You may have heard of a Sitz bath from this website or from another as being a potential treatment for the pain of hemorrhoids aka hemroids.
This article is going to be a detailed look at the Sitz bath, starting by explaining exactly what it is and its history and what you can expect it to do for your pain.
I’ll go on to talk about the potential drawbacks of the Sitz bath, and then have a look at how to get one.
It’s a good descriptive term, for a start. ‘Sitz’ comes from the German ‘sitzen’ which means ‘to sit’, and that’s exactly what you do with this kind of bath. A Sitz bath is one where you only bath your buttocks and hips, and possibly the lower abdomen at the same time. Usually they use warm water, although some are cold, but in either case the water has salt added to it to make a saline solution.
Further to that, a Sitz bath is not only descriptive of any kind of bath that you take in which you are only bathing your bottom and hips, but it has then also come to mean a specific piece of equipment that enables you to do this more easily.
Sitz bath equipment can take the form of a basin, originally made of porcelain, that one sits in for ten to twenty minutes, and is either filled with the warm (or cold) salt water or has it piped in from a reservoir.
More modern Sitz Baths even heat the water continuously, like a power shower does, so that it doesn’t run out half way through.
[If you don't have access to a bath tub or such, you can use warm compresses with a similar effect. According to N.J. Paonessa, D.O., FACOS, a professor of Surgery, "Conservative / Nonoperative Therapy", in I. Khubchandani ed et al., Surgical Treatment of Hemorrhoids, Chapt 6, 2nd ed., Springer, 2009]
Sitz baths are quite a traditional practice, which originated in Europe as part of a rising trend in the 1800s, where Hydrotherapy as vindicated by the Romans was undergoing something of a Renaissance under several doctors of the day.
Sir John Floyer, an English physician of the early eighteenth century, had seen the beneficial effects that various local peasants had obtained from their bathing in natural springs, and wrote a book on the history of cold water treatments.
This book got translated into German later that century, and somehow sparked off a rebirth of hydrotherapy in all its forms under the genius of a farmer called Vincent Priessnitz. He championed the medical efficacy of water treatments until they became an accepted medical therapy around 1829 rather than what was seen as a folk cure until that point.
The modern Sitz bath is used for pain relief not only for hemorrhoids but also for patients recovering from colorectal surgery, to ease the pain of uterine cramps or painful prostates and testicles, to soothe infections in these areas and also in the treatment of certain inflammatory bowel diseases.
[Sitz baths can also soothe the anal and hemorrhoid area if there is discomfort, can also decrease the size of prolapsed internal hemorrhoids and decrease the anal canal pressure. According to N.J. Paonessa, D.O., FACOS, a professor of Surgery, "Conservative / Nonoperative Therapy",in I. Khubchandani ed et al., Surgical Treatment of Hemorrhoids, Chapt 6, 2nd ed., Springer, 2009].
The way that the Sitz bath works is by altering the blood flow to the area you are immersing in water.
Think of putting your hand in a bowl of comfortably warm water (you can try this at home if you need visual proof) - if you leave it there for a minute or so and then take it out, you’ll notice the skin has changed colour, becoming much redder.
The opposite is true for cold water, you skin will go paler than it usually is.
The reason for these colour changes is that the body is very good at detecting local temperature changes and altering the blood supply to that area.
Part of the job the skin does is determine how much heat we lose from our bodies, and it does this by using blood flow.
Even though you are a warm-blooded animal, your blood still acts like a coolant - it absorbs heat from the parts of the body it flows through, and can carry it back to the centre of the body.
If an area of skin is getting too hot, the body increases the amount of blood flowing through that area to carry heat away, just like the coolant flow in a reactor. Otherwise, that region may end up getting so hot the cells there stop working properly, or can even die and become damaged.
Conversely, if an area is too cold, the body will stop excess heat loss (which is just as damaging) by shunting blood away from that area. This prevents the blood getting too cold before it returns to delicate central organs like the brain or heart, which don’t respond well to having a rush of cool blood arriving at them.
Well, the way your body changes blood flow is by controlling the width of the blood vessels using the muscles in their walls. The amount of control your body has is surprising.
Using the hand in a bowl of water example above, you’ll often find a very exact line that corresponds to the water level quite precisely. If you’ve got a lot of free time to kill, you can experiment - I’ve found I can ‘draw’ an exact red circle around the circumference of my elbow using hot water. All in the name of science, of course.
Warm water will dilate the blood vessels, making them bigger, and perhaps allowing the blood to pass out of your swollen piles more quickly. Warm water also helps the larger muscles of the body to relax, helping ease the tone of the rectal sphincter (something that can cause hemorrhoids to get worse or become painful), and the soothing nature of a warm bath is something I’m sure we’ve all had experience of.
Cold water will draw heat out of hot, sore piles and at the same time reduce the blood flow into them, so there’s less pressure inside to make them feel inflamed.
One of the interesting things about Sitz baths is that it seems there isn’t much difference in the effect patients report whether the water is cold or hot - both seem to help equal numbers of people.
Equally, some people use alternating hot and cold water (always ending with cold) in their Sitz bath, as you would do in a sauna, sometimes using two separate basins.
If you don’t happen to have elaborate equipment or multiple basins of water to hand, you can simulate this by running a hot bath but keeping a towel in the sink which you have soaked in cold water. Once you’ve sat in your hot Sitz bath for a while, say five minutes, stand up and wrap the cold towel between your legs like a nappy for a minute or so. Again, this works by altering blood flow and can be very invigorating, just like a sauna can, but it can also take a bit of getting used to before you enjoy it!
If you are using something specifically to wash your bum, it’s important to keep it clean between uses, and not to use it for other things. It’s perfectly fine to use any old plastic basin to give yourself a Sitz bath, but you mustn’t then use it to do the dishes afterwards! Otherwise you are putting yourself at risk of infection, especially if you are treating bleeding or prolapsed piles.
A tablespoon of salt? Vinegar? Nothing? Soap flakes? I’ve seen all of these advocated on different sites.
The salt, it seems, is optional, but if you are using it, you should use enough to make the water noticeably salty to taste.
Vinegar should only be used if you are using your Sitz bath to treat a vaginal yeast infection. If you were to use vinegar when treating hemorrhoids, then, like the use of any harsh soap flakes or perfumed cleaning products, it may well actually make your piles worse.
The safest option for your Sitz bath, if you are in doubt, is to just use clean water and leave it at that.
Checking with NHS guidelines in the UK, it’s also worth pointing out that there is little clinical evidence that Sitz baths do anything to actually treat hemorrhoids.
As the practice of Medicine in the UK is evidence based (meaning if you can’t find good evidence, usually in the form of research papers, to back up a treatment, you must either create that evidence or not use the treatment), Sitz baths are therefore not currently recommended in the treatment of hemorrhoids.
That isn’t to say they don’t help remove the pain, but it is to say that they are unlikely to cure you.
Consider, perhaps with your local doctor, what may have caused your hemorrhoids in the first place, and what lifestyle changes you can put in place to help yourself get rid of them.
Equally, there’s nothing that suggests that Sitz baths, if properly undertaken, will make your piles worse.
Sitz baths are NOT something you can do anywhere, nor at the drop of a hat.
Ask yourself whether they are going to be convenient for your lifestyle.
The last caveat is that getting in and out of hot water, especially if you’re alternating it with cold water, can make anyone dizzy.
This is more likely if you have any heart problems, so take care getting in and out of your Sitz bath and make sure the water isn’t too hot.
If you have a history of heart problems, you may wish to check with your doctor that it is safe for you, and you may want to have someone else around to check you are okay.
[According to N.J. Paonessa, D.O., FACOS, a professor of Surgery, "Conservative / Nonoperative Therapy", prolonged soaking in a sitz bath may have the opposite effect, swell things up and make things worse - I. Khubchandani ed et al., Surgical Treatment of Hemorrhoids, Chapt 6, 2nd ed., Springer, 2009].
The easiest option is to buy a plastic tub big enough that you can comfortably sit your buttocks in it and use that!
If you’re flexible enough, or have a comfortably shaped bath, you can even run the water high enough that you can immerse your hips and bum by sitting on the edge and lowering your hindquarters in carefully. But that’s obviously not going to be for everyone.
The cheaper end of the market is for a helpfully shaped tub that either sits on a chair or over the toilet, which you then fill yourself with water. Some have a holes to let the water spill safely out (rather than splashing over the floor) when you get in. You can probably find something like this over the internet by searching for Sitz baths on your search engine, and you can find them for as little as ten dollars.
As with anything you buy, you can really go as high as you like!
There are very advanced types available that have their own water heaters, or can pipe water in rather like a whirlpool bath. But you might want to try a cheap version first to see if Sitz baths really benefits you.
Be careful what you’re buying, too, see if you can find user testimonies and check for guarantees.
There are even antique Sitz bath versions around on the antique market, if that appeals to you - they are likely to be porcelain and quite heavy, as well as expensive.
The Sitz bath is a simple, safe, cheap and probably effective treatment for the pain of hemorrhoids. But it won’t make them go away by itself, it’s a slightly awkward process in terms of speed of preparation and what you have to do compared to (say) taking a painkiller, and they certainly won’t suit everybody.
As with any harmless symptomatic treatment (that’s something that just deals with the symptoms, e.g. pain, and doesn’t treat the cause), there should be no harm in trying a Sitz bath to see if it helps you. But if the Sitz bath doesn’t work, or if it makes things worse, stop using the Sitz bath and ask someone for advice.
Research and write by James Hogg,(BSc Oxon, MBBS & BA Hons), Doctor of Medicine, minor editing by Donald Urquhart.