Effect of Early Warm Water Sitz Bath on Urinary Retention After Hemorrhoidectomy
Effect of Early Warm Water Sitz Bath on Urinary Retention After Hemorrhoidectomy
Background:

 Hemorrhoid is one of the most common chronic anorectal diseases. The prevalence rate is about
 44%. It occurs in adults aged 45-65 years. Hemorrhoidetomy resection is still the standard
 treatment for grade III and IV hemorrhoid. Urinary retention is one of the most common
 complications after hemorrhoid surgery, and the complications occur within 24 hours after
 surgery. The warm water sitz bath is a routine nursing care after hemorrhoid surgery in the
 clinic. The purpose is to provide moist heat of the perineum and anus to clean, promote
 healing and drainage, relieve pain, stimulate urination and promote relaxation. In contrast,
 all current studies, warm water sitz bath intervention time is the first day after surgery,
 the complications within 24 hours after surgery are not alleviated.

 Objective:

 The main purpose was to use experimental research methods to verify the effect of early warm
 water sitz bath on urinary retention after hemorrhoidectomy. The secondary objective was the
 effect of early warm water sitz bath on wound pain after hemorrhoidectomy.

 Methods:

 This study was a single-blind randomized trial in which subjects were randomly assigned to an
 experimental or control group with symptomatic stage III or IV end hemorrhoid who were
 admitted to the hospital for hemorrhoidectomy. The experimental group started the warm water
 bath 6 hours after the end of the operation, while the control group started the warm water
 sitz bath on the first day after the operation. The investigator assessed the amount of
 residual urine and wound pain index before and after each operation of the warm water sitz
 bath after surgery, and each subject was evaluated 8 times until 24 hours after surgery.
In order to ensure that the results of the study are not distorted by humans, this study is a
 single-blind randomized trial study. The subjects were randomly assigned to the experimental
 group or the control group with a permuted block randomization. For the sample number
 calculation, refer to Hedeker, Gibbons & Waternaux (1999) Comparing the time-dependent
 comparison of the longitudinal design sample size estimates between the two groups, and
 considering the 20% sample loss rate, the total number of samples is estimated to be 64 (32
 in the control group and 32 in the experimental group).

 The two groups of patients also received the same conventional treatment, anesthesia and
 surgery on the night before and on the day of the operation, and the warm water sitz bath was
 performed at different times after the operation. The warm water sitz bath temperature of the
 two groups was also 41-43°C daily 3 times (9:00, 13:00, 17:00), 5 minutes each time, and
 regularly take the same painkillers, stool softeners, and antibiotics. The researchers
 evaluated the wound pain index on the Numerical Rating Scale (NRS) 6 hours after the
 operation, 7 hours after the operation, and before and after each warm water sitz bath; After
 urine, the residual urine volume of the subject was evaluated with a Bladder Scan until the
 first day after the operation. A total of 8 evaluations were performed: 6 hours after the
 operation, 7 hours after the operation, and the first day after the operation 8:30, 9:30,
 12:30, 13:30, 16:30, 17:30.

 During the test, the number of subjects with adverse reactions (vertigo, weakness, sustained
 wound bleeding greater than 100ml) was greater than 3% of the total number of cases (2
 persons). The trial was terminated immediately.

 Acceptance conditions:

 1. Age over 20 years old, easy to move, can get out of bed and take a bath.

 2. Symptomatic grade III or IV hemorrhoids diagnosed by the surgeon.

 3. Accept epidural anesthesia.

 4. Perform hemorrhoidectomy.

 5. Those who have clear awareness and are willing to participate in and fill out the
 research consent form.

 Exclusion conditions:

 1. Diseases around the anus (fistula, abscess).

 2. Urinary tract problems (prostate hypertrophy in the past medical history; urinary tract
 infections on admission routine urine tests, urinary retention as assessed by Bladder
 Scan).

 3. Take painkillers before surgery.

 Statistical methods

 1. Descriptive statistical analysis: Adopt the mean, standard deviation, frequency
 distribution and percentage to present the basic attributes of the subjects.

 2. Inferential statistics: Chi-square test was used to analyze the categorical variables,
 and independent sample t-test was used to analyze the continuous variables.

 3. Use the independent sample t test to compare the differences in the average degree of
 urinary retention and pain between the groups. If the data are not normally distributed,
 switch to the Mann-Whitney U test without parental analysis to compare the experimental
 group and the control group before and after bathing Whether there is a difference, p
 value <0.05 is considered statistically significant.

 4. Use GEE (Generalized Estimating Equation) to check whether there is any difference in
 the degree of urinary retention and pain in each group.

 The use of k-Nearest Neighbours to fill in the missing values is mainly to see that the
 relevant data measured by the subject in the same group is similar to those of other
 subjects, and then average the data measured by these similar subjects at the same time Value
 to fill.
Inclusion Criteria:

 1. The age is more than 20 years old, the action is convenient, you can get out of bed
 and take a bath.

 2. Diagnosed as symptomatic grade III or IV hemorrhoid by a surgeon.

 3. Accept epidural anesthesia.

 4. Perform an open hemorrhoidectomy.

 5. After the researcher explains the purpose of the study, the person with a clear
 consciousness and willing to participate and fill out the study consent form.

 Exclusion Criteria:

 1. Disease around the anus (fistula, abscess).

 2. Urinary tract problems (in the past, there was a hypertrophy of the prostate; the
 routine urine test for admission had a urinary tract infection, and the bladder volume
 tester evaluated urinary retention).

 3. Take analgesics before surgery.