Epsom salt for hemorrhoids: does it help a sitz bath?

An Epsom salt bath for hemorrhoids is one of the most common pieces of home advice, and the salt is the part with no research behind it. No trial has compared a soak with Epsom salt to a soak in plain warm water. What the studies do show is that warm water relaxes the muscle around the anus, which is why a soak eases throbbing and spasm.

So an Epsom salt sitz bath can help, and the salt is optional. This page explains what the warm water does, why magnesium from the bath does not get into your body in a useful way, how to soak safely, and how a soak fits with the rest of a flare plan. Step-by-step soaking instructions are also in how to take a sitz bath.

Does Epsom salt help hemorrhoids?

Epsom salt is magnesium sulfate. The claim online is that the magnesium soaks into the skin and reduces swelling or inflammation. Two separate questions sit inside that claim, and neither has a hemorrhoid study.

A 2017 review on transdermal magnesium, meaning magnesium through the skin, looked at the evidence behind magnesium sprays, flakes and salt baths ¹. It concluded that promoting magnesium absorption through the skin is scientifically unsupported, while magnesium taken by mouth is well studied ¹. A short soak on a small patch of skin is an even weaker case for absorption than a full bath.

What the warm water actually does

The useful part of a sitz bath is the heat. In a study of anal sphincter pressure in warm and cold water, resting pressure in the anal canal fell after the anus was immersed in water at 40°C, and stayed the same at 5°C and at room temperature ². After 5 minutes at 40°C, pressure stayed lower for about 15 minutes in volunteers and about 30 minutes in people with anorectal problems ².

A second study had people with fissures and hemorrhoids sit in warm baths at 40, 45 and 50°C for 10 minutes each ³. Pressure and muscle activity in the internal sphincter dropped in the bath, pain relief was greater at higher temperatures, and the effects wore off 25 to 70 minutes after getting out ³. The authors tied the pain relief to the sphincter relaxing ³. Do not copy the 50°C setting at home. Water that hot can scald, and burns are a reported sitz bath complication ⁴.

How strong is the case for sitz baths?

It is thinner than most people assume. A 2005 review of sitz bath research found 36 articles and only one randomized trial against placebo, and concluded there was a lack of scientific data behind the advice ⁴. It noted reports that cold soaks reduced swelling more than warm ones, and that patients preferred warm ⁴.

A randomized trial in 52 people with acute anal fissures compared plain lukewarm sitz baths twice a day with no baths, on top of psyllium for everyone ⁵. Pain scores were lower with the baths but not by a significant margin, healing was the same, and satisfaction was clearly higher in the bath group ⁵. Two people in that group developed a skin rash ⁵.

Health agencies still recommend soaks for comfort. NIDDK suggests sitting in warm water several times a day for pain ⁶, and the NHS says a warm bath can ease itching and pain ⁷. A soak is a comfort tool you can repeat. It is not the remedy that cut bleeding in half in trials. That was fiber ⁹.

How to take an Epsom salt sitz bath

1. Clean a sitz bath basin or a bathtub. A basin that fits on the toilet seat uses less water and is easier to repeat.
2. Fill it with water that feels warm, not hot, on the inside of your wrist.
3. If you like, stir in Epsom salt following the package directions until it dissolves. Plain water is fine.
4. Sit so the anal area is under water for 10 to 15 minutes.
5. Pat dry gently with a soft towel. Do not rub.
6. Repeat two or three times a day during a flare, and after bowel movements if that helps.

Skip bubble bath, scented oils and soaps in the water. The studies used plain water ^2,5. If the skin gets red, itchy or bumpy, go back to plain water.

Basins for wider hips, budget picks and electric options are compared on the best sitz baths.

Warm soak or ice pack?

They do different jobs. Warm water relaxes the sphincter spasm behind throbbing pain ^2,3. Cold is better for swelling: after hemorrhoid surgery, ice packing gave lower pain scores in the first 16 hours and less swelling at 24 hours than warm sitz baths in 166 people ⁸. Many people use both, a warm soak after a bowel movement and a wrapped cold pack for a few minutes when the area is puffy. When to choose which is in ice or heat for hemorrhoids.

Drinking Epsom salt is a different thing

Epsom salt is also sold as a saline laxative to drink. That use has its own label directions and limits, and it is not the same as a soak. A strong laxative can cause loose, frequent stools, and repeated wiping is hard on sore anal skin. If hard stools are behind your hemorrhoids, fiber is the gentler fix with trial evidence: in seven trials it halved the risk of bleeding ⁹. How to choose between fiber, softeners and laxatives is in stool softener, fiber or laxative. Ask a pharmacist before taking any laxative, and follow the label.

A soak in a full flare plan

A sitz bath is one step of several. The rest of a typical plan for the first few days:

• Fiber and water every day, built up over a week (the hemorrhoid diet)
• Short toilet sits with no straining or scrolling
• A wrapped cold pack for swelling
• A short course of a hemorrhoid cream if itching or pain is the main problem

The timed version, hour by hour and through day 14, is in how to get rid of hemorrhoids fast. Other natural remedies, from flavonoid pills to aloe, are graded in natural remedies for hemorrhoids.

MedlinePlus says to see a clinician if a week of home treatment has not helped, and to get rectal bleeding checked because hemorrhoids are only one possible cause ¹⁰. Colon cancer screening is recommended from age 45 for adults at average risk ¹¹.