The effect of salty warm sitz bath on the conservative management of anal fissure

Abstract

Background: The benefits of the sitz bath method in the management of anorectal diseases in general and anal fissure, in particular, are still not scientifically well-established. In our study, we aim to analyze the effectiveness of the sitz bath method as part of a conservative management protocol to treat anal fissure among Saudi Arabians who fear the surgical option for particularly religious reasons.Methods: The 539 Saudi Arabian patients with acute or chronic anal fissures between January 2004 and December 2013 were included. 386 were male and 153 were female with a mean age of 25.68±5.7 years. The conservative management protocol consisted of three times per day salty warm sitz bath, 2 grams glycerin suppositories per rectum 20 minutes before defecation as lubricant and laxative, Metamucil bulk-forming fiber (a mix of one dose-sachet-within 240 milliliters (8 oz) of cold liquid) once daily after breakfast for constipation.Results: The 379 (70.3%) patients had complete healing with a duration range from 3-7 weeks, while 160 (29.7%) patients did not heal and required surgical intervention. The recurrence rate was 0% in both groups after two years of follow-up.Conclusions: We conclude that sitz bath as part of a conservative management protocol to treat anal fissure showed promising results which were a significant benefit to patients who were reluctant to undergo lateral anal sphincterotomy and dilatation because of the fear to lose anal control. We recommend further specialized studies to investigate the role of sitz bath in the conservative management of anal fissure.