The Efficacy of Sitz Baths as Compared to Lateral Internal Sphincterotomy in Patients with Anal Fissures: A Systematic Review

Abstract

An anal fissure is a common condition that affects patients of all ages. Its clinical presentation is a sharp pain on defecation with or without blood. It is treated by conservative or surgical means. This study aims to assess the efficacy of a sitz bath as compared to lateral internal sphincterotomy in the treatment of anal fissures. The search strategy used keywords related to the topic of study. Three databases were used: PubMed, Google Scholar, and Science Direct. A total of 551 articles were screened. A quality assessment check was done on the articles leaving 11 articles. Four aspects of sitz bath outcomes were evaluated in the articles. In terms of analgesia, articles showed conflicting evidence. However, the overall evidence supports the use of sitz baths for their analgesic properties. In terms of healing, most articles had similar recovery rates of around 80%. Much of the research supported the use of sitz baths as the primary treatment to heal acute fissures. When compared to lateral internal sphincterotomy, the recovery rates of lateral internal sphincterotomy are superior to those of conservative treatment, including sitz baths. However, studies showed incontinence as a side effect of lateral internal sphincterotomy, and no studies reported side effects from the sitz baths. To conclude, the results of the articles support the use of sitz baths to treat anal fissures. Sitz baths have been found to have analgesic properties, as well as a good healing time. But, compared to lateral internal sphincterotomy, there is a significant difference in the healing rate at the end stage of treatment, lateral internal sphincterotomy is found to be superior. With regards to the side effects, none have been reported from using a sitz bath.

Comparative Efficacy of Topical Metronidazole and Glyceryl Trinitrate Versus Topical Glyceryl Trinitrate Alone in the Treatment of Acute Anal Fissure: A Randomized Clinical Trial

“…Nitroglycerine-related headaches were the only adverse effect faced by the patients in our study. This was also observed by the systematic review conducted by Alnasser et al in which multiple studies claimed postural dizziness and headache due to nitrates use [16]. However, as a rescue dose, paracetamol was good enough to manage these headaches.…”

Anal fissure treatment in 2022 - A global snapshot audit conducted by the International Society of University Colon and Rectal Surgeons (ISUCRS)

“…A study undertaken by Jensen et al (13) who used warm sitz baths along with unprocessed bran to treat anal ssures in 96 patients argued that this treatment combination yielded the same results as topical analgesics and anti-in ammatory ointments while avoiding their side-effects and costs. (13) Another study performed by Alnasser et al (14) on 519 patients has shown that the use of conservative management protocol consisting of salty warm sitz bath three times daily, 2 grams glycerin suppositories per rectum 20 minutes before defecation and bulk-forming ber daily yielded complete ssure healing in 379 (70.3%) patients with a duration range from 3-7 weeks. The remaining 160 (29.7%) patients who did not heal ultimately had surgical intervention with a 0% recurrence rate.…”

The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure

“…In addition, patients may also experience a burning, dull perianal discomfort which may last for several hours after defaecation and may be offered nonopioid analgesics such as paracetamol with further escalation as appropriate [12]. The use of sitz baths has been shown to be safe and improve patient satisfaction levels but the evidence that this improves pain scores, or long-term healing rates is conflicting [13].…”