorrhoids. METHODS: The clinical data of 113 patients with mixed hemorrhoids admitted to Chongqing Sanxia Central Hospital were retrospectively collected. All patients underwent Milligan-Morgan hemorrhoidectomy, and were divided into two groups according to different postoperative treatments. Group A was treated with 1/5000 potassium permanganate sitz bath after surgery, while group B was treated with Huhuang Burn Liniment. The treatment efficacy, wound healing time, level of pain, exudation, edema, granulation scores, anal function index, levels of IL-10 and MMP-9, quality of life scores, and complications were compared between the two groups. RESULTS: The effective rate of group B (94.74%) was higher than that of group A (60.71%) (P < 0.05). Group B had shorter length of anorectal hyperbaric zone, higher anal canal resting pressure, anal canal diastolic pressure, and anal canal systolic maximum pressure (P < 0.05), lower scores of trauma pain, edema, exudation, and granulation (P < 0.05), higher IL-10 levels, and lower MMP-9 levels (P < 0.05). The complication rate of group B (8.77%) was lower than that in group A (23.21%) (P < 0.05). After treatment, group B had shorter wound healing time and higher quality of life score than group A (P < 0.05). CONCLUSION: The application of Huhuang Burn Liniment in patients with mixed hemorrhoids after surgery could promote wound healing and anal function, reduce trauma pain, exudation and edema, and improve quality of life.", "provenance": [ { "field": "population", "quote": "patients with mixed hemorrhoids" }, { "field": "intervention", "quote": "group B was treated with Huhuang Burn Liniment" }, { "field": "comparator", "quote": "Group A was treated with 1/5000 potassium permanganate sitz bath after surgery" }, { "field": "n", "quote": "The clinical data of 113 patients with mixed hemorrhoids" }, { "field": "primaryOutcome", "quote": "The treatment efficacy, wound healing time, level of pain, exudation, edema, granulation scores" }, { "field": "result", "quote": "The effective rate of group B (94.74%) was higher than that of group A (60.71%) (P < 0.05)" }, { "field": "result", "quote": "group B had shorter wound healing time and higher quality of life score than group A (P < 0.05)" } ] }, { "id": "pmid:35685735", "pmid": "35685735", "doi": "10.1155/2022/1633965", "nctId": null, "pmcid": "PMC9173983", "title": "Be Kind to Your Behind: A Systematic Review of the Habitual Use of Bidets in Benign Perianal Disease", "firstAuthor": "Baig", "multipleAuthors": true, "journal": "Evid Based Complement Alternat Med", "year": 2022, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with benign perianal conditions like hemorrhoids, anal fissures, and pruritus ani", "intervention": "habitual use of bidets (continuous stream of water) for perianal hygiene", "comparator": "sitz baths and no bidet use", "primaryOutcome": "hemorrhoid symptoms, post-hemorrhoidectomy pain, and pruritus ani", "result": "Bidet use did not reduce odds of hemorrhoids, was non-inferior to sitz baths for post-surgery pain, but was linked to more pruritus ani and some cases of burns or fissures", "resultDirection": "mixed", "quality": "low", "qualityWhy": "The review combined only a few small, variable-quality studies and could not even perform a meta-analysis.", "directness": "indirect", "limitations": "Only a limited number of studies were available, and they were of variable quality; no meta-analysis was performed.", "followUp": "", "plainFinding": "No clear evidence sitz baths help hemorrhoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35685735/", "sourceText": "BACKGROUND: Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia, but its role in perianal disease is unknown. PURPOSE: To critically analyze and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease. Data Sources. A database search was conducted on MEDLINE and Epub Ahead of Print, Embase, ClinicalTrials.gov, the Cochrane Library, and ProQuest Dissertations. All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included. Data Extraction. The studies were screened and critically analyzed by two independent reviewers in line with PRISMA guidelines. RESULTS: Two prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain. Two prospective trials and 1 cross-sectional study determined that habitual bidet use may increase the odds of developing pruritus ani. Two case series found that habitual bidet use may cause perianal burns or anterior anal fissures. A meta-analysis was not performed because only a limited number of studies were available, and they were of variable quality. CONCLUSION: The current evidence does not identify using bidets as a treatment modality for perianal disease, and further research is warranted to study this increasingly utilized technology.", "provenance": [ { "field": "population", "quote": "All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included." }, { "field": "intervention", "quote": "habitual use of bidets" }, { "field": "comparator", "quote": "One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain." }, { "field": "primaryOutcome", "quote": "To critically analyze and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease." }, { "field": "result", "quote": "Two prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain. Two prospective trials and 1 cross-sectional study determined that habitual bidet use may increase the odds of developing pruritus ani. Two case series found that habitual bidet use may cause perianal burns or anterior anal fissures." }, { "field": "limitations", "quote": "A meta-analysis was not performed because only a limited number of studies were available, and they were of variable quality." } ] }, { "id": "pmid:35064300", "pmid": "35064300", "doi": "10.1007/s00423-021-02415-2", "nctId": null, "pmcid": null, "title": "Perianal thrombosis: no need for surgery", "firstAuthor": "Alldinger", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2022, "design": "case-series", "n": 619, "nField": "reported", "population": "patients with thrombosis of internal or external hemorrhoids (perianal thrombosis or thrombosed hemorrhoids)", "intervention": "conservative treatment with sitz baths and oral pain medication if needed", "comparator": "no surgery was performed; no separate control group", "primaryOutcome": "pain resolution and recurrence after conservative treatment", "result": "pain was largely resolved after 5 days and completely gone after 10 days, with a 6.3% recurrence rate", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective analysis of a single treatment group with no surgical comparison arm, so it cannot show whether sitz baths work better than doing nothing.", "directness": "indirect", "limitations": "Retrospective data analysis, no control or comparator group, no randomization, and sitz baths were combined with pain medication so their individual effect cannot be isolated.", "followUp": "10 days", "plainFinding": "Healed well without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35064300/", "sourceText": "AIM: There is little evidence for the best therapy for perianal thrombosis. No prospective trials exist. Even quality of retrospective data is low, due to low patient numbers or vague follow-up data. PATIENTS AND METHODS: Six hundred nineteen patients with thrombosis of internal or external hemorrhoids who presented in our clinic between March 2017 and August 2018 were enrolled in the study. All patients were treated conservatively, with sitz baths and oral pain medication, if needed. No surgery was performed. Follow-up data was obtained by personal examination. Data was gathered prospectively, and data analysis was retrospective. RESULTS: Five hundred four patients had perianal thrombosis (81.4%), and 115 patients had thrombosed hemorrhoids. Mean pain on a numerical rating scale (0-10) was 3.8 for perianal thrombosis and 5.2 for thrombosed hemorrhoids. Five hundred forty-eight patients (88.5%) did not need a sick leave. On follow-up, patients stated that their pain had largely resolved after 5 days and completely disappeared after 10 days. Local recurrence rate after perianal thrombosis was 6.3%. CONCLUSION: Perianal thrombosis and thrombosed hemorrhoids heal well without surgery. There is no evidence for advantages surgical therapy could offer.", "provenance": [ { "field": "n", "quote": "Six hundred nineteen patients with thrombosis of internal or external hemorrhoids" }, { "field": "population", "quote": "Six hundred nineteen patients with thrombosis of internal or external hemorrhoids who presented in our clinic between March 2017 and August 2018 were enrolled in the study." }, { "field": "intervention", "quote": "All patients were treated conservatively, with sitz baths and oral pain medication, if needed." }, { "field": "comparator", "quote": "No surgery was performed." }, { "field": "primaryOutcome", "quote": "On follow-up, patients stated that their pain had largely resolved after 5 days and completely disappeared after 10 days." }, { "field": "result", "quote": "On follow-up, patients stated that their pain had largely resolved after 5 days and completely disappeared after 10 days. Local recurrence rate after perianal thrombosis was 6.3%." } ] }, { "id": "pmid:34539803", "pmid": "34539803", "doi": "10.1155/2021/6473754", "nctId": null, "pmcid": "PMC8443359", "title": "Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications", "firstAuthor": "Zeng", "multipleAuthors": true, "journal": "Evid Based Complement Alternat Med", "year": 2021, "design": "rct", "n": 106, "nField": "reported", "population": "patients having surgery for hemorrhoids (PPH procedure)", "intervention": "Kangfuxin solution fumigation bath after surgery", "comparator": "warm water sitz bath after surgery", "primaryOutcome": "overall treatment success and postoperative wound healing, pain, bleeding, swelling", "result": "the fumigation bath group had a higher treatment success rate and faster healing than the warm water sitz bath group", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This article was later retracted, so its findings cannot be trusted regardless of its design.", "directness": "indirect", "limitations": "The paper is a retracted publication, studied post-surgical patients rather than hemorrhoids in general, and compared two bath types rather than testing sitz baths against no treatment.", "followUp": "", "plainFinding": "Herbal fumigation bath beat plain sitz bath, but study retracted", "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": "population", "quote": "all of whom were treated with PHH surgery" }, { "field": "intervention", "quote": "an observation group treated with Kangfuxin solution fumigation bath" }, { "field": "comparator", "quote": "a control group treated with warm water sitz bath" }, { "field": "primaryOutcome", "quote": "The results of the evaluation of the efficacy of patients after the treatment period" }, { "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:32421480", "pmid": "32421480", "doi": "10.12968/jowc.2020.29.5.289", "nctId": null, "pmcid": null, "title": "Pain control and early wound healing effect using sitz bath with ozonised water after haemorrhoidectomy", "firstAuthor": "Kim", "multipleAuthors": true, "journal": "J Wound Care", "year": 2020, "design": "rct", "n": 80, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids (haemorrhoidectomy)", "intervention": "sitz bath using ozonised water after surgery", "comparator": "sitz bath using ordinary tap water after surgery", "primaryOutcome": "pain level and time for wound to heal", "result": "patients using ozonised water sitz baths had lower pain scores and healed faster than those using tap water sitz baths", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a small single study where the data were analysed retrospectively from a randomised trial, so there is limited confidence in the result.", "directness": "indirect", "limitations": "small sample size, retrospective analysis of prospectively collected data, and it compares two types of sitz bath rather than sitz bath versus no sitz bath", "followUp": "", "plainFinding": "Ozone water bath eased pain faster", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32421480/", "sourceText": "OBJECTIVE: Studies have shown that ozone in an aqueous state on a scar, because of its antibacterial effect, aids wound-healing. This study aimed to compare the pain control effect, based on the time to wound healing, of using a sitz bath with ozonised water with that of using a sitz bath with ordinary tap water in patients who have had a haemorrhoidectomy. METHOD: Patients were divided into two equal-sized groups: Group O used a sitz bath with ozonised water after haemorrhoidectomy and patients in Group T used a sitz bath with ordinary tap water. Different concentrations (1ppm, 2ppm and 4ppm) of ozonized water were tested to determine their bactericidal activities. Pain levels were measured using the Visual Analogue Scale (ranging from 0-10 where 0 is 'no pain' and 10 is 'unbearable pain'), on days two, three and seven. Cohort analysis was retrospectively performed on the prospectively randomised collected data for this study. RESULTS: A total of 80 patients participated in the study. No case showed any signs of bacterial growth. On postoperative day seven, patients in Group O showed a significantly lower pain level than those in Group T (1.35±0.48 versus 2.40±0.9; p<0.001). The time needed for anus scars to be completely healed was significantly shorter for Group O than that for Group T (2.75±0.63 weeks versus 3.85±0.80 weeks; p<0.001). CONCLUSION: The results of this study showed that using a sitz bath with ozonised water reduced pain and accelerated healing in patients who have had a haemorrhoidectomy.", "provenance": [ { "field": "n", "quote": "A total of 80 patients participated in the study." }, { "field": "population", "quote": "patients who have had a haemorrhoidectomy" }, { "field": "intervention", "quote": "Group O used a sitz bath with ozonised water after haemorrhoidectomy" }, { "field": "comparator", "quote": "patients in Group T used a sitz bath with ordinary tap water" }, { "field": "primaryOutcome", "quote": "compare the pain control effect, based on the time to wound healing" }, { "field": "result", "quote": "patients in Group O showed a significantly lower pain level than those in Group T (1.35±0.48 versus 2.40±0.9; p<0.001). The time needed for anus scars to be completely healed was significantly shorter for Group O than that for Group T (2.75±0.63 weeks versus 3.85±0.80 weeks; p<0.001)." } ] }, { "id": "pmid:30091329", "pmid": "30091329", "doi": null, "nctId": null, "pmcid": null, "title": "[Proctological emergencies in pregnant women]", "firstAuthor": "Freymond", "multipleAuthors": true, "journal": "Rev Med Suisse", "year": 2018, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "Pregnant women with hemorrhoids or anal fissures", "intervention": "Sitz baths as part of conservative treatment", "comparator": "", "primaryOutcome": "", "result": "Abstract lists sitz baths among conservative measures but reports no outcome data", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review of proctological emergencies in pregnancy with no study data or outcomes tested for sitz baths.", "directness": "indirect", "limitations": "No original data, no comparison group, no effect size reported; focuses on pregnant population only.", "followUp": "", "plainFinding": "No outcome data reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30091329/", "sourceText": "Hemorrhoids affect up to 85 % of pregnant women during the last two trimesters. The maximum incidence for anal fissure is 20 %. One of the common risk factors is constipation promoted during pregnancy. The history of anal pathology, the length of delivery and the baby's birth weight also promote these two entities. The treatment includes above all hygiene and dietary measures to prevent constipation and conservative measures (local anesthetics, sitz baths). Surgical procedures should be avoided and indicated only in case of failure of conservative treatment. Rectal prolapse is more rare and must be reduced manually before surgery. Measures to prevent constipation also apply.", "provenance": [ { "field": "population", "quote": "Hemorrhoids affect up to 85 % of pregnant women during the last two trimesters." }, { "field": "intervention", "quote": "conservative measures (local anesthetics, sitz baths)" }, { "field": "result", "quote": "The treatment includes above all hygiene and dietary measures to prevent constipation and conservative measures (local anesthetics, sitz baths)." } ] }, { "id": "pmid:29431977", "pmid": "29431977", "doi": null, "nctId": null, "pmcid": null, "title": "Hemorrhoids: Diagnosis and Treatment Options", "firstAuthor": "Mott", "multipleAuthors": true, "journal": "Am Fam Physician", "year": 2018, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "adults with hemorrhoids", "intervention": "sitz baths (along with stool softeners, dietary changes, topical treatments)", "comparator": "", "primaryOutcome": "", "result": "Not separately reported; sitz baths listed as part of initial therapy without specific outcome data", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a general review article that lists sitz baths as a standard recommendation without citing specific studies or outcome data for this treatment.", "directness": "direct", "limitations": "No specific data, trial results, or comparison given for sitz baths alone; it is grouped with other initial therapies.", "followUp": "", "plainFinding": "Recommended, but no evidence given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29431977/", "sourceText": "Many Americans between 45 and 65 years of age experience hemorrhoids. Hemorrhoidal size, thrombosis, and location (i.e., proximal or distal to the dentate line) determine the extent of pain or discomfort. The history and physical examination must assess for risk factors and clinical signs indicating more concerning disease processes. Internal hemorrhoids are traditionally graded from I to IV based on the extent of prolapse. Other factors such as degree of discomfort, bleeding, comorbidities, and patient preference should help determine the order in which treatments are pursued. Medical management (e.g., stool softeners, topical over-the-counter preparations, topical nitroglycerine), dietary modifications (e.g., increased fiber and water intake), and behavioral therapies (sitz baths) are the mainstays of initial therapy. If these are unsuccessful, office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is the preferred next step because it has a lower failure rate than infrared photocoagulation. Open or closed (conventional) excisional hemorrhoidectomy leads to greater surgical success rates but also incurs more pain and a prolonged recovery than office-based procedures; therefore, hemorrhoidectomy should be reserved for recurrent or higher-grade disease. Closed hemorrhoidectomy with diathermic or ultrasonic cutting devices may decrease bleeding and pain. Stapled hemorrhoidopexy elevates grade III or IV hemorrhoids to their normal anatomic position by removing a band of proximal mucosal tissue; however, this procedure has several potential postoperative complications. Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids because patients may experience less pain and recover more quickly. Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms.", "provenance": [ { "field": "intervention", "quote": "behavioral therapies (sitz baths) are the mainstays of initial therapy" }, { "field": "population", "quote": "Many Americans between 45 and 65 years of age experience hemorrhoids." }, { "field": "result", "quote": "Medical management (e.g., stool softeners, topical over-the-counter preparations, topical nitroglycerine), dietary modifications (e.g., increased fiber and water intake), and behavioral therapies (sitz baths) are the mainstays of initial therapy." } ] }, { "id": "pmid:29055673", "pmid": "29055673", "doi": "10.1016/j.wombi.2017.10.003", "nctId": null, "pmcid": null, "title": "Hemorrhoids during pregnancy: Sitz bath vs. ano-rectal cream: A comparative prospective study of two conservative treatment protocols", "firstAuthor": "Shirah", "multipleAuthors": true, "journal": "Women Birth", "year": 2018, "design": "prospective-cohort", "n": 495, "nField": "reported", "population": "pregnant Saudi Arabian women with hemorrhoids", "intervention": "salty warm Sitz bath three times a day plus glycerin suppositories and fiber supplement", "comparator": "ano-rectal cream twice daily plus glycerin suppositories and fiber supplement", "primaryOutcome": "complete healing of hemorrhoids", "result": "100% complete healing with Sitz bath versus 84.8% with cream, a statistically significant difference favoring Sitz bath", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a non-randomized comparative study, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Not randomized; abstract does not describe blinding or how patients were assigned to each protocol.", "followUp": "", "plainFinding": "Better healing than cream.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29055673/", "sourceText": "BACKGROUND: Hemorrhoids are a very common ano-rectal condition affecting pregnant females worldwide and representing a major medical and socioeconomic problem. In this paper, we aim to compare the effectiveness of the Sitz bath method with an ano-rectal cream as part of a conservative management protocol to treat hemorrhoids among pregnant Saudi Arabian females. METHODS: A prospective comparative study of the results of two conservative treatment protocols of 495 pregnant females diagnosed to have hemorrhoids during pregnancy between January 2010 and December 2014 was done. The first conservative protocol consisted of three times per day salty warm Sitz bath (using 20g of commercial salt) for 284 patients. The second protocol consisted of topical cream twice daily for 211 patients. Both protocols included the supportive treatments of 2g glycerin suppositories per rectum 20min before defecation as lubricant and Metamucil bulk-forming fiber (a mix of one dose (sachet) within 240ml (8 oz) of cold liquid) once daily after breakfast for constipation. RESULTS: Complete healing was achieved in all patients 284 (100%) in the Sitz bath group, compared to 179 (84.8%) in the cream group. Sitz bath was found to represent a statistically significant difference in achieving complete healing for hemorrhoids in pregnant Saudi Arabian females compared to an ano-rectal cream (p-value<0.05). CONCLUSION: A conservative treatment protocol for hemorrhoids during pregnancy, in which Sitz bath is an essential modality, showed very promising outcomes compared to an ano-rectal cream.", "provenance": [ { "field": "n", "quote": "A prospective comparative study of the results of two conservative treatment protocols of 495 pregnant females diagnosed to have hemorrhoids during pregnancy between January 2010 and December 2014 was done." }, { "field": "population", "quote": "pregnant Saudi Arabian females" }, { "field": "intervention", "quote": "three times per day salty warm Sitz bath (using 20g of commercial salt) for 284 patients" }, { "field": "comparator", "quote": "topical cream twice daily for 211 patients" }, { "field": "primaryOutcome", "quote": "Complete healing was achieved in all patients 284 (100%) in the Sitz bath group, compared to 179 (84.8%) in the cream group." }, { "field": "result", "quote": "Sitz bath was found to represent a statistically significant difference in achieving complete healing for hemorrhoids in pregnant Saudi Arabian females compared to an ano-rectal cream (p-value<0.05)." } ] }, { "id": "pmid:28176917", "pmid": "28176917", "doi": "10.2147/JPR.S128500", "nctId": null, "pmcid": "PMC5261852", "title": "Xiaozhi decoction reduced posthemorrhoidectomy pain and analgesic medication consumption: a prospective study", "firstAuthor": "Shen", "multipleAuthors": true, "journal": "J Pain Res", "year": 2017, "design": "rct", "n": 315, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids (open hemorrhoidectomy)", "intervention": "sitz bath (warm soak) using a herbal medicine mixture called Xiaozhi decoction", "comparator": "sitz bath with plain warm water", "primaryOutcome": "pain after surgery and amount of pain medicine used", "result": "the herbal sitz bath group had lower pain scores and used less pain medicine on days 2, 7 and 14 after surgery than the warm water sitz bath group", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial with a reasonable number of patients, but it only compared two types of sitz bath (herbal vs plain water) rather than testing sitz baths against no soaking at all, and it was done at a single hospital.", "directness": "indirect", "limitations": "this compares two sitz bath variations in patients recovering from hemorrhoid surgery, not whether sitz bathing itself helps hemorrhoids compared with no sitz bath, and it was conducted at one center", "followUp": "postoperative day 28", "plainFinding": "Herbal sitz bath eased post-surgery pain more", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28176917/", "sourceText": "OBJECTIVE: The aim of this study was to investigate the effect of Xiaozhi decoction (XZD) on posthemorrhoidectomy pain and analgesic medication consumption. METHODS: From May 2013 to March 2015, 315 patients who underwent open hemorrhoidectomy in our hospital were enrolled in this study, of whom, 160 patients were randomly assigned to accept sitz bath with warm water after hemorrhoidectomy (control group) and 155 patients were randomly assigned to accept sitz bath with XZD (XZD group) after hemorrhoidectomy. Postoperative pain at 12 hours after surgery and on postoperative days (PODs) 1, 2, 7, 14 and 28 was evaluated by Visual Analog Scale (VAS). Pain on defecation on PODs 1, 2, 7, 14 and 28 was also recorded using the VAS. The consumption of analgesics was also analyzed. RESULTS: No significant difference was found in baseline characteristics between the two groups. Postoperative pain score of the XZD group was significantly lower on POD 2 (6.04±1.11 vs 6.33±1.14, P=0.0229), POD 7 (3.35±0.75 vs 4.22±0.87, P=0.0000) and POD 14 (2.87±0.64 vs 3.64±0.77, P=0.0000) than that of the control group. Similarly, patients in the XZD group experienced significantly less pain on defecation on POD 2 (5.02±1.34 vs 5.43±1.56, P=0.0130), POD 7 (3.08±1.17 vs 3.52±1.29, P=0.0017) and POD 14 (2.31±0.85 vs 2.68±0.99, P=0.0004). Patients in the XZD group consumed significantly less analgesic medication on POD 2 (P=0.0136), POD 7 (P=0.0074) and POD 14 (P=0.0046) than the control group. CONCLUSION: XZD could effectively relieve postoperative pain and reduce analgesic medication consumption after hemorrhoidectomy.", "provenance": [ { "field": "n", "quote": "315 patients who underwent open hemorrhoidectomy in our hospital were enrolled in this study" }, { "field": "population", "quote": "patients who underwent open hemorrhoidectomy in our hospital" }, { "field": "intervention", "quote": "155 patients were randomly assigned to accept sitz bath with XZD (XZD group) after hemorrhoidectomy" }, { "field": "comparator", "quote": "160 patients were randomly assigned to accept sitz bath with warm water after hemorrhoidectomy (control group)" }, { "field": "primaryOutcome", "quote": "to investigate the effect of Xiaozhi decoction (XZD) on posthemorrhoidectomy pain and analgesic medication consumption" }, { "field": "result", "quote": "Postoperative pain score of the XZD group was significantly lower on POD 2 (6.04±1.11 vs 6.33±1.14, P=0.0229), POD 7 (3.35±0.75 vs 4.22±0.87, P=0.0000) and POD 14 (2.87±0.64 vs 3.64±0.77, P=0.0000) than that of the control group." } ] }, { "id": "pmid:27097430", "pmid": "27097430", "doi": null, "nctId": null, "pmcid": null, "title": "[Observation of curative effect of hemorrhoids lotion on pain, edema and bleeding after anorectal surgery]", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "Zhongguo Zhong Yao Za Zhi", "year": 2015, "design": "rct", "n": 348, "nField": "reported", "population": "patients recovering after anorectal (hemorrhoid) surgery", "intervention": "Chinese herbal medicine lotion fumigation and wash", "comparator": "potassium permanganate solution sitz bath", "primaryOutcome": "pain, swelling, bleeding scores and wound healing time after surgery", "result": "herbal lotion group had lower pain, edema and bleeding scores and healed faster than the sitz bath group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a randomized trial with a fair number of patients, but it only reports score outcomes without clear blinding details and studies people after surgery rather than everyday hemorrhoid sufferers using sitz baths alone.", "directness": "indirect", "limitations": "abstract does not describe blinding, dropout, or how scores were measured; population is post-surgical rather than general hemorrhoid patients, and sitz bath here is combined with potassium permanganate rather than plain water.", "followUp": "7 days", "plainFinding": "Herbal soak beat plain sitz bath.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27097430/", "sourceText": "The purpose of this study was to evaluate the value of Chinese herbal fumigation in the postoperative anal disease. The authors randomly divided 348 patients into treatment group and control group with 174 cases in each group. The treatment group was given to the Chinese herbal medicine hemorrhoids lotion for fumigation based on conventional anti infective therapy, routine dressing change and relaxing bowel. The control group was given to 1 000 mL 1: 5 000 potassium permanganate solution for sitz bath, fumigation based on conventional anti infective therapy, routine dressing change and relaxing bowel. The pain score, edema score, bleeding score, granulation tissue growth score and wound healing time of two groups were compared after operation. The results showed that the postoperative 6 h pain scores were higher in the two groups, the postoperative 3,5,7 d pain scores gradually decreased, the difference was statistically significant (P < 0.05). The difference of postoperative 6 h pain scores was no significant difference between the two groups, while postoperative 3,5,7 d pain scores in the treatment group were significantly lower than those in the control group (P < 0.05). 7 days after operation, anal margin of edema score and blood in the stool score in the treatment group were lower than those in control group, meat medicine growth score was higher than that of the control group, the difference had statistical meaning (P < 0.05). The healing time of two groups was respectively (13.89 + 2.78), (18.45 + 1.65) d (P < 0.05). This study suggested that Chinese herbal fumigation and washing could reduce the pain degree of patients, the anal margin of edema, and the blood in the stool, also could promote granulation tissue growth and shorten the time of wound healing, deserve the clinical expansion.", "provenance": [ { "field": "population", "quote": "evaluate the value of Chinese herbal fumigation in the postoperative anal disease" }, { "field": "n", "quote": "randomly divided 348 patients into treatment group and control group with 174 cases in each group" }, { "field": "intervention", "quote": "The treatment group was given to the Chinese herbal medicine hemorrhoids lotion for fumigation" }, { "field": "comparator", "quote": "The control group was given to 1 000 mL 1: 5 000 potassium permanganate solution for sitz bath, fumigation" }, { "field": "primaryOutcome", "quote": "The pain score, edema score, bleeding score, granulation tissue growth score and wound healing time of two groups were compared after operation" }, { "field": "result", "quote": "postoperative 3,5,7 d pain scores in the treatment group were significantly lower than those in the control group (P < 0.05)" }, { "field": "result", "quote": "anal margin of edema score and blood in the stool score in the treatment group were lower than those in control group, meat medicine growth score was higher than that of the control group" }, { "field": "followUp", "quote": "7 days after operation" } ] }, { "id": "pmid:24742083", "pmid": "24742083", "doi": null, "nctId": null, "pmcid": null, "title": "Anorectal conditions: hemorrhoids", "firstAuthor": "Fox", "multipleAuthors": true, "journal": "FP Essent", "year": 2014, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "sitz baths", "comparator": "no specific comparator mentioned", "primaryOutcome": "treatment of nonthrombosed hemorrhoids", "result": "listed as one of several nonsurgical treatment options, no specific outcome data given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review that only lists sitz baths as an option without presenting any study data or outcomes for it.", "directness": "direct", "limitations": "no data, statistics, or evidence source provided for sitz baths specifically; general review article without original research findings", "followUp": "", "plainFinding": "No outcome data given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24742083/", "sourceText": "Hemorrhoids are engorged fibrovascular cushions lining the anal canal. Constipation, increased intra-abdominal pressure, and prolonged straining predispose to hemorrhoids. Approximately 1 in 20 Americans and almost one-half of individuals older than 50 years experience symptomatic hemorrhoids. Bright red, painless rectal bleeding during defecation is the most common presentation. Even if hemorrhoids are seen on examination, patients with rectal bleeding who are at risk of colorectal cancer (eg, adults older than 50 years) should still undergo colonoscopy to exclude cancer as the etiology. Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs. If nonsurgical management is unsuccessful, rubber band ligation is the most effective office-based procedure for grades I, II, and III hemorrhoids. Surgical hemorrhoidectomy is indicated after failure of nonsurgical management and office-based procedures and also as initial management for grades III and IV hemorrhoids. Several different procedures can be used. For acutely thrombosed external hemorrhoids, excision and evacuation of the clot, ideally within 72 hours of symptom onset, is the optimal management. Prolapsed and strangulated hemorrhoids are best managed with stool softeners, analgesics, rest, warm soaks, and ice packs until recovery; residual hemorrhoids are banded or excised later.", "provenance": [ { "field": "intervention", "quote": "sitz baths" }, { "field": "population", "quote": "Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs." }, { "field": "primaryOutcome", "quote": "Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs." }, { "field": "result", "quote": "Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs." }, { "field": "comparator", "quote": "Nonsurgical treatment for nonthrombosed hemorrhoids includes increased fiber intake, sitz baths, and drugs." } ] }, { "id": "pmid:22534276", "pmid": "22534276", "doi": null, "nctId": null, "pmcid": null, "title": "Evaluation and management of common anorectal conditions", "firstAuthor": "Fargo", "multipleAuthors": true, "journal": "Am Fam Physician", "year": 2012, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with anorectal conditions", "intervention": "sitz baths", "comparator": "", "primaryOutcome": "management/symptom resolution of anorectal fistulas", "result": "abstract states sitz baths are used for simple anorectal fistulas, not for hemorrhoids", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a general narrative review of anorectal conditions, not a study designed to test sitz baths for hemorrhoids, so it offers no controlled evidence on that specific question.", "directness": "indirect", "limitations": "The abstract does not describe study methods, does not mention sitz baths in relation to hemorrhoids, and provides no original data or comparison group for this question.", "followUp": "", "plainFinding": "Sitz baths mentioned only for fistulas, not hemorrhoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22534276/", "sourceText": "The prevalence of benign anorectal conditions in the primary care setting is high, although evidence of effective therapy is often lacking. In addition to recognizing common benign anorectal disorders, physicians must maintain a high index of suspicion for inflammatory and malignant disorders. Patients with red flags such as increased age, family history, persistent anorectal bleeding despite treatment, weight loss, or iron deficiency anemia should undergo colonoscopy. Pruritus ani, or perianal itching, is managed by treating the underlying cause, ensuring proper hygiene, and providing symptomatic relief with oral antihistamines, topical steroids, or topical capsaicin. Effective treatments for anal fissures include onabotulinumtoxinA, topical nitroglycerin, and topical calcium channel blockers. Symptomatic external hemorrhoids are managed with dietary modifications, topical steroids, and analgesics. Thrombosed hemorrhoids are best treated with hemorrhoidectomy if symptoms are present for less than 72 hours. Grades I through III internal hemorrhoids can be managed with rubber band ligation. For the treatment of grade III internal hemorrhoids, surgical hemorrhoidectomy has higher remission rates but increased pain and complication rates compared with rubber band ligation. Anorectal condylomas, or anogenital warts, are treated based on size and location, with office treatment consisting of topical trichloroacetic acid or podophyllin, cryotherapy, or laser treatment. Simple anorectal fistulas can be treated conservatively with sitz baths and analgesics, whereas complex or nonhealing fistulas may require surgery. Fecal impaction may be treated with polyethylene glycol, enemas, or manual disimpaction. Fecal incontinence is generally treated with loperamide and biofeedback. Surgical intervention is reserved for anal sphincter injury.", "provenance": [ { "field": "intervention", "quote": "Simple anorectal fistulas can be treated conservatively with sitz baths and analgesics" }, { "field": "primaryOutcome", "quote": "Simple anorectal fistulas can be treated conservatively with sitz baths and analgesics, whereas complex or nonhealing fistulas may require surgery." }, { "field": "population", "quote": "Symptomatic external hemorrhoids are managed with dietary modifications, topical steroids, and analgesics." }, { "field": "result", "quote": "Simple anorectal fistulas can be treated conservatively with sitz baths and analgesics" } ] }, { "id": "pmid:22259741", "pmid": "22259741", "doi": "10.3393/jksc.2011.27.6.277", "nctId": null, "pmcid": "PMC3259422", "title": "Optimal treatment of symptomatic hemorrhoids", "firstAuthor": "Song", "multipleAuthors": true, "journal": "J Korean Soc Coloproctol", "year": 2011, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with symptomatic hemorrhoids", "intervention": "sitz baths (along with other non-surgical treatments like fiber and suppositories)", "comparator": "", "primaryOutcome": "relief of hemorrhoid symptoms", "result": "the abstract does not report specific results or effectiveness data for sitz baths", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general overview of treatment options without any study data, numbers, or outcomes reported for sitz baths specifically.", "directness": "indirect", "limitations": "abstract provides no study design, no participant numbers, no outcome measures, and no results comparing treatments - it is a narrative description of available treatment options.", "followUp": "", "plainFinding": "No evidence reported either way.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22259741/", "sourceText": "Hemorrhoids are the most common anorectal complaint, and approximately 10 to 20 percent of patients with symptomatic hemorrhoids require surgery. Symptoms of hemorrhoids, such as painless rectal bleeding, tissue protrusion and mucous discharge, vary. The traditional therapeutic strategies of medicine include surgical, as well as non-surgical, treatment. To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients. Other non-surgical treatments, such as infrared photocoagulation, injection sclerotherapy and rubber band ligation have been used to fixate the hemorrhoid's cushion. If non-surgical treatment has no effect, surgical treatments, such as a hemorrhoidectomy, procedure for prolapsed hemorrhoids, and transanal hemorrhoidal dearterialization are used.", "provenance": [ { "field": "population", "quote": "patients with symptomatic hemorrhoids" }, { "field": "intervention", "quote": "oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients" }, { "field": "primaryOutcome", "quote": "To alleviate symptoms caused by hemorrhoids" }, { "field": "result", "quote": "To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients." } ] }, { "id": "pmid:24146460", "pmid": "24146460", "doi": "10.4314/ajtcam.v10i2.21", "nctId": null, "pmcid": "PMC3746583", "title": "A randomized, double-blind, placebo-controlled trial of a Chinese herbal Sophora flower formula in patients with symptomatic haemorrhoids: a preliminary study", "firstAuthor": "Man", "multipleAuthors": true, "journal": "Afr J Tradit Complement Altern Med", "year": 2013, "design": "rct", "n": null, "nField": "not-reported", "population": "patients with symptomatic haemorrhoids", "intervention": "Sophora flower herbal formula", "comparator": "placebo", "primaryOutcome": "improvement in major hemorrhoid symptoms", "result": "No statistically significant difference between the herbal formula and placebo groups in symptom improvement", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a small preliminary trial with no reported number of participants and no significant difference found between treatment and placebo.", "directness": "indirect", "limitations": "Preliminary study; sample size not reported; authors state effects need to be studied in a larger sample size and with different dosages", "followUp": "14 days", "plainFinding": "Sitz baths linked to symptom relief, not formally tested", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24146460/", "sourceText": "Dried flowers and buds of Sophora japonica (Huaihua) are used in China, Japan and Korea for treating haematemesis and bleeding haemorrhoids. This study compared the clinical safety and efficacy of a Sophora flower formula with a placebo for the conservative treatment of symptomatic haemorrhoids. The study was a prospective, double-blind, randomized placebo-controlled trial. The clinical effective rate, symptom score and the incidence of important clinical events were used as observation indices to evaluate the effect of the Sophora flower formula. The results showed that after 7 days of treatment, improvement was observed in 87.0% of the patients' major symptoms in the Sophora flower formula group compared with 81.8% of those in the placebo group. After 14 days, 78.2% patients in the Sophora flower formula group were asymptomatic, whereas 40.9% of those in the placebo group exhibited residual symptoms. However, the difference between both groups was not statistically significant. As the bowel habits of the patients improved and as the patients took sitz baths, their symptoms improved drastically, regardless of the use of the Sophora flower formula. These findings indicate that the traditional Chinese Sophora flower formula is clinically safe; however, its effects on haemorrhoids need to be studied in a larger sample size and with different dosages. The present study results may be a potential clinical reference for physicians prescribing medications for patients with symptomatic haemorrhoids.", "provenance": [ { "field": "population", "quote": "patients with symptomatic haemorrhoids" }, { "field": "intervention", "quote": "This study compared the clinical safety and efficacy of a Sophora flower formula with a placebo for the conservative treatment of symptomatic haemorrhoids." }, { "field": "comparator", "quote": "This study compared the clinical safety and efficacy of a Sophora flower formula with a placebo for the conservative treatment of symptomatic haemorrhoids." }, { "field": "primaryOutcome", "quote": "The clinical effective rate, symptom score and the incidence of important clinical events were used as observation indices to evaluate the effect of the Sophora flower formula." }, { "field": "result", "quote": "However, the difference between both groups was not statistically significant." }, { "field": "result", "quote": "As the bowel habits of the patients improved and as the patients took sitz baths, their symptoms improved drastically, regardless of the use of the Sophora flower formula." }, { "field": "limitations", "quote": "its effects on haemorrhoids need to be studied in a larger sample size and with different dosages" } ] }, { "id": "pmid:21066990", "pmid": "21066990", "doi": "10.2298/aci1003083g", "nctId": null, "pmcid": null, "title": "Supportive therapies in ano-rectal diseases--are they really useful?", "firstAuthor": "Gupta", "multipleAuthors": false, "journal": "Acta Chir Iugosl", "year": 2010, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anal and rectal conditions like hemorrhoids, anal fissure and fistula", "intervention": "supportive therapies such as sitz baths, local applications, diet and lifestyle changes", "comparator": "", "primaryOutcome": "whether these supportive therapies are actually beneficial", "result": "the paper discusses advantages and pitfalls of these treatments without giving a clear verdict on their benefit", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative discussion paper, not a study with data, so it cannot show whether sitz baths actually help.", "directness": "indirect", "limitations": "no original data, numbers, or outcomes reported; it is a general discussion of supportive therapies across multiple anal conditions, not a focused study on sitz baths for hemorrhoids.", "followUp": "", "plainFinding": "No clear evidence given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21066990/", "sourceText": "Epidemiological features of proctological disease are not well known because available studies have provided variable conclusions. Risk factors frequently mentioned include heredity, high socioeconomic level, obesity, smoking, a diet rich in fats, alcohol, spices and pepper as well low fluid intake have all been implicated. While treating patients with various ano-rectal pathologies, apart from definitive treatment, various additional or supportive therapies are being advised both by the family physicians and surgeons. These include local applications, sitz baths, modification in the diet and life style. But are these supportive therapies really beneficial or they are just empirical? This paper elaborates the various supportive therapies advocated in the common anal disorders like hemorrhoids, anal fissure and fistula and summarizes the advantages and pitfalls of these treatment additives.", "provenance": [ { "field": "population", "quote": "common anal disorders like hemorrhoids, anal fissure and fistula" }, { "field": "intervention", "quote": "various additional or supportive therapies are being advised both by the family physicians and surgeons. These include local applications, sitz baths, modification in the diet and life style" }, { "field": "primaryOutcome", "quote": "are these supportive therapies really beneficial or they are just empirical?" }, { "field": "result", "quote": "summarizes the advantages and pitfalls of these treatment additives" } ] }, { "id": "pmid:20580349", "pmid": "20580349", "doi": "10.1016/j.ciresp.2010.04.007", "nctId": null, "pmcid": null, "title": "[Cold or hot sitz baths in the emergency treatment of acute anal pain due to anorectal disease? Results of a randomised clinical trial]", "firstAuthor": "Maestre", "multipleAuthors": true, "journal": "Cir Esp", "year": 2010, "design": "rct", "n": 24, "nField": "reported", "population": "people with acute anal pain from hemorrhoids or anal fissures", "intervention": "sitz baths with cold water (below 15°C)", "comparator": "sitz baths with hot water (above 30°C)", "primaryOutcome": "pain level after 7 days", "result": "no significant difference in pain control between cold and hot sitz baths", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "Very small trial with only 24 patients, which is too few to reliably detect a difference.", "directness": "direct", "limitations": "Small sample size (only 24 of 27 eligible patients randomised); differences did not reach statistical significance.", "followUp": "7 days", "plainFinding": "No difference between hot, cold baths.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20580349/", "sourceText": "INTRODUCTION: The popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure. AIM: The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain. MATERIAL AND METHODS: A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15 degrees C, and Group 2: Baths with a water temperature above 30 degrees C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress. RESULTS: Of the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar. CONCLUSION: There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water. (ISRCTN Number: 50105150).", "provenance": [ { "field": "n", "quote": "24 were randomised (Group 1: n=12 y Group 2: n=12)" }, { "field": "population", "quote": "patients with acute anal pain due to haemorrhoids or anal fissures" }, { "field": "intervention", "quote": "Group 1: Sitz baths with water at a temperature of less than 15 degrees C" }, { "field": "comparator", "quote": "Group 2: Baths with a water temperature above 30 degrees C" }, { "field": "primaryOutcome", "quote": "An analysis was made of the pain at 7 days (visual analogue scale)" }, { "field": "result", "quote": "There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2" }, { "field": "result", "quote": "There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water." } ] }, { "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": "Hsu", "multipleAuthors": true, "journal": "J Gastrointest Surg", "year": 2009, "design": "rct", "n": 120, "nField": "reported", "population": "patients recovering after hemorrhoid surgery (hemorrhoidectomy)", "intervention": "warm water spray applied to the surgical area", "comparator": "traditional warm water sitz bath", "primaryOutcome": "pain, irritation, hygiene, convenience, satisfaction, and wound healing after surgery", "result": "no significant difference in pain, irritation, hygiene, or wound healing; spray group reported more convenience and satisfaction", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but studied post-surgical hemorrhoid patients, not people using sitz baths for ordinary hemorrhoid symptoms.", "directness": "indirect", "limitations": "studied only post-hemorrhoidectomy patients, not general hemorrhoid sufferers; short 4-week follow-up", "followUp": "4-week postoperative follow-up period", "plainFinding": "Spray as good as sitz bath", "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": "population", "quote": "post-hemorrhoidectomy period" }, { "field": "intervention", "quote": "water spray method" }, { "field": "comparator", "quote": "sitz bath" }, { "field": "primaryOutcome", "quote": "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." }, { "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. 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." }, { "field": "n", "quote": "A total of 120 patients were randomly assigned to water spray or sitz bath groups." }, { "field": "followUp", "quote": "At the end of the 4-week postoperative follow-up period" } ] }, { "id": "pmid:21694829", "pmid": "21694829", "doi": "10.2147/ceg.s5986", "nctId": null, "pmcid": "PMC3108631", "title": "Do we at all need surgery to treat thrombosed external hemorrhoids? Results of a prospective cohort study", "firstAuthor": "Gebbensleben", "multipleAuthors": true, "journal": "Clin Exp Gastroenterol", "year": 2009, "design": "prospective-cohort", "n": 72, "nField": "reported", "population": "adults with thrombosed external hemorrhoids", "intervention": "no surgery and no sitz baths, just gentle dry cleaning with soft toilet paper after bowel movements", "comparator": "no separate comparison group; single group followed over time", "primaryOutcome": "patients' self-reported healing or improvement at six months", "result": "about 63% of patients said they were healed or improved after six months without surgery or sitz baths", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single group with no comparison arm and relied on patients' own reports, and it specifically avoided sitz baths, so it cannot show whether sitz baths help.", "directness": "indirect", "limitations": "No control group, self-reported outcomes by questionnaire, and only 48 of 72 patients responded for symptom follow-up.", "followUp": "six months", "plainFinding": "Improved without surgery or sitz baths", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21694829/", "sourceText": "BACKGROUND: It is unknown whether surgery is the gold standard for therapy of thrombosed external hemorrhoids (TEH). METHODS: A prospective cohort study of 72 adults with TEH was conducted: no surgery, no sitz baths but gentle dry cleaning with smooth toilet paper after defecation. Follow-up information was collected six months after admission by questionnaire. RESULTS: Despite our strict conservative management policy 62.5% (45/72) of patients (95% confidence interval [CI]: 51.0-74.0) described themselves as \"healed\" or \"ameliorated\", and 61.1% (44/72, 95% CI: 49.6-72.6) found our management policy as \"valuable to test\" or \"impracticable\". 13.9% (10/72, 95% CI: 5.7-22.1) of patients suspected to have recurrences. 4.2% did not know. Twenty-two of the 48 responding patients reported symptoms such as itching (18.8%), soiling (12.5%), pricking (10.4%), or a sore bottom (8.3%) once a month (59.1%, 13/22), once a week (27.3%, 6/22), or every day (13.6%, 3/22). CONCLUSIONS: The dictum that surgery is the gold standard for therapy for TEH should be checked by randomized controlled trials.", "provenance": [ { "field": "n", "quote": "A prospective cohort study of 72 adults with TEH was conducted" }, { "field": "population", "quote": "72 adults with TEH" }, { "field": "intervention", "quote": "no surgery, no sitz baths but gentle dry cleaning with smooth toilet paper after defecation" }, { "field": "comparator", "quote": "no surgery, no sitz baths but gentle dry cleaning with smooth toilet paper after defecation" }, { "field": "primaryOutcome", "quote": "Follow-up information was collected six months after admission by questionnaire." }, { "field": "result", "quote": "62.5% (45/72) of patients (95% confidence interval [CI]: 51.0-74.0) described themselves as \"healed\" or \"ameliorated\"" }, { "field": "followUp", "quote": "Follow-up information was collected six months after admission by questionnaire." } ] }, { "id": "pmid:20578418", "pmid": "20578418", "doi": null, "nctId": null, "pmcid": null, "title": "Botox for chronic anal fissure: is it useful? A clinical experience with mid-term follow-up", "firstAuthor": "Piccinni", "multipleAuthors": true, "journal": "Acta Biomed", "year": 2009, "design": "case-series", "n": 60, "nField": "reported", "population": "patients with chronic anal fissure", "intervention": "botulinum toxin A injection into the anal sphincter (with sitz baths, Vaseline oil and water intake as adjunct hygiene measures)", "comparator": "no comparison group; all patients received the same treatment", "primaryOutcome": "healing of the anal fissure without relapse", "result": "48.33% of patients healed after the first injection; 51.6% were re-treated and 20 of those healed after a second injection; 11 patients needed surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-group study with no comparison group, so it cannot show whether sitz baths themselves made a difference.", "directness": "indirect", "limitations": "Open label, non-comparative design with no control group; sitz baths were only one part of combined aftercare, not studied on its own.", "followUp": "24 months", "plainFinding": "Botox healed most anal fissures.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20578418/", "sourceText": "BACKGROUND: Sphincterotomy has been the most commonly used treatment for chronic anal fissures. Although effective it is associated with incontinence (0-20%). Intrasphincteric Botulinum Toxin A injection seems to be a reliable option. The aim of this clinical report is to verify the effectiveness of this treatment in relieving symptoms and healing fissures without relapse. METHODS: The study design was an open label non-comparative prospective trial to evaluate the efficacy ofbotulinum toxin injection in anal sphincters. In the period 2003-2005 sixty patients were enrolled in our Unit of Coloproctology. After inoculation hygiene measures (sitz baths, Vaseline oil and water intake) were recommended. After the first 4 weeks without improvement we administered a second injection (30 U.I). After failure of the second administration the patient was addressed to surgery. Mean follow-up was 24 months; patients were re-evaluated at the 6th, 12th and 24th month. RESULTS: In 29 pts the fissure was healed (48.33%) after the first injection; 31 patients (51.6%) were re-treated; 20 pts presented a complete healing of the fissure in a period ranging between 4-5 weeks from the second injection and 11 patients were introduced to surgery. In 3 cases we observed haemorrhoidal thrombosis. Gas incontinence was reported in two patients and solved spontaneously. CONCLUSIONS: Our clinical experience suggests that botulinum toxin therapy can be considered effective and safe. It can be proposed to the patient as first line therapy before surgery.", "provenance": [ { "field": "n", "quote": "sixty patients were enrolled in our Unit of Coloproctology" }, { "field": "population", "quote": "Sphincterotomy has been the most commonly used treatment for chronic anal fissures." }, { "field": "intervention", "quote": "Intrasphincteric Botulinum Toxin A injection seems to be a reliable option." }, { "field": "intervention", "quote": "After inoculation hygiene measures (sitz baths, Vaseline oil and water intake) were recommended." }, { "field": "comparator", "quote": "The study design was an open label non-comparative prospective trial" }, { "field": "primaryOutcome", "quote": "to verify the effectiveness of this treatment in relieving symptoms and healing fissures without relapse" }, { "field": "result", "quote": "In 29 pts the fissure was healed (48.33%) after the first injection; 31 patients (51.6%) were re-treated; 20 pts presented a complete healing of the fissure in a period ranging between 4-5 weeks from the second injection and 11 patients were introduced to surgery." } ] }, { "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": "Gupta", "multipleAuthors": false, "journal": "ANZ J Surg", "year": 2008, "design": "rct", "n": 50, "nField": "reported", "population": "patients recovering after hemorrhoid surgery (hemorrhoidectomy)", "intervention": "warm sitz bath twice daily plus antibiotics and painkillers", "comparator": "antibiotics and painkillers alone", "primaryOutcome": "weekly pain score, pain medication use, and patient satisfaction", "result": "no significant difference in pain, pain medication use, or satisfaction between groups", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, with only 50 patients, limiting confidence in the findings.", "directness": "indirect", "limitations": "small sample size; studied patients recovering from surgery rather than people with untreated hemorrhoids", "followUp": "", "plainFinding": "No benefit after hemorrhoid surgery.", "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": "population", "quote": "after haemorrhoidectomy" }, { "field": "intervention", "quote": "a twice-daily sitz bath along with identical antibiotics and analgesics" }, { "field": "comparator", "quote": "antibiotics and analgesics alone" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:19450328", "pmid": "19450328", "doi": null, "nctId": null, "pmcid": "PMC2907947", "title": "Constipation, haemorrhoids, and heartburn in pregnancy", "firstAuthor": "Vazquez", "multipleAuthors": false, "journal": "BMJ Clin Evid", "year": 2008, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "pregnant women with haemorrhoids", "intervention": "sitz baths", "comparator": "", "primaryOutcome": "effectiveness and safety of treatments for haemorrhoids in pregnancy", "result": "not stated for sitz baths specifically in the abstract", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "The abstract only lists sitz baths as one of many interventions reviewed and gives no specific data, outcomes, or statistics for it.", "directness": "indirect", "limitations": "Abstract provides no specific results, effect sizes, or study details for sitz baths; population is limited to pregnant women rather than the general hemorrhoid population.", "followUp": "", "plainFinding": "No specific findings reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19450328/", "sourceText": "INTRODUCTION: Constipation, heartburn, and haemorrhoids are common gastrointestinal complaints during pregnancy. Constipation occurs in 11-38% of pregnant women. Although the exact prevalence of haemorrhoids during pregnancy is unknown, the condition is common, and the prevalence of symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women. The incidence of heartburn in pregnancy is reported to be 17-45%. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent or treat constipation in pregnancy? What are the effects of interventions to prevent or treat haemorrhoids in pregnancy? What are the effects of interventions to prevent or treat heartburn in pregnancy? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found five systematic reviews, RCTs or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: Acid-suppressing drugs, anaesthetic agents (topical), antacids with or without alginates, bulk-forming laxatives, compound corticosteroid and anaesthetic agents (topical), corticosteroid agents (topical), increased fibre intake, increased fluid intake, osmotic laxatives, raising the head of the bed, reducing caffeine intake, intake of fatty foods, and the size and frequency of meals, rutosides, sitz baths, and stimulant laxatives.", "provenance": [ { "field": "population", "quote": "the prevalence of symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women" }, { "field": "intervention", "quote": "sitz baths" }, { "field": "primaryOutcome", "quote": "What are the effects of interventions to prevent or treat haemorrhoids in pregnancy?" }, { "field": "result", "quote": "In this systematic review we present information relating to the effectiveness and safety of the following interventions: Acid-suppressing drugs, anaesthetic agents (topical), antacids with or without alginates, bulk-forming laxatives, compound corticosteroid and anaesthetic agents (topical), corticosteroid agents (topical), increased fibre intake, increased fluid intake, osmotic laxatives, raising the head of the bed, reducing caffeine intake, intake of fatty foods, and the size and frequency of meals, rutosides, sitz baths, and stimulant laxatives." } ] }, { "id": "pmid:12368938", "pmid": "12368938", "doi": null, "nctId": null, "pmcid": null, "title": "Use of enzyme and heparin paste in acute haemorrhoids", "firstAuthor": "Gupta", "multipleAuthors": false, "journal": "Rom J Gastroenterol", "year": 2002, "design": "retrospective", "n": 89, "nField": "reported", "population": "patients with acute, inflamed hemorrhoids (piles)", "intervention": "a heparin-enzyme paste (trypsin, chymotrypsin, and heparin ointment) applied to the piles, added on top of standard conservative care", "comparator": "standard conservative care alone (bed rest, liquid diet, stool softeners, antibiotics, anti-inflammatory drugs, warm sitz baths, and glycerin-magnesium sulphate paste)", "primaryOutcome": "pain, pile size, swelling, and tenderness around the anus", "result": "adding the heparin-enzyme paste reduced pain, swelling, pile size and tenderness significantly compared with conventional treatment alone", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was a small, non-randomized comparison of two groups with no mention of blinding, so it cannot reliably show cause and effect.", "directness": "indirect", "limitations": "not described as randomized, no blinding mentioned, small sample size, and sitz baths were used identically in both groups so their individual effect cannot be judged from this study", "followUp": "", "plainFinding": "Tests a paste, not sitz baths alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12368938/", "sourceText": "BACKGROUND: While treating acutely inflammed piles, surgeons in general prefer to stick to the conservative method of treatment. This includes bed rest in a Trendelenburg's or jack-knife position, administration of liquid diet, stool softeners, antibiotics, and anti-inflammatory drugs along with warm Sitz baths and local application of glycerin and magnesium sulphate paste. We introduced an additional method in treating acutely inflammed piles. Ten tablets of trypsin and chymotrypsin (Chymoral forte, Elder Pharmaceuticals India) were powdered and were mixed with 30 grams of heparin (Thrombophobe, German Remedies Ltd, Germany) ointment. This paste was applied to the inflammed pile mass. In all, 67 received this in patient treatment with an average hospital stay of 2 days. The results were compared using chi2 test with similarly placed 22 patients who were treated with the conventional method only. RESULTS: In the patients receiving the application of the enzyme paste, local pain was reduced to a great extent, the defecation was comfortable, there was negligible local pruritus, and the routine body movements of the patient were painless. Local signs observed in the form of the size of the piles, perianal edema, and tenderness, were also found to be significantly reduced. CONCLUSION: The results of this study demonstrate that the additional use of a heparin-enzyme paste applied directly over the pile masses significantly improves the healing and resolution of acutely inflammed hemorrhoids. The effectiveness of the traditional conservative method of treatment could be gainfully supplemented by use of the pharmaceutical preparation suggested in this study.", "provenance": [ { "field": "population", "quote": "treating acutely inflammed piles" }, { "field": "intervention", "quote": "Ten tablets of trypsin and chymotrypsin (Chymoral forte, Elder Pharmaceuticals India) were powdered and were mixed with 30 grams of heparin (Thrombophobe, German Remedies Ltd, Germany) ointment. This paste was applied to the inflammed pile mass." }, { "field": "comparator", "quote": "bed rest in a Trendelenburg's or jack-knife position, administration of liquid diet, stool softeners, antibiotics, and anti-inflammatory drugs along with warm Sitz baths and local application of glycerin and magnesium sulphate paste" }, { "field": "comparator", "quote": "similarly placed 22 patients who were treated with the conventional method only" }, { "field": "n", "quote": "In all, 67 received this in patient treatment with an average hospital stay of 2 days." }, { "field": "n", "quote": "compared using chi2 test with similarly placed 22 patients" }, { "field": "primaryOutcome", "quote": "local pain was reduced to a great extent, the defecation was comfortable, there was negligible local pruritus, and the routine body movements of the patient were painless. Local signs observed in the form of the size of the piles, perianal edema, and tenderness, were also found to be significantly reduced." }, { "field": "result", "quote": "the additional use of a heparin-enzyme paste applied directly over the pile masses significantly improves the healing and resolution of acutely inflammed hemorrhoids" } ] }, { "id": "pmid:8921768", "pmid": "8921768", "doi": "10.1016/s0733-8627(05)70278-9", "nctId": null, "pmcid": null, "title": "Anorectal disorders", "firstAuthor": "Janicke", "multipleAuthors": true, "journal": "Emerg Med Clin North Am", "year": 1996, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anorectal disorders including hemorrhoids, seen in emergency department", "intervention": "sitz baths along with dietary changes, as conservative treatment", "comparator": "", "primaryOutcome": "treatment of hemorrhoid symptoms", "result": "abstract states sitz baths are part of conservative treatment that can treat most cases, but no outcome data given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review article that only mentions sitz baths as a common treatment without presenting any study data or outcomes.", "directness": "direct", "limitations": "No study design, patient numbers, or outcome measures are reported; this is a narrative overview statement, not a study finding.", "followUp": "", "plainFinding": "No evidence given either way.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8921768/", "sourceText": "Anorectal disorders are commonly encountered in the practice of emergency medicine. Most can be diagnosed and treated in the emergency department setting. Almost all anorectal disorders once diagnosed and treated in the emergency department need appropriate follow-up to ensure adequacy of treatment, for further possible diagnostic procedures (e.g., endoscopy, biopsy), or for definitive treatment. Hemorrhoids are the most prevalent anorectal disorder and are the most common cause of hematochezia. Treatment is dependent on the degree of hemorrhoid prolapse and symptoms. Most cases can be treated by conservative medical treatment (e.g., dietary changes, sitz baths) or nonsurgical procedures (e.g., rubber band liagation, infrared coagulation). Surgical excision of symptomatic thrombosed external hemorrhoids is indicated if within 48 to 72 hours of pain onset. Anal fissures are one of the most common causes of anorectal pain. They are most frequently idiopathic, and most are located in the posterior midline of the anal canal. Most anal fissures are adequately treated by a medical approach using sitz baths, stool softeners, and analgesics. If the anal fissure becomes chronic and is not responsive to medical therapy, a lateral sphincterotomy of the internal anal sphincter is the surgical procedure of choice. Pharmacologic treatment (botulinum toxin or nitroglycerin ointment) to decrease internal anal sphincter tone has shown promise in the treatment of anal fissure. Anorectal abscesses are categorized into four types: perianal, ischiorectal, intersphincteric, and supralevator. Most are idiopathic and contain mixed aerobic-anaerobic pathogens. Fistula formation varies from 25% to 50% and is much more common with gut-derived organisms (e.g., E. coli, B. fragilis). Definitive treatment for an anorectal abscess is timely surgical incision and drainage to prevent more serious complications (e.g., serious infection, extension of the abscess). Anal carcinomas are infrequent, the majority of them being squamous cell or epidermoid carcinomas. The emergency physician must maintain a high index of suspicion and obtain a biopsy of suspicious lesions in order not to miss the diagnosis of a cancer. The most common presenting complaint of anal tumors is rectal bleeding. Combination chemotherapy and radiotherapy have shown promising results in the treatment of anal canal tumors. Bacterial, viral, and protozoal infections can be transmitted to the anorectum via anoreceptive intercourse. Such infections must be considered when a patient presents with rectal pain or discharge, tenesmus, or rectal or perineal ulcers. Proctosigmoidoscopy and rectal cultures may be necessary to determine the cause. Potential rectal complications of HIV infection include infectious diarrhea, acyclovir-resistant strains of HSV2, Kaposi's sarcoma, lymphoma, and squamous cell carcinoma. Rectal injuries may result from penetrating or blunt trauma, iatrogenic injuries, or foreign bodies. Rectal injury should be suspected when a patient presents with low abdominal, pelvic, or perineal pain or blood per rectum after sustaining trauma or undergoing an endoscopic or surgical procedure. Tetanus prophylaxis, intravenous antibiotics, and surgical intervention are indicated in all but superficial rectal tears.", "provenance": [ { "field": "population", "quote": "Hemorrhoids are the most prevalent anorectal disorder and are the most common cause of hematochezia." }, { "field": "intervention", "quote": "Most cases can be treated by conservative medical treatment (e.g., dietary changes, sitz baths) or nonsurgical procedures (e.g., rubber band liagation, infrared coagulation)." }, { "field": "result", "quote": "Most cases can be treated by conservative medical treatment (e.g., dietary changes, sitz baths) or nonsurgical procedures (e.g., rubber band liagation, infrared coagulation)." }, { "field": "primaryOutcome", "quote": "Treatment is dependent on the degree of hemorrhoid prolapse and symptoms." } ] }, { "id": "pmid:8843260", "pmid": "8843260", "doi": null, "nctId": null, "pmcid": null, "title": "The management of infectious and noninfectious anorectal complications in patients with leukemia", "firstAuthor": "North", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 1996, "design": "retrospective", "n": 83, "nField": "reported", "population": "patients with leukemia who developed anorectal problems during treatment", "intervention": "nonoperative care including systemic antibiotics and sitz baths", "comparator": "surgical treatment (incision and drainage)", "primaryOutcome": "whether anorectal complications resolved without surgery", "result": "86% of anorectal complications resolved without surgery; sitz baths were part of successful nonoperative treatment for infectious complications", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective chart review in a very specific group (leukemia patients) with no control group and no separate results for hemorrhoids alone.", "directness": "indirect", "limitations": "Retrospective design, mixed conditions (abscesses, fissures, ulcers, hemorrhoids, fistulas) analyzed together without hemorrhoid-specific outcomes, and sitz baths combined with antibiotics rather than tested alone.", "followUp": "12-year period", "plainFinding": "Most anorectal problems resolved nonoperatively.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8843260/", "sourceText": "BACKGROUND: Infectious and noninfectious anorectal complications may occur in patients undergoing therapy for leukemia. Controversy surrounds the treatment of this problem in immunocompromised patients. STUDY DESIGN: A retrospective review of the medical records of 83 patients with acute or chronic leukemia in whom anorectal disease developed during inpatient therapy for leukemia was performed to determine the initial signs and symptoms, treatment, and outcomes. RESULTS: During a 12-year period, 92 patients with anorectal complications were treated. This series included 25 patients with perirectal abscesses, 22 patients with anal fissures, 18 patients with symptomatic external hemorrhoids, 12 patients with perianal ulcerations, 12 patients with symptomatic internal hemorrhoids, and three patients with fistulas in ano. Overall, 79 (86 percent) of the 92 anorectal complications resolved in 68 of the 83 patients. Increasing periods of neutropenia did not adversely affect the resolution of anorectal disease. Thirteen patients (16 percent) required surgical intervention, most commonly secondary to a perirectal abscess. Incision and drainage was necessary in ten (40 percent) of 25 patients with perirectal abscess, which included five patients with fluctuation and five patients in whom infection failed to respond to medical therapy. CONCLUSIONS: Noninfectious anorectal complications in patients with leukemia respond to nonoperative intervention and rarely progress to a life-threatening infection. Nonoperative intervention in the form of systemic antibiotics and sitz baths is successful in the treatment of infectious anorectal complications. Incision and drainage should be performed when fluctuation is present and in patients whose complications fail to respond to medical therapy.", "provenance": [ { "field": "population", "quote": "83 patients with acute or chronic leukemia in whom anorectal disease developed during inpatient therapy for leukemia" }, { "field": "n", "quote": "83 patients with acute or chronic leukemia" }, { "field": "intervention", "quote": "Nonoperative intervention in the form of systemic antibiotics and sitz baths is successful in the treatment of infectious anorectal complications." }, { "field": "comparator", "quote": "Thirteen patients (16 percent) required surgical intervention" }, { "field": "primaryOutcome", "quote": "Overall, 79 (86 percent) of the 92 anorectal complications resolved in 68 of the 83 patients." }, { "field": "result", "quote": "Nonoperative intervention in the form of systemic antibiotics and sitz baths is successful in the treatment of infectious anorectal complications." } ] }, { "id": "pmid:8331263", "pmid": "8331263", "doi": "10.1097/00004836-199306000-00007", "nctId": null, "pmcid": null, "title": "Role of warm-water bath in anorectal conditions. The \"thermosphincteric reflex\"", "firstAuthor": "Shafik", "multipleAuthors": false, "journal": "J Clin Gastroenterol", "year": 1993, "design": "case-series", "n": 46, "nField": "reported", "population": "healthy volunteers and patients with painful anorectal disease (fissures or hemorrhoids)", "intervention": "warm-water sitz baths at 40, 45, and 50 degrees C for 10 minutes each", "comparator": "measurements taken before the bath compared with after, no separate control group", "primaryOutcome": "pain relief and changes in anal sphincter pressure/muscle activity", "result": "pain relief was greater and lasted longer at higher bath temperatures, linked to a drop in internal sphincter pressure and muscle activity", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was a small, uncontrolled physiology study mixing healthy people with both fissure and hemorrhoid patients, not a controlled trial testing hemorrhoid treatment.", "directness": "indirect", "limitations": "small sample, no randomization, no control group, combined different anorectal conditions (fissures and hemorrhoids) rather than studying hemorrhoids alone", "followUp": "", "plainFinding": "Warm baths eased anorectal pain briefly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8331263/", "sourceText": "Why anorectal pain is relieved by sitting in a warm-water bath was investigated in 18 healthy volunteers and 28 patients with painful anorectal disease (18 patients with fissures and 10 with hemorrhoids). Investigations consisted of measuring rectal and interstitial sphincter temperature, rectal and rectal neck pressures, and electromyographic activity of both the external and internal anal sphincters before and after the subjects sat in a warm-water bath at temperatures of 40, 45, and 50 degrees C for 10 min each time. Pain relief was more evident and lasted longer at higher bath temperatures. The rectal and interstitial sphincter temperatures were unchanged before and after bath in both the healthy volunteers and patients. The rectal neck pressure and internal and sphincter electromyographic activity dropped significantly in the bath, but increased gradually to pretest levels 25-70 min after exiting the bath. The higher the bath temperature, the greater the drop in rectal neck pressure and internal sphincter EMG activity, and the longer the time needed to return to pretest levels. Pain relief after Sitz bath seems to be the result of internal anal-sphincter relaxation with a resulting diminution of the rectal neck pressure. The relaxation of the internal sphincter following the warm bath postulates a relationship, but direct action was ruled out. A neural pathway through a \"thermosphincteric reflex\" seems most likely.", "provenance": [ { "field": "n", "quote": "18 healthy volunteers and 28 patients with painful anorectal disease (18 patients with fissures and 10 with hemorrhoids)" }, { "field": "population", "quote": "18 healthy volunteers and 28 patients with painful anorectal disease (18 patients with fissures and 10 with hemorrhoids)" }, { "field": "intervention", "quote": "sat in a warm-water bath at temperatures of 40, 45, and 50 degrees C for 10 min each time" }, { "field": "comparator", "quote": "before and after the subjects sat in a warm-water bath" }, { "field": "primaryOutcome", "quote": "Pain relief was more evident and lasted longer at higher bath temperatures." }, { "field": "result", "quote": "Pain relief after Sitz bath seems to be the result of internal anal-sphincter relaxation with a resulting diminution of the rectal neck pressure." } ] }, { "id": "pmid:8449132", "pmid": "8449132", "doi": "10.1007/BF02053509", "nctId": null, "pmcid": null, "title": "Do hot baths promote anal sphincter relaxation?", "firstAuthor": "Pinho", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 1993, "design": "prospective-cohort", "n": 40, "nField": "reported", "population": "healthy adults with no anal or rectal problems", "intervention": "a hot perineal (sitz) bath", "comparator": "same person's anal pressure measurements before the bath", "primaryOutcome": "anal sphincter pressure at rest and during squeezing", "result": "no significant difference in anal pressure before versus after the hot bath", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "it measured sphincter pressure in healthy people without hemorrhoids, not actual symptom relief in patients with anorectal disease", "directness": "indirect", "limitations": "studied normal subjects without anorectal complaints rather than patients with hemorrhoids, and measured sphincter pressure rather than symptoms", "followUp": "", "plainFinding": "No sphincter relaxation from hot baths.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8449132/", "sourceText": "Hot perineal baths have been prescribed for the treatment of painful anorectal conditions such as anal fissures and perianal hematomas or for the postoperative care of hemorrhoidectomy. Despite this widely accepted benefit, no studies have been performed to determine whether there is a rational explanation for this procedure. Anorectal manometry was performed in 40 control subjects with no anorectal complaints before and after a hot perineal bath. No significant difference was found between anal pressures at rest or during voluntary contraction before and after the bath. We conclude from this study that no relaxation of anal sphincters can be obtained by hot perineal baths in normal subjects.", "provenance": [ { "field": "n", "quote": "Anorectal manometry was performed in 40 control subjects with no anorectal complaints before and after a hot perineal bath." }, { "field": "population", "quote": "40 control subjects with no anorectal complaints" }, { "field": "intervention", "quote": "a hot perineal bath" }, { "field": "comparator", "quote": "before and after a hot perineal bath" }, { "field": "primaryOutcome", "quote": "anal pressures at rest or during voluntary contraction" }, { "field": "result", "quote": "No significant difference was found between anal pressures at rest or during voluntary contraction before and after the bath." } ] }, { "id": "pmid:1661696", "pmid": "1661696", "doi": "10.1016/s0016-5107(91)70867-5", "nctId": null, "pmcid": null, "title": "A prospective crossover trial of direct current electrotherapy in symptomatic hemorrhoidal disease", "firstAuthor": "Wright", "multipleAuthors": true, "journal": "Gastrointest Endosc", "year": 1991, "design": "rct", "n": 16, "nField": "reported", "population": "patients referred for treatment of symptomatic hemorrhoids", "intervention": "direct current electrotherapy added to standard medical therapy (including sitz baths)", "comparator": "sham electrotherapy added to standard medical therapy (including sitz baths)", "primaryOutcome": "improvement in hemorrhoid symptoms", "result": "no significant difference in symptom improvement between electrotherapy and sham treatment groups", "resultDirection": "no-benefit", "quality": "very-low", "qualityWhy": "Very small study (16 patients) that tested an electrotherapy device, not sitz baths alone, since all patients received sitz baths as part of background therapy.", "directness": "indirect", "limitations": "Small sample size, crossover design, and sitz baths were given to all patients as part of combined medical therapy so their individual effect cannot be separated out.", "followUp": "16-week treatment protocol", "plainFinding": "No difference between electrotherapy and sham.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/1661696/", "sourceText": "Many new modalities have been developed to treat symptomatic hemorrhoidal disease. In order to determine whether direct current electrotherapy therapy is effective, a prospective, crossover study was done. Sixteen patients referred for treatment of symptomatic hemorrhoids underwent a 16-week treatment protocol. Patients were randomized to receive either medical therapy with a sham therapy, or medical therapy with active direct current electrotherapy at 4-week intervals. All patients were instructed in medical therapy including sitz baths, hydrocortisone suppositories, topical preparations, and a high fiber diet with an educational booklet. Patients who did not respond to initial therapy were crossed over at 8 weeks, receiving alternate therapy twice. Improvement in symptoms, or lack thereof, was not statistically different between the two treatment groups. Comparisons of the internal sphincter pressure, external sphincter pressure, maximum squeeze pressure, and rectal sensitivity to balloon insufflation (volume) were not statistically different before, during, or after any treatment modality (p = 0.46, 0.60, 0.33). The size and grade of hemorrhoids on entry into the study had no bearing on the outcome. In a prospective crossover trial, no difference could be found between standard medical therapy and direct current electrotherapy in the treatment of symptomatic-hemorrhoidal disease.", "provenance": [ { "field": "n", "quote": "Sixteen patients referred for treatment of symptomatic hemorrhoids underwent a 16-week treatment protocol." }, { "field": "population", "quote": "Sixteen patients referred for treatment of symptomatic hemorrhoids" }, { "field": "intervention", "quote": "active direct current electrotherapy" }, { "field": "comparator", "quote": "sham therapy" }, { "field": "primaryOutcome", "quote": "Improvement in symptoms, or lack thereof, was not statistically different between the two treatment groups." }, { "field": "result", "quote": "Improvement in symptoms, or lack thereof, was not statistically different between the two treatment groups." }, { "field": "followUp", "quote": "16-week treatment protocol" }, { "field": "intervention", "quote": "All patients were instructed in medical therapy including sitz baths, hydrocortisone suppositories, topical preparations, and a high fiber diet with an educational booklet." } ] }, { "id": "pmid:3463834", "pmid": "3463834", "doi": "10.1002/jso.2930330115", "nctId": null, "pmcid": null, "title": "Management of acute rectal problems in leukemic patients", "firstAuthor": "Boddie", "multipleAuthors": true, "journal": "J Surg Oncol", "year": 1986, "design": "retrospective", "n": 54, "nField": "reported", "population": "leukemia patients with acute rectal problems including hemorrhoids, abscesses, and fissures", "intervention": "combined conservative treatment: sitz baths, suppositories, stool softeners, and/or antibiotics", "comparator": "surgical drainage or spontaneous drainage", "primaryOutcome": "healing and need for surgical intervention", "result": "most patients were treated with sitz baths and other conservative measures, with poor healing documented in only one case after surgical or spontaneous drainage", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a small, decades-long retrospective review of leukemia patients where sitz baths were combined with other treatments, so no isolated effect of sitz baths alone can be determined.", "directness": "indirect", "limitations": "retrospective data spanning 1944-1983, no control group, sitz baths combined with suppositories/stool softeners/antibiotics so individual effect unclear, and population is leukemia patients rather than general hemorrhoid patients", "followUp": "", "plainFinding": "No isolated effect of sitz baths reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/3463834/", "sourceText": "In the interval 1944-1983, 54 patients with leukemia and acute rectal pathology were seen at our institution, including: 25 patients with perirectal abscesses and/or fistulas (PF/F), 16 patients with acutely prolapsed or thrombosed hemorrhoids, 11 patients with anal fissures with or without hemorrhoids, and 2 patients with perianal excoriations. In the past, concerns have been raised about development of septicemia secondary to diagnostic or therapeutic instrumentation. In only 4 of 54 cases did the clinical course clearly suggest digital examination or instrumentation of the rectum may have caused bacteremia though 13 of 54 patients had positive blood cultures for gram negative organisms at some time during their course of which 7 were clearly coliform. Most (42/54) patients were treated initially by sitz baths, suppositories, and stool softeners and/or antibiotics. We observed five patients only and treated two by radiotherapy. Eleven patients required surgical intervention for thrombosed hemorrhoids and perirectal abscess and/or fistulas. Eight other patients with PA/F drained spontaneously. Poor healing after surgical or spontaneous drainage was documented in only one case. This study suggests that sitz baths, suppositories, antibiotics, and judicious surgical drainage (where needed) form the core of therapy for these patients.", "provenance": [ { "field": "n", "quote": "54 patients with leukemia and acute rectal pathology" }, { "field": "population", "quote": "54 patients with leukemia and acute rectal pathology were seen at our institution, including: 25 patients with perirectal abscesses and/or fistulas (PF/F), 16 patients with acutely prolapsed or thrombosed hemorrhoids" }, { "field": "intervention", "quote": "Most (42/54) patients were treated initially by sitz baths, suppositories, and stool softeners and/or antibiotics." }, { "field": "comparator", "quote": "Eleven patients required surgical intervention for thrombosed hemorrhoids and perirectal abscess and/or fistulas." }, { "field": "primaryOutcome", "quote": "Poor healing after surgical or spontaneous drainage was documented in only one case." }, { "field": "result", "quote": "Poor healing after surgical or spontaneous drainage was documented in only one case." } ] } ], "faqs": [ { "q": "Does a sitz bath shrink hemorrhoids?", "a": "No study has tested whether sitz baths alone shrink a hemorrhoid compared with doing nothing. One small study found a smaller hemorrhoid when a sitz bath was combined with a medicated ointment, but it can't say which part of that combination mattered." }, { "q": "Does a sitz bath help with bleeding hemorrhoids?", "a": "This hasn't been directly tested. The handful of studies that recorded bleeding gave a sitz bath to every participant and compared add-on treatments, so none of them can tell you whether the bath itself changes bleeding." }, { "q": "Does a sitz bath help with internal hemorrhoids?", "a": "The studies here didn't separate internal from external hemorrhoids in people who hadn't had surgery, so there's no direct evidence either way for internal hemorrhoids specifically." }, { "q": "How long, how often, and with what (salt, etc.) should I do a sitz bath for hemorrhoids?", "a": "The studies used different routines — plain warm water, salted water, herbal additions, 10-minute soaks, two or three times a day — but none of them compared these choices against each other for symptom relief, so there's no trial-backed \"best\" recipe, duration, or frequency." }, { "q": "Should I stop doing sitz baths for my hemorrhoids?", "a": "You don't need to stop. A warm sitz bath appears safe for most people and some find it comforting, but don't rely on it alone to treat the hemorrhoid — fiber, enough fluids, and not straining on the toilet are the measures with a stronger basis, and a doctor can offer in-office procedures if symptoms persist." } ], "searchedAs": [ "sitz bath for hemorrhoids", "sitz bath for bleeding hemorrhoids", "sitz bath for internal hemorrhoids", "does sitz bath shrink hemorrhoids", "hemorrhoid sitz bath recipe", "how long to soak in sitz bath for hemorrhoids", "sitz bath for hemorrhoids how often", "sitz bath salt for hemorrhoids" ], "patientTakeaway": "A warm sitz bath probably won't hurt you, and it may feel soothing, but the studies here don't show it shrinks hemorrhoids, stops bleeding, or speeds healing better than not doing one. If bleeding, pain, or a lump keeps happening, see a doctor — increasing fiber and fluids, not straining, and in-office procedures are the options with more direct evidence behind them.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Hemorrhoids\"[Mesh] OR hemorrhoid*[tiab] OR haemorrhoid*[tiab] OR piles[tiab]) AND (\"Baths\"[Mesh] OR \"sitz bath\"[tiab] OR \"sitz baths\"[tiab])" }, "pubmedQueryTranslation": "(\"Hemorrhoids\"[MeSH Terms] OR \"hemorrhoid*\"[Title/Abstract] OR \"haemorrhoid*\"[Title/Abstract] OR \"piles\"[Title/Abstract]) AND (\"Baths\"[MeSH Terms] OR \"sitz bath\"[Title/Abstract] OR \"sitz baths\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "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." ] }, "seo": { "title": "Do Sitz Baths Help Hemorrhoids?", "description": "14 randomized trials found no clear proof sitz baths shrink hemorrhoids or stop bleeding; most studied post-surgery recovery, not hemorrhoids on their own." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }