From the Research
Sitz baths are recommended after incision and drainage of a pilonidal cyst to promote wound healing and reduce morbidity. According to the most recent and highest quality study available, which is a systematic review published in 2019 1, the management of pilonidal disease has shifted towards less invasive procedures with equivalent or better outcomes compared to classic excision. While this study does not specifically address sitz baths, it emphasizes the importance of post-operative wound care in promoting healing and reducing complications.
Post-Operative Care
To prepare a sitz bath, fill a clean bathtub with a few inches of warm water (not hot) or use a specialized sitz bath basin that fits over a toilet seat. Adding 1-2 tablespoons of Epsom salt to the water may provide additional soothing benefits, though plain warm water is also effective. After each bath, gently pat the area dry with a clean towel—never rub the wound. Sitz baths help keep the surgical area clean, reduce inflammation, improve blood circulation to promote healing, and provide pain relief. They also help soften and remove debris from the wound, which is particularly important for pilonidal cysts that have been packed with gauze.
Recommendations
- Patients should take warm sitz baths 2-3 times daily for 10-15 minutes each session.
- Continue sitz baths for 1-2 weeks after the procedure or until the wound has significantly healed.
- Patients should continue any prescribed antibiotics and pain medications as directed by their healthcare provider alongside the sitz bath regimen.
Considerations
The use of negative-pressure wound therapy has been explored as an alternative to standard open wound care after surgical excision of pilonidal sinus disease, showing a positive effect on wound size reduction in the first 2 weeks, although it did not significantly reduce the time to complete wound healing or the time to resume daily activities 2. However, the primary focus remains on optimizing wound care and management post-operatively to minimize morbidity and improve quality of life for patients with pilonidal cysts.