Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

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One of the finest of the simple remedies is the sitz bath. It can be used for afflictions of the skin on the seat area, for many rectal and anal problems, for prostate problems, for vaginal and other pelvic conditions of women, and even for deep pelvic infections and pain.

• The sitz bath can be administered in a bathtub: the person sitting with the knees flexed out of the water, the feet and buttocks in the water. The thighs should not be hyperflexed up onto the abdomen, as a sharp degree of flexion interferes with circulation. It should be remembered that the sitz bath may be exchanged for the "half bath" with knees lowered into the water and the water level up to the umbilicus.
• The temperature may be cold, cool, neutral, tepid, hot, or very hot.
• There are also the rubbing sitz bath, the flowing sitz bath, and the revulsive sitz bath.

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Kinds of Sitz Baths

• ‍Rubbing Sitz Bath - During the rubbing sitz, a friction with loofa or other coarse sponge can be used to mechanically increase the flow of blood to the skin of the area.
• ‍Flowing Sitz Bath - In the flowing sitz bath, a stream of water is directed to the pelvic area, the person sitting on a low stool in the bathtub.
• ‍Revulsive Sitz Bath - In the revulsive sitz bath, a tub of hot water is used alternately with a tub of cold water. It can best be done if two tubs are used with alternating hot and cold temperatures. The tubs should be the size of a #2 washtub, and if turned slightly to the edge and supported by blocks, the patient may be comfortably seated in it by leaving the feet outside and flexing the knees. The feet should be placed in a separate smaller tub for simultaneous administration of a hot foot bath, which greatly decreases the blood flow to the pelvic organs.

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Temperatures and Times

For the cold sitz bath, the temperature is 55° to 65°, about the temperature of tap water. The time should be between one and five minutes. The cool bath is between 70° and 80°, and the tepid bath is 90° to 97°. The cool or tepid bath should be maintained for ten to fifteen minutes. Never put a chilled person into a cold bath. During the cold sitz bath the feet should be kept warm to prevent chilling. This may be accomplished by a hot foot bath, hot water bottles, or hot towels. The thighs should not be pressed tightly against the abdomen, and there should be no pressure from the tub rim behind the knees or at the crease of the thighs to impede circulation.

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Other Conditions, Sitz Baths Helpful

• Jaundice
• Hepatitis
• Mental fatigue
• Liver or spleen congestion
• Chronic diarrhea
• Chronic inflammation of prostate
• Bedwetting in children
• Chronic uterine relaxation
• Prostatic problems
• Excessive or painful menstruation
• Bleeding of the bladder, intestine
• Insomnia
• Delayed labor
• To normalize uterus after childbirth
• Blood pressure (increase / decrease)
• Itchiness
• Irritability or nervousness
• Hemorrhoids and rectal fissures

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Effects

The physiologic effect of a hot or a cold bath, either sitz or half bath, is to increase the circulation to the inner surfaces of the thighs, the entire seat area, and the external and internal genitals. The cold sitz bath will slow the pulse, increase the blood pressure, and if it is short (one to three minutes), will have a powerful reaction on all parts brought in contact with the water, and reflexively to the internal organs associated with the skin. The blood vessels are actively dilated on the lower abdomen and internally in the pelvis, increasing the circulation of blood through these parts. The nutritive processes of tissues are increased, and there is contraction of the muscular structures of the internal organs beneficially influencing the bladder, pelvic organs, rectum, and various associated tissues. The supporting structures of the low abdomen and pelvic viscera are benefited, and this bath may be used to strengthen sagging muscles in this area.

The most frequent use of this treatment is for the female pelvic organs. The cold sitz may also be used in jaundice, or hepatitis, after a sweating or fever treatment has been given. It stimulates the outflow of bile by increasing the tension of the portal circulation. For vigorous patients the cold sitz bath is helpful for those who have mental fatigue, liver or spleen congestion, bedwetting in children, chronic uterine relaxation, and in prostatic problems.

For a prolonged cold bath, 30 to 45 minutes at 65°to 75° (beginning at 89° to 90° and gradually lowering it after the first few minutes), accompanied by a hot foot bath at 104° to 110° is good for excessive or painful menstruation, for chronic diarrhea, or for bleeding of the bladder, intestine, or uterus. In men it may be used for diarrhea or for chronic inflammation of the prostate.

The revulsive sitz with a hot bath for three to eight minutes at 115°, and then into the cold water for a few seconds, is a very powerful sedative for painful menstruation, or a painful prostate.

A cold bath should never be used for those who have high blood pressure or for a chilled patient. In some acute pelvic conditions, because of the powerful reaction on the muscles by the influence of cold water, an increase in pain may be experienced during and after the bath. If the pain is troublesome, merely change the bath to a hot sitz for 15 to 20 minutes.

The cold rubbing sitz bath is used for constipation, bedwetting in children, slow return of the uterus to normal size following childbirth, and for insomnia. It has also been used for delayed labor, cold water being poured down the spine while the patient is in the bath.

The commonest, but not always the most effective, form of the sitz bath is a hot sitz bath at a temperature from 106° to 116° for three to thirty minutes. It can be used to reduce blood pressure, to reduce congestion of the pelvic organs, to treat infections of the bladder, prostate, epididymis, fallopian tubes or uterus, and to drain the portal circulation in liver disease. It can help restore proper function in menstrual irregularities.

Hemorrhoids and rectal fissures have their treatment of choice in the very hot sitz bath. For kidney colic with the passage of a stone, the hot sitz bath is a most powerful painkiller. For the best effect it should be followed by a short cold rub with a cold towel in the area covered by the hot water. The slightest chilliness following the bath can be accompanied by a return of pain or unpleasant symptoms.

The neutral sitz bath between 90° and 97° has a calming effect both on the pelvic viscera as well as on the central nervous system. It may be used in persons who are irritable or nervous for any reason, in mental illness, in itching, and many other uses.