A1.2: Be Kind to Your Behind: A Systematic Review on the Habitual Use of Bidets in Benign Perianal Disease

Background: Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia but its role in perianal disease is unknown.

Purpose: To critically analyse and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease. Data Sources: A database search was conducted on MEDLINE and Epub Ahead of Print, Embase, Clinicaltrials.gov, the Cochrane Library, and ProQuest Dissertations. All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included.

Data Extraction: The studies were screened and critically analyzed by two independent reviewers in line with PRISMA guidelines. Results: 2 prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. 1 RCT identified that using bidets was non-inferior to sitz-bath for post-hemorrhoidectomy pain. 2 prospective trials and 1 cross-sectional study identified that habitual bidet use may increase the odds of developing pruritus ani. 2 case series identified that habitual bidet use may cause perianal burns or anterior anal fissures. A systematic review was not performed because only a limited number of studies were available, and they were of variable quality

Conclusion: The current evidence does not identify using bidets as a treatment modality for perianal disease, and further research is warranted to study this increasingly utilized technology.