The effectiveness of sitz bath in managing adult patients with anorectal disorders: A systematic review.

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.