Evaluation of Different Sitz Bath Methods as a Treatment Modality in Acute Anal Fissure

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Abstract
Background: Conservative management of anal fissure mainly involves Sitz Bath as a treatment modality. Considering the controversies in the application of Sitz bath in treatment of anal fissure, lack of adequate scientific evidence, this study is designed to evaluate the efficacy of Sitz Bath as a treatment modality. Aim & Objectives: The study evaluates the efficacy of Sitz Bath in the treatment of acute anal fissure with respect to pain relief, patient satisfaction, healing of lesions and overall improvement in symptomatology, as well as to assess its effect on the Quality of Life of these patients. Materials and Methods: This is a prospective study of 60 patients of acute anal fissure carried out over 2 years with three groups - Group A1 (Warm Sitz Bath with analgesics and high fiber diet), Group A2 (Cold Sitz Bath with analgesics and high fiber diet) and Group B (Analgesics and high fiber diet alone). Results: The evaluation parameters were: assessment of pain, patient satisfaction score and improvement in symptomatology. Warm sitz bath resulted in significant reduction in pain scores, greater improvement in symptomatology and patient satisfaction scores. Conclusion: An overall improvement in symptomatology is evident with the use of warm sitz bath, thereby giving more patient satisfaction.
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JKIMSU, Vol. 5, No. 1, January-March, 2016
54
ORIGINAL ARTICLE
ISSN 2231-4261
Journal of Krishna Institute of Medical Sciences University
c
Abstract :
Background: Conservative management of anal
fissure mainly involves Sitz Bath as a treatment
modality. Considering the controversies in the
application of Sitz bath in treatment of anal fissure,
lack of adequate scientific evidence, this study is
designed to evaluate the efficacy of Sitz Bath as a
treatment modality. Aim & Objectives: The study
evaluates the efficacy of Sitz Bath in the treatment of
acute anal fissure with respect to pain relief, patient
sat i s fact i o n, heal i ng of lesi o ns and ove r all
improvement in symptomatology, as well as to assess
its effect on the Quality of Life of these patients.
Materials and Methods: This is a prospective study of
60 patients of acute anal fissure carried out over 2 years
with three groups - Group A1 (Warm Sitz Bath with
analgesics and high fiber diet), Group A2 (Cold Sitz
Bath with analgesics and high fiber diet) and Group B
(Analgesics and high fiber diet alone). Results: The
evaluation parameters were: assessment of pain,
patient satisfaction score and improvement in
sy mptomatology. Warm s itz bath res ult ed in
signif ica nt re duct ion i n pai n sco res, grea ter
im pro vement in sy mptomato log y an d patient
sat i sfact ion sco r es. Conc l usio n : An over a ll
improvement in symptomatology is evident with the
use of warm sitz bath, thereby giving more patient
satisfaction.
Keywords: Anal spasm, Anal Sphincter, Hip bath,
Thermo-sphincteric Reflex
Introduction:
Anorectal disorders include a diverse group of
pathological disorders that generate significant
patient discomfort and disability [1]. Despite the
fact that the exact nature and cause of the
conditions is known, the standard conservative
treatment options are still a matter of debate. Anal
Fissure is a linear ulcer in the squamous
epithelium of the anal canal located just distal to
the dentate line occurring usually in the posterior
midline. It causes severe pain with spasm of the
anal canal due to hypertonia of the internal anal
sphincter [2]. Sitz bath is frequently prescribed for
the management of acute anal fissure, but proper
instructions as to how to perform it are seldom
given to the patients. It is thought to relieve the
pain, and improve healing by increasing the local
blood circulation. Very little scientific evidence is
available on the issue regarding the most suitable
temperature for sitz baths [3].Considering the
controversies in the application of conservative
measures in treatment of anal fissure, lack of
adequate scientific evidence, this study is
designed to evaluate the efficacy of sitz bath as a
treatment modality in management of acute anal
fissure. The objective of the study was to evaluate
the efficacy of sitz bath in the treatment of acute
Evaluation of Different Sitz Bath Methods as a Treatment Modality
in Acute Anal Fissure
1* 1 1
Siddharth P. Dubhashi , Krishna J. Parmar , I. Rege
1Department of Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.
Y. Patil Vidyapeeth, Pimpri, Pune-411008 (Maharashtra) India
Siddharth P. Dubhashi et.al.
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Journal of Krishna Institute of Medical Sciences University
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(Temperature being hot or cold depending on the
group allotted) for 15 minutes, twice daily,
carefully drying the area after each bath.
The evaluation parameters were: assessment of
pain (using Visual Analogue Scale) (daily),
patient satisfaction score (using Analogue Scale)
(after 7 days) and improvement in sympto-
matology (using Analogue Scale) (days 3, 5 and
7). Chi Square test, ANOVA, and Tukey's tests
were used for statistical analysis. All procedures
performed in the study were in accordance with
the ethical standards of the Institute and with the
1964 Helsinki Declaration and its later amend-
ments or comparable ethical standards.
Results:
All patients included in the study were compa-
rable for age and sex. Majority of the patients were
in the age group of 31-40 years. 55% of patients
were males. Pain during defaecation was the most
common presenting symptom, followed by hard
stools, bleeding per rectum and constipation.
The mean pain score in patients receiving warm
sitz bath (Group A1), cold sitz bath (Group A2)
and the control group (Group B), on day 1 was
7.07 and 7.33 and 7.73 respectively, and that
measured on the 7th day were 2.80, 4.67 and 5.47
respectively, with pain relief most evident with
warm sitz bath followed by cold sitz bath. The
difference in pain scores was statistically
significant on days 1-3 and highly significant on
day 4-7 (Tables 1A and 1B).
anal fissure, with reference to: pain relief, patient
satisfacti on, and ove rall i mpro vement in
symptomatology.
Material and Methods:
This is a prospective study carried out at a tertiary
care centre over a period of two years. The study
was approved by the Institute Review Board.
Sixty patients were divided into two groups
(Group A and Group B of 30 each). Group A was
further divided into Group A1 and Group A2.
0
Group A1 (15 cases) - Warm Sitz Bath (>30 C),
twice daily along with high fibre diet and
analgesics.
0
Group A2 (15 cases) - Cold sitz bath (<15 C),
twice daily along with high fibre diet and
analgesics
Group B (30 cases) - Analgesics and high fibre
diet alone.
Analgesic- Injection Diclofenac sodium.1cc I/M
12 hourly in all groups
Written informed consent was obtained from all
patients before enrollment into the study.
Patients in age group 21 to 60 years presenting
with acute anal fissure were included in the study.
Patients <15 years of age and pregnant females
were excluded from the study. The first case was
allocated to study/control group by lottery method
and subsequently cases were allotted alternately
to each group.
Sitz Bath –Patients were asked to soak their hips
and buttocks in a tub containing plain water
JKIMSU, Vol. 5, No. 1, January-March, 2016
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JKIMSU, Vol. 5, No. 1, January-March, 2016
Table 1A: Pain Scores
Pain Score
on
GroupA1 Group A2 Group B F value p value
Mean ± SD Mean ± SD Mean ± SD D
Day 1 7.07 ± 0.96 7.33 ± 0.62 7.73 ± 0.83 3.59 <0.05
Day 2 6.60 ± 0.91 6.93 ± 0.79 7.40 ±1.07 3.63 <0.05
Day 3 6.00 ± 1.00 6.67 ± 0.90 6.92 ±1.08 4.05 <0.05
Day 4 5.07 ± 1.10 6.30 ± 0.96 6.57 ±1.08 10.34 <0.001
Day 5 4.13 ± 1.36 5.67 ± 1.17 6.12 ±1.37 11.36 <0.001
Day 6 3.60 ± 1.50 5.13 ± 1.12 5.87 ±1.28 15.13 <0.001
Day 7 2.80 ± 1.01 4.67 ± 0.98 5.47 ±1.19 29.32 <0.001
(Visual Analogue Scale; 0-10, 0: No pain, 10: Agonizing pain)
Table 1B: Pain Scores – Intergroup Comparison
Pain Score on A1 Vs A2 A1 Vs B A2 Vs B
p P p
Day 1 >0.05 <0.05 >0.05
Day 2 >0.05 <0.05 >0.05
Day 3 >0.05 <0.05 >0.05
Day 4 <0.01 <0.001 >0.05
Day 5 <0.01 <0.001 >0.05
Day 6 <0.01 <0.001 >0.05
Day 7 <0.001 <0.001 >0.05
three was 2.13, 1.60, 0.83 whereas on day seven, it
was 4, 2.47 and 1.78 in patients receiving warm,
cold and no sitz bath respectively (Tables 3A and
3B).
The overall patient satisfaction score (mean)
assessed on day 7 was 3.93 in group A1, 2.47 in
group A2 and 1.82 in group B patients (Table 2).
The improvement in symptomatology on day
Siddharth P. Dubhashi et.al.
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JKIMSU, Vol. 5, No. 1, January-March, 2016
Table 2: Patient Satisfaction Score
Patient
Satisfaction
Score on
Group A1
(n=15)
Group A2
(n=15)
Group B
(n=30)
F Value p Value
Mean ± SD
Day 7 3.93 ± 0.94 2.47 ± 0.52 1.82±0.48 55.78 <0.0001
Table 3A: Improvement in Symptomatology
Improvement in
symptomatology on
Group A1
(n=15)
Group A2
(n=15)
Group B
(n=30)
F Value p Value
Mean ± SD Mean± SD Mean±SD
Day 3 2.13 ±0.64 1.60±0.91 0.83 ± 0.66 17.24 <0.001
Day 5 3.07 ±0.88 2.0±0.93 1.35 ± 0.57 25.89 <0.001
Day 7 4±0.73 2.47±0.55 1.78 ±0.66 57.02 <0.001
(Visual Analogue Scale; 0-5, 0- no improvement, 5- comfortable)
Table 3B: Improvement in Symptomatology
- Intergroup Comparison
Improvement in
symptomatology on
A1 Vs A2 A1 Vs B A2 Vs B
ppp
Day 3 >0.05 <0.001 <0.05
Day 5 <0.001 <0.001 <0.05
Day 7 <0.001 <0.001 <0.05
(Visual Analogue Scale; 0-5, 0- very poor, 5- excellent)
Siddharth P. Dubhashi et.al.
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Journal of Krishna Institute of Medical Sciences University
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been proposed for relaxation of the internal
urethral sphincter to induce urination in patients
after anorectal operations [6]. The perceived
advantages of sitz bath include improvements in
hygiene, relief of discomfort such as burning
sensation or itching, and wound healing [7]. In
addition, sitz bath has been reported as beneficial
for limiting infectious disease and preventing
sepsis following surgery [8].
A variety of medicaments and additives have been
used and recommended with sitz bath for different
proctologic disorders. These include antiseptic
solutions, table salt, povidone iodine, potassium
permanganate, vinegar, etc. How far these
additives are useful remains an issue of debate.
The basis of sitz bath is application of variable
temperature to the ano-perineal region, and the
oth er fac t ors are s e cond ary. Addit ion of
medicaments to the water can cause various
allergic skin reactions. In general, the water is
expected to cover only the perineum and lower
pelvis. Immersing other parts of the body in warm
water could lead to systemic vasodilatation and
decreased circulation to the perianal area [9].
Cold sitz bath causes a contraction of the
cutaneous blood vessels of the area covered by the
water. This effect seems especially felt in the head,
and may on certain occasions be used to increase
cerebral activity. Superficial cold application may
cause physiologic reactions such as decrease in
local metabolic function, local oedema, nerve
conduction velocity, muscle spasm and increase in
local anaesthetic effects [10].
The hot water causes an atonic dilation in the
cutaneous blood vessels. The quantity of blood in
Discussion:
Historically, the use of sitz bath to improve the
th
blood circulation can be traced to early 19
century as part of the old European tradition.
Today, sitz bath has been a commonly used
conservative therapy for patients with acute anal
fissure to relieve symptoms like pain. Although
the effect of using sitz bath in anorectal disorders
has not been established yet, clinicians still
prescribe sitz baths for patients with anal fissure
and other anorectal disorders. The clinical impact
of sitz bath has been unclear. Patients with anal
fissure often showed improvement and fissures
healed regardless of the adherence to a strict sitz
bath regimen. There has been no rigid analysis
conducted to examine the evidence using a
systematic approach [4].
A Sitz bath, also called a hip bath is a type of bath
in which only the hips and buttocks are soaked in
wate r or saline solutio n . S i tz b aths are
recommended for their soothing effect and their
ability to relax the anal sphincter muscles. It is
frequently recommended because of the low
morbidity it carries [5].
It has been hypothesized that the pain relief after
sitz bath could be the result of internal anal
sphincter relaxation, with a resulting diminution
of the rectal neck pressure. A decrease in the
internal sphincter pressure during the sitz bath has
been observed. It is postulated that the relaxation
of the internal sphincter muscle is mediated
through sensory perianal skin receptors getting
stimulated by warm water. The decrease in the
spasm and pain relief is attributed to this 'thermo-
sphincteric reflex'. The same mechanism also has
JKIMSU, Vol. 5, No. 1, January-March, 2016
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significant effect on overall intensity of pain (one
study), post-operative pain (two studies).
A study by Jensen [15] showed that in patients
with a first episode of acute posterior anal fissure,
simple measures such as warm sitz baths
combined with a dietary intake of unprocessed
bran may relieve symptoms significantly better
t h a n t h e a p p l i c a t i o n o f l i g n o c a i n e o r
hydrocortisone ointment to the anal canal.
Cross et al [2] have reported level 1, Grade A
evidence that conservative treatment will heal a
significant proportion of acute anal fissures.
Recurrence rates were reduced from 68 % to 16 %
at one year following continued conservative
management [16].
One study [13] has reported that patients in the sitz
bath group expressed greater satisfaction than the
patients in control group at the end of 4 weeks.
Two patients reported a perianal rash after sitz
bath. A review [4] of three studies assessing
patient satisfaction had conflicting views about
the same. One of the studies reported no
significant difference between sitz bath and
control groups. Our study showed significant
patient satisfaction with warm sitz bath. There
were no complications. Tejirian et al [5] have
reviewed the literature on the use of sitz baths in
anorectal disease and have concluded that there is
no conclusive scientific evidence and studies on
its effect. Alt hou gh the Cl inical P rac tice
Guidelines recommend the use of hot water sitz
baths for the treatment of anal pain for its known
effect on the resting anal pressure, popular belief
encourages the use of cold water sitz baths. This
has also been reported by Maestre et al [3]
the pelvis is largely increased. Hot sitz bath
relieves pain by lowering anal pressure, and
improves anal blood circulation that relieves the
congestion and oedema [11]. It is hypothesized
that hot water baths have a greater analgesic effect
than the cold water with longer durations of low
internal sphincter pressure [3,12].
A study of 24 patients of acute anal pain due to
haemorrhoidal disease/acute anal fissure rando-
mized into two groups: one receiving warm sitz
bath and the other receiving cold sitz bath has
demo nstrat e d no statis ticall y s ignifi c ant
difference in the pain scores. The variation in
maximum anorectal resting pressure measured
before and after the sitz bath also has shown no
significant difference [3].
A study by Gupta [13] compared the analgesic
effect of treatment with and without sitz bath in
patients with anal fissure through a randomised
clinical trial. It shows that there was no significant
pain relief or wound healing in patients taking
warm water sitz baths, although there was greater
overall patient satisfaction.
The benefits of hydrotherapy on different systems
of the body have been reviewed. These depend on
the temperature of the water. Though these effects
are scientifically evidence-based, there is lack of
evidence for the mechanism on how hydrotherapy
brings about an improvement in the disease
process [14].
A systemic review [4] of four studies (268
participants) was conducted. One study was a
ran domi zed con troll ed tri al with a c lear
computerized sequential randomization and
allocation concealment. Use of a sitz bath had no
JKIMSU, Vol. 5, No. 1, January-March, 2016
Siddharth P. Dubhashi et.al.
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Journal of Krishna Institute of Medical Sciences University
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Conclusion:
The temperature of sitz bath is an important factor
in determining the outcome of the use of this
treatment method. Warm sitz bath provides
significant analgesia. An overall improvement in
symptomatology is evident with the use of warm
sitz bath, thereby giving more patient satisfaction.
In an era of industry driven treatment 'packages', it
is definitely worthwhile considering the potential
of use of a natural source like water in the
management of common surgical ailments.
The current study has attempted to evaluate the
effectiveness of sitz bath in the management of
acute anal fissure. The re sults hav e be en
statistically significant especially with reference
to pain relief and patient satisfaction. It is noted
that a lot of apprehension exists in the mind of
patients about the feasibility of the sitz bath. Space
limitations and effort involved in preparing the
sitz bath are issues often raised by them. Proper
counseling about the correct technique and
potential benefits of sitz bath will go a long way in
removing the misconceptions.
JKIMSU, Vol. 5, No. 1, January-March, 2016
9. Ng CL. Levator ani syndrome: a case study and
literature review. Aust Fam Physician 2007; 36: 449-
452.
10. Weston M, Taber C, Casagranda L, Cornwall M.
Changes in local blood volume during cold gel pack
application to traumatized ankles. J Orthop Sports Phys
Ther 1994; 19: 197-199.
11. Yang HK. Non surgical treatment of haemorrhoids.
Haemorrhoids 2014; 47-63. doi: 10.1007/978-3-642-
41798-6.
12. Shak A. 'Somatoanal' reex or 'thermosphincteric
reex? Dis Colon Rectum 2000; 43: 726-728.
13. Gupta P. Randomised controlled study comparing sitz-
bath and no-sitz-bath treatment in patients with acute
anal ssures. ANZ J Surg 2006; 76(8): 718-721.
14. Mooventhan A, Nivethitha L. Scientic Evidence
Based effects of Hydrotherapy on various systems of
the body. North Am J Med Sci 2014; 6(5):199-209.
15. Jensen SL. Treatment of rst episodes of acute anal
ssure: prospective randomized study of lignocaine
ointment versus hydrocortisone ointment or warm sitz
bath plus bran. Br Med J 1986; 292: 1167-1169.
16. Jenson SL. Maintenance therapy with unprocessed bran
in the prevention of acute anal ssure recurrence. J R
Soc Med 1987; 80: 296-298.
1. Gupta PJ .A review of ano-rectal disorders and their
treatment. Bratisl Lek Listy 2006; 107(8): 323-331.
2. Cross KLR, Massey EJD, Fowler AL, Monson JRT. The
managemen t o f a nal ssure. ACPGBI Po sition
Statement. Colorectal Disease 2008; 10(Suppl 3): 1-7.
3. Yolanda Maestre, David Pares, Silvia Salvans, Ines
Ibanez-Zafon, Esther Nve, Maria Jose Pons, et al. Cold
or hot sitz baths in the emergency treatment of acute
anal pain due to anorectal disease ? Results of a
randomized clinical trial. Cir Esp 2010; 88(2): 97-102.
4. Lan g DSP, Tho PC, L i GM, Ang ENK. The
effectiveness of sitz bath in managing adult patients
with anorectal disorders: A systematic review. JBI
Library of systematic reviews 2010; 8(11): 447-469.
5. Tejirian T, Abbas MA. Sitz Bath: where is the evidence?
Scientic basis of a common practice. Dis Colon
Rectum 2005; 48(12): 2336-2340.
6. Shak A. Role of warm water bath in inducing
micturition in postoperative urinary retention after
anorectal operations. Urol Int 1993; 50: 213-217.
7. Gupta PJ. Effects of warm water sitz bath on symptoms
in postanal sphincterotomy in chronic anal ssure - A
randomized and controlled study. World J Surg 2007;
31:1480-1484.
8. Goto S, Mori M, Fukaya Y, Nakamura K. Nursing
measures against adverse reaction from anti-cancer
chemotherapy. Nippon Rinsho 2003; 61:943-948.
References
*Author for Correspondence: Dr. Siddharth P. Dubhashi, A-2 / 103, Shivranjan Towers, Someshwarwadi, Pashan,
Pune- 411008 Email: spdubhashi@gmail.com Cell: 09881624422
ResearchGate has not been able to resolve any citations for this publication.
  • Article
    Background: Sitz bath is commonly prescribed for anorectal disorders in conjunction with dietary and pharmacological therapies. However, the effectiveness of sitz bath for anorectal disorders is not certain and there has been no previous examination of the evidence using a systematic approach. Objective: The objective of this review was to critically analyse and systematically review the evidence to determine the effectiveness of sitz bath in managing adult patients with anorectal disorders. Inclusion criteria: Types of participants The participants of interest included adults over 18 years of age with diagnosis of anorectal disorders with or without surgical interventions. The participants who underwent episiotomy were excluded from the review.Types of interventions Intervention of interest was sitz bath with or without the combination of pharmacological and dietary therapies.Types of outcome measures The outcomes of interest included overall intensity of pain; post-operative pain score; post-defecation pain score; acceleration of fissure/wound healing; patients' satisfaction level and presence of complications.Types of studies The review considered only randomised controlled trials (RCTs) and quasi-RCTs. Search strategy: Initially, mesh terms from PubMed were established and were used to search in MEDLINE and CINAHL for analysis of the text words contained in the title and abstract, and the text terms used to describe the article. A second search using all the identified keywords and the search terms were utilised across all accessible and relevant databases from Year 1990 to November 2009 in English language only. Thirdly, the relevant lists of all identified articles were searched for additional studies. Methodological quality: Selected articles were appraised by 2 reviewers independently for methodological validity using the standardised critical appraisal instruments from Joanna Briggs Institute Systems Meta Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI). Data collection/extraction: Data were extracted from the articles included in the review using standardised data extraction tools from the JBI-MAStARI. Data synthesis: The findings were presented in narrative form as statistical pooling was not possible due to clinical heterogeneity. Results: A total of 4 RCTs were included in the review. The use of sitz bath had no significant impact in reducing overall intensity of pain and post operative pain. Conflicting findings for post defecation pain were reported. It had no impact in accelerating fissure or wound healing. However, patients were satisfied using sitz bath and no severe complications were reported. Conclusion: There was no strong evidence to support the use of sitz bath for pain relief, and accelerate fissure or wound healing among adult patients with anorectal disorders, however no complications were reported. Implications for practice: The benefit of sitz bath is limited to the patients' satisfaction based on the current evidence. Use of water spray as alternative method to sitz bath could be considered for future research. Implications for research: More rigorous research methodology and standardisation tool for outcome measurement are needed for future investigations.
  • Article
    Full-text available
    The use of water for various treatments (hydrotherapy) is probably as old as mankind. Hydrotherapy is one of the basic methods of treatment widely used in the system of natural medicine, which is also called as water therapy, aquatic therapy, pool therapy, and balneotherapy. Use of water in various forms and in various temperatures can produce different effects on different system of the body. Many studies/reviews reported the effects of hydrotherapy only on very few systems and there is lack of studies/reviews in reporting the evidence-based effects of hydrotherapy on various systems. We performed PubMed and PubMed central search to review relevant articles in English literature based on "effects of hydrotherapy/balneotherapy" on various systems of the body. Based on the available literature this review suggests that the hydrotherapy has a scientific evidence-based effect on various systems of the body.
  • Article
    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. 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. 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. 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. 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).
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    One hundred and three patients with an acute first episode of posterior anal fissure were randomised to receive a three week trial of lignocaine ointment (n = 33) versus hydrocortisone ointment (n = 35) or warm sitz baths combined with an intake of unprocessed bran (n =35). Seven patients were withdrawn owing to failure to adhere to the trial protocol. After one and two weeks of treatment symptomatic relief was significantly better among patients treated with sitz baths and bran than among patients treated with lignocaine ointment or hydrocortisone ointment. After three weeks there was no difference in symptomatic relief among the three groups. Patients treated with lignocaine, however, had significantly fewer healed fissures (60%) than patients treated with hydrocortisone (82.4%) or warm sitz baths and bran (87%). In this study warm sitz baths plus an intake of unprocessed bran came out as the treatment of choice for an acute first episode of posterior anal fissure. This treatment is cheap, has no potential serious side effects, and brings the best and quickest relief of symptoms.
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    The effect of unprocessed bran in a dose of 5 g three times daily and a dose of 2.5 g three times daily for one year on the recurrence rate of anal fissures was studied in a double-blind, placebo-controlled trial in 90 patients with recently healed acute posterior anal fissures. Fifteen patients (16.6%) were withdrawn before the code was broken due to failure to follow the trial protocol for various reasons. Significantly fewer recurrences occurred in patients receiving bran 5 g three times daily (recurrence rate 16%, 95% confidence limits, 4.54 to 36.08) when compared with patients receiving bran 2.5 g three times daily (60%; 38.67 to 78.87) (P less than 0.01) and with patients receiving placebo three times daily (68%; 46.50 to 85.05) (P less than 0.01). No significant difference in recurrences was found between patients on bran 2.5 g and those on placebo.
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    Whether application of a cold modality following soft tissue trauma causes reactive vasodilation causes reactive vasodilation is an important clinical question since one goal of using a cold modality is to limit edema formation. The purpose of this study was to measure change in local blood volume during application of a cold gel pack following inversion sprain of the ankle. Fifteen volunteers participated as subjects (age range: 18-46 years, mean age: 22.2 years). A bilateral tetrapolar impedance plethysmograph was used with venous occlusion to measure the change in local limb volume at the ankle over a 20-minute period during two conditions: at rest and with cold gel pack application. A significant reduction in local blood volume occurred during cold gel pack application compared with rest. A significant vasodilation response was not observed. The lack of vasodilation response lends support to the clinical use of a cold gel pack following soft tissue trauma when applied to the ankle for a period of up to 20 minutes.
  • Combination chemotherapy for leukemia develops bone marrow suppression. Infection or hemorrhage disorders the treatment, and may influence the clinical result. The caring staff must understand the pathology of bone marrow suppression. Visitors observe the hospital rules. Foods are also limited, city water and uncooked foods are prohibited. To keep oral cavity clean, pretreatment of some decayed teeth, and frequent gargling with sterilized water are needed. Defecation control is important. Sitz bath or shower toilet is helpful. Hand cleaning is essential for before a meal, after defecation and after a going out. Bathing is fundamental to cleaning body. No bathing is dirty. Medical catheters are checked up every day. Thrombocytopenia(< 30,000/microliter) develops a spontaneous bleeding. Severe thrombocytopenia(< 10,000/microliter) does a fatal organ bleeding.
  • Article
    This study was designed to determine if evidence exists to justify and support the recommendation of sitz bath in the management of anorectal disorders. A Medline search was conducted using the key words "sitz bath" and "hot bath." Thirty-six articles were found which highlighted the physiology, benefits, risks, complications, and techniques of sitz bath. Most of the studies were published in gynecologic or nursing journals. One randomized study comparing sitz bath to placebo was found. Two articles speculated that sitz bath induces relaxation of the internal sphincter muscle. Cold sitz bath was reported to decrease perineal edema more than warm sitz bath, although patients tended to prefer the latter. Five articles reported complications of sitz bath, including dissemination of herpes, maternal-neonatal Streptococcus outbreak, and skin burns. A review of the literature demonstrated a lack of scientific data to support the use of sitz bath in the treatment of anorectal disorders. Additional randomized and controlled clinical studies are needed to investigate whether this time consuming recommendation is beneficial to patients.