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Baig Z, Abu-Omar N, Harington M, Gill D, Nathan Ginther D. Be Kind to Your Behind: A Systematic Review of the Habitual Use of Bidets in Benign Perianal Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1633965. [PMID: 35685735 PMCID: PMC9173983 DOI: 10.1155/2022/1633965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Zarrukh Baig
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Nawaf Abu-Omar
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Michael Harington
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Dilip Gill
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
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Arroyo A, Montes E, Calderón T, Blesa I, Elía M, Salgado G, García-Armengol J, de-la-Portilla F. Treatment algorithm for anal fissure. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons. Cir Esp 2018. [PMID: 29525120 DOI: 10.1016/j.ciresp.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons propose this consensus document with a treatment algorithm for anal fissure that could be used for decision making. Non-surgical therapy and surgical treatment of anal fissure are explained, and the recommended algorithm is provided. The methodology used was: creation of a group of experts; search in PubMed, MEDLINE and the Cochrane Library for publications from the last 10 years about anal fissure; presentation at the 21st National Meeting of the Spanish Association of Coloproctology Foundation 2017 with voting for/against each conclusion by the attendees and review by the scientific committee of the Spanish Association of Coloproctology.
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Affiliation(s)
- Antonio Arroyo
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario, Elche, Alicante, España.
| | - Elisa Montes
- Servicio de Cirugía General y Aparato Digestivo, Hospital de Jerez, Jerez de la Frontera, Cádiz, España
| | - Teresa Calderón
- Servicio de Cirugía General y Aparato Digestivo, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
| | - Isabel Blesa
- Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario Torrecárdenas, Almería, España
| | - Manuela Elía
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Gervasio Salgado
- Sección de Cirugía Colorrectal, Hospital Santa Elena, Málaga, España
| | - Juan García-Armengol
- Servicio de Cirugía General y Aparato Digestivo, Hospital Nisa 9 de Octubre, Valencia, España
| | - Fernando de-la-Portilla
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España
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Balta AZ, Ozdemir Y, Sucullu I, Filiz A, Yucel E, Akin ML. The Effect of Early Warm Plastic Bag Application on Postoperative Pain after Hemorrhoidectomy: A Prospective Randomized Controlled Trial. Am Surg 2015. [DOI: 10.1177/000313481508100232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure™. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy.
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Affiliation(s)
- Ahmet Ziya Balta
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Yavuz Ozdemir
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Ilker Sucullu
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Aliilker Filiz
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Ergun Yucel
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Mehmet Levhi Akin
- Department of Surgery, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
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LANG DS, THO PC, ANG EN. Effectiveness of the Sitz bath in managing adult patients with anorectal disorders. Jpn J Nurs Sci 2011; 8:115-28. [DOI: 10.1111/j.1742-7924.2011.00175.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gupta PJ. WARM SITZ BATH DOES NOT REDUCE SYMPTOMS IN POSTHAEMORRHOIDECTOMY PERIOD: A RANDOMIZED, CONTROLLED STUDY. ANZ J Surg 2008; 78:398-401. [DOI: 10.1111/j.1445-2197.2008.04485.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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; 31:1480-4. [PMID: 17534541 DOI: 10.1007/s00268-007-9096-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sitz bath is frequently recommended by physicians for a variety of anal disorders including anal fissure. The aim of the present study was to determine whether sitz bath does have any therapeutic properties improving upon a patient's postoperative symptoms after a closed lateral sphincterotomy. MATERIALS AND METHODS Forty-six patients were randomly assigned to receive analgesics and fiber supplement alone (control patients) or a twice-daily sitz bath along with identical fiber and analgesics (sitz bath group). A 24-h pain score--post-defecation anal burning and symptom improvement--was evaluated on a visual analog scale (VAS). RESULTS The groups were equally matched for age, gender distribution, and duration of disease. No significant difference in mean pain score between groups (p = 0.284) was noticed after one week. However, the patients from the control group experienced significant anal burning compared with patients from sitz bath group (p < 0.0001). The improvement score was higher in the sitz bath group when compared with the control group; however, it did not reached a statistically significant level. CONCLUSIONS Patients after sphincterotomy for anal fissure receiving sitz bath experienced similar levels of pain when compared with those not receiving sitz bath. However, they reported a significant relief in anal burning and a marginally better satisfaction score and no reported adverse side effects.
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Lee JK, Kim HS, Lee EY, Choi IS, Oh NG. Detection of HBV DNA and HCV RNA in Public Bath; A Study about Safety of Prolapsed Hemorrhoidal Patients. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2007. [DOI: 10.3393/jksc.2007.23.5.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jin-kwon Lee
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Hyun-sung Kim
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Eun-yup Lee
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, Korea
| | - In-seok Choi
- Department of Surgery, Busan Medical Center, Busan, Korea
| | - Nahm-gun Oh
- Department of Surgery, Pusan National University Hospital, Busan, Korea
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Gupta P. RANDOMIZED, CONTROLLED STUDY COMPARING SITZ-BATH AND NO-SITZ-BATH TREATMENTS IN PATIENTS WITH ACUTE ANAL FISSURES. ANZ J Surg 2006; 76:718-21. [PMID: 16916391 DOI: 10.1111/j.1445-2197.2006.03838.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine the efficacy and safety of sitz baths in the management of acute anal fissures. METHOD Individual patients were randomized to either receive sitz baths or no sitz baths for 4 weeks in addition to oral psyllium husk. Patients were asked to soak their hips and buttocks in a tub containing plain lukewarm water for 10 min, once after defecation in the morning and again at bedtime. Each week, the patients were called to assess pain scores and healing of fissures, whereas the level of satisfaction was recorded at the end of 4 weeks. Main outcome measures were validated pain scores and levels of satisfaction. RESULTS Fifty-eight subjects were recruited for this study. In all, 52 of them completed the trial (27 in the sitz bath group and 25 in the control group). Although the pain score was lesser in the sitz bath group than in the control group, it failed to reach statistical significance. There were no significant differences in fissure healing between the two groups over the 4-week study period. However, patients in the sitz bath group reported better satisfaction levels than the control group (P < 0.01). Although no serious adverse effects were observed, two patients from sitz bath group developed perianal skin rash. CONCLUSION This study suggests that sitz baths improve patient satisfaction in acute anal fissures. However, the healing and overall pain relief was not significant enough to attract attention. It was also found to be associated with adverse effects in few patients.
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Abstract
PURPOSE This study was designed to determine if evidence exists to justify and support the recommendation of sitz bath in the management of anorectal disorders. METHODS A Medline search was conducted using the key words "sitz bath" and "hot bath." RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Talar Tejirian
- Department of Surgery, Section of Colon and Rectal Surgery, Kaiser Permanente, Los Angeles, California 90027, USA
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Jiang JK, Chiu JH, Lin JK. Local thermal stimulation relaxes hypertonic anal sphincter: evidence of somatoanal reflex. Dis Colon Rectum 1999; 42:1152-9. [PMID: 10496555 DOI: 10.1007/bf02238567] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Although it is generally believed that warm perineal baths reduce pain resulting from anal fissure, complicated hemorrhoids, or anal surgery, the exact mechanisms remain unclear. Because hypertonicity of the internal anal sphincter contributes to increasing pain in these conditions, it has been postulated that warm perineal baths could help to relax the anal sphincter, hence reducing pain. It is our purpose to demonstrate response of the anal sphincter to local thermal stimulation via a somatoanal reflex. METHODS Continuous anorectal manometry tracings were obtained from 15 healthy volunteers, 22 patients with hemorrhoid, and 20 patients with anal fissure. Local thermal stimulation was achieved by applying a heat pad on the right infragluteal region (local area), and subsequently on the right first interphalangeal region (control area). RESULTS Obvious response to local thermal stimulation was shown by 13.3 percent of volunteers, 36.4 percent of patients with hemorrhoid, and 60 percent of patients with fissure. Heat-sensitive patients who responded to local thermal stimulation were divided to two groups, those with ultraslow waves and those without ultraslow waves. In patients with ultraslow waves, the amplitude of ultraslow waves decreased significantly after local thermal stimulation, with amplitude before local thermal stimulation, (mean +/- standard deviation) 66.2 +/- 30.6 mmHg, and during local thermal stimulation, 43.2 +/- 22.3 mmHg, respectively, P = 0.003. By contrast, in patients without ultraslow waves, the tonic pressure measured before local thermal stimulation and during local thermal stimulation was 74.2 +/- 23.5 and 60.5 +/- 18.5 mmHg, respectively, P = 0.001. The response began at approximately three minutes after local thermal stimulation when the skin temperature was 42.1 +/- 0.3 degrees C. No anal response was observed when the heat pad was applied to the control area. The maximum resting pressure of the heat-sensitive patients was significantly higher than that of the nonresponding patients (97.3 +/- 0.1 vs. 76.9 +/- 23.3 mmHg; P = 0.012). CONCLUSIONS Local thermal stimulation evokes relaxation of the hypertonic internal anal sphincter through a somatoanal reflex, thus providing an easy and feasible method of clinical application.
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Affiliation(s)
- J K Jiang
- Department of Surgery, Veterans General Hospital-Taipei, and National Yang-Ming University, Institute of Clinical Medicine, Taiwan, Republic of China
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Affiliation(s)
- T R Koch
- Section of Gastroenterology, West Virginia University, Morgantown, USA
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