Comparison of Warm Sitz Bath and Ice Therapy for Postoperative Management After Hemorrhoidectomy
DOI:
https://doi.org/10.63682/jns.v14i32S.8403Keywords:
Hemorrhoidectomy, postoperative pain, sitz bath, ice therapy, wound healingAbstract
Background: Hemorrhoidectomy is a common surgical procedure for grade 3 and 4 hemorrhoids, often associated with significant postoperative pain and wound healing challenges. This study aimed to compare the efficacy of warm sitz bath and ice therapy in postoperative pain management and wound healing after hemorrhoidectomy.
Methods: A prospective comparative study was conducted at KLE Co-operative Hospital and affiliated KAHER institutes in Hubballi, North Karnataka. One hundred twenty patients (60 in each group) aged 18-75 years with grade 3 or 4 external hemorrhoids undergoing Ferguson's hemorrhoidectomy were randomized to receive either warm sitz bath or ice therapy postoperatively. Pain was assessed using the Visual Analog Scale (VAS), and wound healing was evaluated using the REEDA scale (Redness, Edema, Ecchymosis, Discharge, Approximation) at 24 hours, 3 days, 7 days, and 14 days postoperatively. Secondary outcomes included analgesic consumption, patient satisfaction, and time to return to normal activities.
Results: Patients in the ice therapy group experienced significantly lower pain scores at 24 hours (mean VAS: 5.2±1.3 vs. 6.8±1.5, p<0.001) and 3 days (mean VAS: 3.8±1.1 vs. 4.9±1.3, p<0.001) compared to the sitz bath group. However, the sitz bath group demonstrated better wound healing parameters at 7 days (mean REEDA score: 3.1±0.9 vs. 4.2±1.1, p<0.001) and 14 days (mean REEDA score: 1.2±0.6 vs. 2.3±0.8, p<0.001). Analgesic consumption was significantly lower in the ice therapy group during the first 3 days (p=0.002), while patient satisfaction scores were comparable between groups at the end of the follow-up period (p=0.346).
Conclusion: Ice therapy provides superior early postoperative pain control and reduces analgesic requirements following hemorrhoidectomy, while warm sitz bath promotes better wound healing in the later recovery phase. A sequential approach of ice therapy in the immediate postoperative period followed by warm sitz bath after 3-4 days may optimize both pain management and wound healing outcomes
Downloads
Metrics
References
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009-2017.
Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006;(4):CD005393.
Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg. 2015;102(13):1603-1618.
Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141-1157.
Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. J Am Coll Surg. 2007;204(1):102-117.
Gupta PJ. Effects of warm water sitz bath on symptoms in post-anal sphincterotomy in chronic anal fissure--a randomized and controlled study. World J Surg. 2007;31(7):1480-1484.
Shafik A. Role of warm-water bath in anorectal conditions. The "thermosphincteric reflex." J Clin Gastroenterol. 1993;16(4):304-308.
Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65.
Ead H. Glyceryl trinitrate (GTN) for anal fissure. Gastroenterol Nurs. 2012;35(1):61-64.
Higuero T, Abramowitz L, Castinel A, et al. Guidelines for the treatment of hemorrhoids (short report). J Visc Surg. 2016;153(3):213-218.
Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg. 2016;29(1):22-29.
Hollingshead JR, Phillips RK. Haemorrhoids: modern diagnosis and treatment. Postgrad Med J. 2016;92(1083):4-8.
Balta G, Gokbayrak M, Gokbayrak N, Mansur O, Ustundag Y. Cryotherapy applied after hemorrhoidectomy: a prospective, randomized, controlled study. Tech Coloproctol. 2019;23(9):859-864.
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004;32(1):251-261.
Rakel B, Barr JO. Physical modalities in chronic pain management. Nurs Clin North Am. 2003;38(3):477-494.
Stein C. Opioid treatment of chronic nonmalignant pain. Anesth Analg. 1997;84(4):912-914.
Hsu KF, Chia JS, Jao SW, et al. Comparison of clinical effects between warm water spray and sitz bath in post-hemorrhoidectomy period. J Gastrointest Surg. 2009;13(7):1274-1278.
Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
Nystrom PO. The systemic inflammatory response syndrome: definitions and aetiology. J Antimicrob Chemother. 1998;41 Suppl A:1-7.
Demling RH, Mazess RB, Witt RM, Wolberg WH. The study of burn wound edema using dichromatic absorptiometry. J Trauma. 1978;18(2):124-128.
Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010;89(3):219-229.
Cheetham MJ, Phillips RK. Evidence-based practice in haemorrhoidectomy. Colorectal Dis. 2001;3(2):126-134.
Tejirian T, Abbas MA. Sitz bath: where is the evidence? Scientific basis of a common practice. Dis Colon Rectum. 2005;48(12):2336-2340.
Brown J, Lukacz E, Menefee S, et al. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomized controlled trial in primary care. BMJ. 2014;349:g7378.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
