Ice Packing Versus Warm Sitz Baths for Post-Hemorrhoidectomy Pain Management: A Randomized Controlled Trial.

Background: Post-hemorrhoidectomy pain management remains challenging, with warm sitz baths being a common yet debated intervention.

Objective: To compare the efficacy of ice packing versus warm sitz baths in managing post-hemorrhoidectomy pain and wound healing.

Design: Randomized controlled trial.

Settings: Single-center study at E-DA Hospital, Taiwan.

Patients: 166 patients undergoing Ferguson hemorrhoidectomy.

Interventions: Patients were randomized to receive either ice packing (n = 82) or warm sitz bath (n = 84) for initial post-operative care.

Main outcome measures: Primary outcomes were pain (visual analog scale) and swelling. Secondary outcomes included wound healing (REEDA scale), analgesic consumption, and adverse events.

Results: Ice packing group showed lower pain scores within 16h post-surgery ( p < 0.01), reduced swelling at 24h (76.8% vs. 56.0% with no/mild swelling, p = 0.03), superior wound healing at 7 days (REEDA score: 2.56±1.89 vs. 3.27±2.12, p = 0.02), and lower 24h morphine consumption (4.58±2.56 mg vs. 6.39±2.7 mg, p < 0.01).

Limitations: Single-center design, short follow-up period, lack of validated hemorrhoid-specific wound assessment tools, and exclusion of ASA III patients limiting generalizability.

Conclusions: Ice packing demonstrated superior efficacy in managing post-hemorrhoidectomy pain, reducing edema, and promoting wound healing, with comparable safety profile and lower opioid requirements. See Video Abstract .