Warm Sitz Research Articles

Topical Calcium channel blockers for effective post operative analgesia for hemorrhoidectomy patients; A Randomized Control Trial at a Tertiary Care Hospital.

Objective: To compare the mean pain scores after hemorrhoidectomy in patients given topical calcium channel blocker and patients being given routine post-operative treatment only. Study Design: Randomized Controlled Trial. Setting: Surgical Department of Holy Family Hospital. Period: 7th January 2022 to 7th July 2022. Material & Methods: Patients fulfilling the inclusion criteria were divided into two groups. Group A patients will receive topical calcium channel blockers whole group B will receive conventional analgesic medications. Patients in both groups underwent open hemorrhoidectomy under saddle block anesthesia. At the end of procedure, a lignocaine gel-soaked pack was placed in rectum which was removed after 6 hours. The post-operative treatment of test group was similar in all regards except that they were given 2% diltiazem ointment to apply to perianal region twice a day. Oral stool softeners were started after NPO duration. The patients were advised to start warm sitz bath and application of 2% lignocaine gel to perianal region 12 hourly after removal of pack. The patients in both groups were compared for the degree of pain on the second post-operative day using visual analogue scale. Results: In this study, on comparison of mean pain scores after hemorrhoidectomy in patients given topical calcium channel blocker and patients being given routine post-operative treatment only shows that pain in Group-A was 5.89+0.80 and in Group-B 3.60+0.77, p value was 0.0001. Conclusion: Topical Calcium Channel Blockers are effective in managing post hemorrhoidectomy pain.

A COMPARATIVE STUDY OF LATERAL INTERNAL SPHINCTEROTOMY WITH FISSURECTOMY VS WITHOUT FISSURECTOMY IN FISSURE IN ANO IN A TERTIARY CARE HOSPITAL.

An anal ssure is dened as a longitudinal split in the distal anoderm which extends from the anal verge to the dentate line. A high percentage of acute ssures heal spontaneously within three weeks with conservative medical management comprising of a high bre diet, warm sitz bath, and topical analgesic with steroids. The lateral internal sphincterotomy (LIS) is one of the most practiced treatments for chronic anal ssure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. Fissurectomy is one of the options among those techniques which address the issues with LIS. The present study was conducted to compare the outcomes of lateral internal sphincterotomy with ssurectomy and lateral internal sphincterotomy in the treatment of chronic anal ssure and compare recurrence and postoperative complications among both the procedures

Conservative management of anal fissure accompanying constipation in school-age children

An anal fissure is a common problem in children and it refers to a longitudinal tear or an ulcer in the anoderm. The conventional therapy for anal fissures has been warm sitz baths and lthe ocal application of analgesic ointments, stool softeners ,and behavioral therapy as necessary. Simple wound care may often be sufficient for the treatment of anal fissure, but a comprehensive approach is required for accompanying constipation. Between 2015-2022, a total of 263 children suffering from constipation and perianal pain were diagnosed with anal fissure (AF) based on physical examination. Anal fissure and constipation (AFC) questionnaire forms were retrospectively reviewed and results of routine management protocol were assessed which was focused on local wound care and dietary regulation. The ratio of children consuming more than 2-3 cups of packed beverages containing artificial sweeteners, colorants or corn syrup was found 63,89 % (n=167). Daily water consumtion of less than five glasses was 71.1% (n=187). Daily milk consuming was 71,86% (n=189). Stool withholding and soiling was found 57,41% (n=151) and 48,67% (n=128) respectively. In only four cases (1.52%), constipation persisted for more than eight weeks despite meticulous management and improvement was achieved with anal dilatation on the tenth week. It is possible to treat anal fissures successfully and in a reasonable duration with simple local care with prednisolone pomade and a strict diet arrangement that restricts the consumption of packed foods, beverages, snacks, and milk while promoting drinking water and raw fiber intake.

Management of acute anal fissure with open and closed internal sphincterotomy

Introduction: An anal fissure is a lacerate tear in inner thin lining of anus. The tear exposes the muscle (anal sphincter) around the anus. The damage leads to muscle spasm, which pull the fissure edges even more. The spasms lead to pain and it also slow down the healing. An anal fissure is considered acute anal fissure if it occurs in less than 6 weeks or if it recently happened. Treatment done by breaking the cycle of spasm, relieving pain, and to avoid ischemia, which all are cause for anal fissure. First-line of treatment to minimize anal trauma includes stool softeners, bulk agents, and warm sitz baths(5) if not relived then sphincterotomy open or closed type surgery can be done. Material & Methods: We had conducted a comparative observational study from May 2019 to April 2021 at Dhiraj General Hospital, Vadodara in General Surgery department. In admitted patients posted for Sphincterotomy after consent & explaining risk factor, patients were operated. Detailed clinical history, clinical examination including per abdominal and per rectal examination, routine blood investigations & chest x-ray screening was done. In all the patients undergoing Sphincterotomy done either with open or closed method.

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

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.

Fissurectomy Versus Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure: A Randomized Control Trial.

IntroductionAn anal fissure is defined as a longitudinal split in the distal anoderm which extends from the anal verge to the dentate line. Fissures can be of primary or secondary type. The posterior midline is the most common location for primary fissures, while, anterior primary fissures, though rare, are more common in females. The cause of primary fissure is idiopathic. But secondary fissures are associated with other systemic diseases and can occur at an abnormal position anywhere in the anoderm. A high percentage of acute fissures heal spontaneously within three weeks with conservative medical management comprising of a high fiber diet, warm sitz bath, and topical analgesic with steroids. Secondary anal fissures will not heal in any form of treatment until the primary cause is addressed. These fissures often need surgical treatment. The lateral internal sphincterotomy (LIS) is one of the most practiced treatments for chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. Fissurectomy is one of the options among those techniques which address the issues with LIS. Some studies showed that patients with chronic fissures who are refractory to medical treatment responded well to fissurectomy. Hence, this study was conducted to compare the outcomes of fissurectomy and lateral internal sphincterotomy in the treatment of chronic anal fissure and compare recurrence and postoperative complications among both the procedures.MethodsAll consecutive patients attending the department of surgery with chronic fissure and age above 18 years were included in the study. All the included patients were randomized into two groups (fissurectomy and LIS) using the serially numbered opaque-sealed envelope (SNOSE) technique. The patients were discharged on the third day. The first visit was scheduled after two weeks and subsequent visits on the first and second months. Then the patients were followed up by telephonic conversation for the next six months. At the end of the follow-up, post-surgical complications were enquired, recorded, and interpreted.ResultsIn the present study, out of a total of 87 patients, 80 patients were included in the study. Among all the patients, 16 patients (20%) developed retention of urine. Four patients in the LIS group showed retention of urine whereas in the fissurectomy group it was twelve. The difference was not statistically significant (p-value: 0.025). A total of 10 patients required catheterization postoperatively. More patients in the fissurectomy group developed incontinence to flatus (p-value: 0.02). Incontinence to liquid and solid was significantly higher in the fissurectomy group (p-value: 0.03 and 0.002, respectively).ConclusionIn the present study, it was found that LIS was a better treatment option for chronic anal fissure than Fissurectomy. The postoperative complications were less in LIS than in fissurectomy. But the recurrence was higher in the LIS group while there was no recurrence in the fissurectomy group.

Outcome of Seton in the Management of Complex Fistula in Ano in a Tertiary Care Center in Bangladesh

Background: The management of high and complex anal fistulas remain a therapeutic challenge as it is often associated with recurrence and anal incontinence. The oldest and theoretically the simplest technique is to use a seton. The aim of this study is to find out the outcome of seton in the treatment of complex fistula in ano.
 Materials and methods: This cross-sectional study was done in surgical units of ShSMCH and colorectal surgery units of BSMMU from September 2014 to August 2015. Fifty patients with high anal fistula having internal opening above dentate line and with multiple fistulas tract were included by purposive sampling. Patients with low anal fistula, fistula in ano associated with Crohn’s disease, active abdominal tuberculosis, carcinoma of rectum, previous radiation therapy, with recurrent fistula in ano and in whom the internal opening could not be located were excluded. After initial evaluation, the fistula tract and opening were located. The skin and anoderm overlying the fistulous tract were incised. This double-strand seton was then tied over itself on the sphincter without excessive tension. The long end of each suture was tapped to the patient’s medial thigh. Postoperatively warm sitz bath after each bowel movement was advised. The patients were informed in detail about the presence of seton prosthesis and they were warned about the possible serous discharge that would continue until the seton dropped, and the wound healed. Data were recorded on the predesigned questionnaire and analyzed using SPSS version 16.
 Results: Among 50 cases mean age was 41 years, M: F was 4.5:1. Discharge from perianal sinus, pain, swelling and itching were common clinical presentation. All of the patients were discharged on the third postoperative day. None required readmission or needed narcotic analgesics after discharge. The average time for the seton to cut through the sphincter was 1 to 3 months. 28% had complete healing at 1 month and 66% at 3 months postoperatively. Flatus Incontinence was noted 16% cases followed by recurrence (6%), liquid stool incontinence (4%) and postoperative anal stricture was (2%) of cases.
 Conclusion: This study found that the seton is a safe and low morbidity option for the treatment of high and complex fistula-in-ano, having higher healing rates, with good quality of life. It can therefore be recommended as the standard treatment for complex fistula-in-ano.
 J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 15-19

Effectiveness of lavender sitzbath therapy on epissiorraphy of postpartum mother

High maternal birth with vaginal delivery causes high rate for perineal trauma and episiotomy. Epissiorraphy healing is prolonged in primiparous mother because lack of knowledge to care of their wound. It will interfere with the mother activity because of discomfort and pain on episiorrhaphy site. That is why non-pharmacologic management is recommended such as warm sitz bath therapy. Warm sitzbath therapy can increase blood flow to the perineal area through vasodilatation, increased capillary permeability, and reduced blood viscosity. Increased blood flows bring oxygen, nutrients and white blood cells to the wound that cause so the episiorraphy can heal faster The design of this research was pre-test and post-test nonequivalent control group. The sample was 15 participant for the intervention group using lavender sitzbath therapy and 15 participant for control group using sitzbath therapy only. The instrument using REEDA scale. Bivariate statistical test using Wilcoxon and Mann Whitney. The experiment group using lavender sitzbath therapy in pre-test “slightly healed” on the effectiveness of the lavender sitzbath therapy in terms of the healing process of episiorraphy on primiparous mother with the weighted mean 8.87 and the post-test “fully healed” with the weighted means 1.37. The result of pre-test and post-test had p-value of 0.001. it was interpreted that the lavender sitzbath therapy had a significant relationship in the healing process of primiparous mother. Lavender sitzbath therapy was effective on episiorraphy among postpartum mother.

Comparative study of conservative management of anal fissure with warm sitz bath and warm sitz shower bath

Background: Conservative treatment of anal fissure encompasses sitz bath as the prime modality. The present study was conducted to evaluate the comparative outcome of warm sitz bath and warm sitz shower bath among the anal fissure patients.Methods: The present study was prospective comparative evaluation of warm sitz bath and warm sitz shower bath method on 50 anal fissure patients attending the surgery department, Government Medical College, Dungarpur. The fifty patients were divided into two groups (n=25) as patients instructed with warm sitz bath and warm sitz shower bath respectively. The outcome such as pain relief, improvement in symptomatology and satisfaction were evaluated using visual analogue scale for 7 days.Results: The mean age of patients was 31-40 years. The day 1 pain core in warm sitz bath and warm sitz shower bath was found to be 7.54±0.87 and 7.87±0.65 respectively. On day 7 the pain score as significantly (p<0.05) reduced in warm sitz shower bath group as that of the warm sitz bath (2.67±0.47 vs 4.21±0.51) respectively. The patient satisfaction was significantly (p<0.05) higher in patients receiving warm sitz shower bath as that of the warm sitz bath. Further, significant (p<0.05) improvement in symptomology was observed in warm sitz shower bath group as that of warm sitz bath on day 3,5 and 7.Conclusions: Thus, the present study suggests that warm sitz shower bath showed significant efficacy in pain relief and satisfaction as that of the warm sitz bath.

CONSERVATIVE TREATMENT FOR ANAL FISSURE – FOR HOW LONG? – REVIEW OF THE LITERATURE AND PERSONAL EXPERIENCE

Anal fissure (AF) is a common proctologic disease and health problem, with potential for chronicity, causing the patient a debilitating suffering. The pathogenesis, in most of the cases consists in a vicious circle of pain-internal anal sphincter (IAS) spasm-decrease blood irrigation of mucosa-delay of healing. Treatment should aim to break this mechanism by cutting or relaxing the IAS and restoring adequate blood flow to promote healing. If anal stretch is becoming history, surgical sphincterotomy has the highest rate of healing and the least percentage of recurrence, but incontinence for flatus and stool may occur so “medical or “chemical” sphincterotomy using calcium channel blockers (CCB), nitric oxide donors, botulinum toxin injection are used with success rates from 50% to over 90%, also in combination with other conservative measures like warm sitz baths, stool softeners, high fiber and more liquid daily ingestion. All of those therapeutic measures are also stated in current guidelines. The question we tried to answer in this paper is for how long we can prolong the conservative, non-operative treatment in AF. Based upon literature research and our personal experience we may state that the earlier institution of medical specific treatment (CCB, nitric oxide donors, botulinum toxin) has more chances to heal the patient and avoid surgery. Success is also dependent on the good communication with the patient, detailed explanation of the purpose of the treatment, how to assess himself the evolution, and employ botulinum toxin earlier if patient is less compliant to topic treatment. Conservative non-operative management should be pushed as long as it is correctly applied and progression is made both from subjective and objective point of view and patient is compliant and content.

Is conservative treatment an effective option for pilonidal sinus disease in children?

Pilonidal sinus disease (PSD) is associated with a complex disease process in children, and its management remains controversial. There are a few published studies on PSD in the paediatric literature; therefore, we present our experience of conservatively treating PSD in children. This study involved a retrospective review with telephone follow up. All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery. All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess). Data collection included demographics, type of management, recurrence, presence of infection, and total healing time. In the study period, 29 children were identified. Their mean age was 14.94 ± 1.09 (range: 12-16) years, and 51.7% were girls. The mean length of follow up was 8.34 ± 6.36 (range: 1-25) months. Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery. PSD is being seen in children more frequently in recent years. Conservative treatment may be the recommended initial approach for PSD in children.

Clinical Profile of Haemorrhoid Cases Admitted in Various Tertiary Care Hospitals in an Urban Area of Southern India

Introduction: Clinical presentation of haemorrhoids is varied resembling number of anorectal diseases. Aim: To assess risk factors, clinical profile and management practices of haemorrhoid cases. Materials and Methods: This retrospective record based study was done at a government and private tertiary care hospital in Mangalore. Data from medical records of 220 haemorrhoid cases, over the past 10 years were collected and analysed. Chi-square test was used to test association. Results: Out of the 220 cases, 196 (89.1%) were males, 87.3% were unskilled workers and 123 (55.9%) were from urban areas. Among the cases, 96.5% were non-vegetarians, 150 (68.2%) gave history of frequent lifting of heavy weights, 69 (31.4%) had positive history of prolonged standing and 68 (30.9%) had history of constipation. Majority of cases had internal haemorrhoids 177 (80.5%) and were of third degree 92 (41.8%) variety. As many as 99 (45%) presented with haemorrhoids in 3 o’ clock position. The most common presentation was rectal bleeding 175 (79.5%) followed by anal pain 55 (25%). Rectal bleeding was present among most cases (80.8%) with internal haemorrhoids while majority of cases (28.2%) with external haemorrhoids complained of anal pain. Proctoscopy was the most common investigative procedure performed in 75% cases. Among conservative procedures, majority of cases 79 (35.9%) received warm sitz bath. Ferguson haemorrhoidectomy (closed haemorrhoidectomy) was the most common surgical procedure done in 83.8% cases. The outcome of management was recovery in 214 (97.3%) cases and recurrence reported in 6 (2.7%) cases. Conclusion: The high risk groups identified in this study such as non-vegetarians and those with history of frequent lifting of heavy weights need to be made aware of the risk of developing haemorrhoids. Suitable changes in their lifestyles will be useful in prevention of haemorrhoids. Information on its common clinical presentation would be useful in screening activities.

Effect of Electronic Toilet System (Bidet) on Anorectal Pressure in Normal Healthy Volunteers: Influence of Different Types of Water Stream and Temperature

Although bidets are widely used in Korea, its effects on anorectal pressures have not been studied in detail in terms of the water settings used. Twenty healthy volunteers were placed on a toilet equipped with a bidet, and anorectal pressures were measured with a manometry catheter inserted into the rectum and anal canal before and after using the bidet at different water forces (40, 80, 160, 200 mN), temperatures (24℃ vs 38℃), and water jet widths (narrow vs wide). The pressure at anal high pressure zone decreased from 96.1 ± 22.5 to 81.9 ± 23.3 mmHg at water jet pressure of 40 mN and 38℃ wide water jet (P < 0.001), from 94.3 ± 22.4 to 80.0 ± 24.1 mmHg at water jet pressure of 80 mN and 38℃ narrow water jet (P < 0.001), and from 92.3 ± 22.4 to 79.6 ± 24.7 mmHg at a water jet pressure of 80 mN and 38℃ wide water jet (P < 0.001). At other settings, no significant changes were observed. Our results indicate that, in addition to cleansing effect, bidet could be used to reduce anal resting pressure in the same manner as the traditional warm sitz bath under the conditions of low or medium water jet pressure, a warm water temperature, and a wide type water jet.

Efficacy of lanolin and bovine type I collagen in the treatment of childhood anal fissures: A prospective, randomized, controlled clinical trial

We designed an open-labeled, prospective, randomized, controlled clinical trial to test the efficacy of topical lanolin ointment (PureLan) and bovine type I collagen spray (Gelfix) in the treatment of childhood anal fissures. Seventy-one children with acute anal fissure were divided randomly into three groups: group I (control; n = 25), group II (PureLan; n = 28), and group III (Gelfix; n = 18). All children were assigned to have warm sitz baths, topical analgesic creams, and stool softeners. Patients in groups II and III were also treated with topical lanolin ointment and bovine type I collagen, respectively. All children were re-examined 4 weeks later. Complete healing of the anal fissure was observed in 68% of the group I patients, but in 92.9% and 100% of the group II and III patients, respectively. The difference among groups was significant in terms of complete fissure healing (P = 0.003), but the efficacy of topical lanolin ointment and bovine type I collagen spray did not differ significantly (P = 0.078). Our data suggest that topical lanolin ointment and bovine type I collagen spray are effective in the treatment of acute anal fissure in children.

Warm Sitz Bath: Are There Benefits after Transurethral Resection of the Prostate?

PurposeWe aimed to evaluate the efficacy of warm water sitz baths in patients who have undergone transurethral resection of the prostate (TURP) owing to lower urinary tract symptoms secondary to benign prostatic hyperplasia.Materials and MethodsWe reviewed the records of 1,783 patients who had undergone TURP between 2001 and 2009. In the warm water sitz bath group, patients were instructed to sit in a tub containing lukewarm water at 40-45℃ for 10 minutes each time. Patients were advised to perform the procedure for at least 5 days immediately after the removal of a Foley urethral catheter. The differences in post-TURP complications between the warm water sitz bath group and the no sitz bath group were compared.ResultsAfter TURP, 359 of the 1,561 patients performed a warm water sitz bath. Complications after TURP, such as hemorrhage, urinary tract infection, urethral stricture, and acute urinary retention were found in 19 (5.3%) and 75 (6.2%) patients in the sitz bath and no sitz bath groups, respectively (p=0.09). There was a significant difference in postoperative complications such as urethral stricture between the warm sitz bath group and the no sitz bath group (p=0.04). The group that did not undergo warm water sitz bath treatment showed a 1.13-fold increased risk of rehospitalization within 1 month after TURP due to postoperative complications compared with the warm water sitz bath group (odds ratio [OR]=1.134; 95% confidence interval [CI], 1.022 to 1.193; p=0.06).ConclusionsWarm water sitz bath treatment reduced postoperative complications such as urethral stricture. These results suggest that large-scale prospective studies are needed to establish an ideal method and optimal duration of sitz baths.

Sitz Bath: Where Is the Evidence? Scientific Basis of a Common Practice

This study was designed to determine if evidence exists to justify and support the recommendation of sitz bath in the management of anorectal disorders. A Medline search was conducted using the key words "sitz bath" and "hot bath." 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. 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.

Chronic anal fissure

Today, chronic anal fissure can be treated and often cured by nonsurgical therapy. Both topical application of glyceryl tri nitrate and intra-sphincteric injection of botulinum toxin appear to be safe and effective in relieving symptoms and in healing the anal fissure in 70% to 90% of patients. These drugs should now be regarded as the mainstay of therapy for chronic fissure-in-ano. Surgery should only be performed in refractory cases and should no longer be the first-line approach, largely because of the unpredictable and unacceptable adverse effects. It is important to emphasize that although the aforementioned therapies can heal fissure-in-ano, simpler lifestyle measures may be effective in the majority of patients with acute anal fissure. These include avoiding excessive straining, consuming a high fiber diet, using stool softeners, and taking warm sitz baths, together with local emollients with or without local anesthetics and steroids.

Effects of Heat and Cold on the Perineum after Episiotomy/Laceration

The Redness Edema Ecchymosis Discharge Approximation (REEDA) tool, devised to evaluate postpartum healing of the perineum following an episiotomy/laceration, was used to evaluate the effects of heat and cold on the perineum during the first 24 hours after delivery. Ninety patients were randomly assigned to one of three treatment groups. Treatment consisted of 30 subjects applying a warm perineal pack, 30 applying a cold perineal pack, and 30 taking a warm sitz bath. Analysis of variance indicated no difference in the REEDA score before or two hours after treatment. A Pearson r correlation indicated the REEDA score was associated with a laceration and not with infant weight. Although these findings do not support assumptions from the literature, this study provides baseline data and trends for future study.

A Comparison of Cold Warm Sitz Baths for Relief of Postpartum Perineal Pain

The effect of cold sitz baths for relieving perineal pain in the postpartum period after an episiotomy was evaluated. Forty patients took both cold and warm sitz baths with random assignment of the initial bath. Patients rated the degree of perineal pain before and after each sitz bath and at half-hour and one-hour intervals after each bath. A pain scale using 0-5, 0 representing no pain and 5 representing extreme pain, was used. Analysis of pain scale scores using a two-way analysis of variance with replications showed that cold sitz baths were significantly more effective in relieving perineal pain. The greatest amount of pain relief was experienced immediately after the cold sitz baths.