Warm water alone is the most reliable thing to put in a sitz bath for hemorrhoids. Cleveland Clinic’s guidance is clear: you don’t need Epsom salt or any additive for a sitz bath to work. Salts, oils, and other substances can actually cause inflammation in sensitive tissue. That said, a few simple additions like Epsom salt or baking soda are commonly used and generally well tolerated, so here’s what to know about each option.
Why Warm Water Works on Its Own
The therapeutic benefit of a sitz bath comes primarily from the warm water, not from anything you add to it. Heat applied to the anal area relaxes the internal sphincter muscle, which tends to tighten and spasm when hemorrhoids are inflamed. That relaxation improves blood flow, eases pressure on swollen veins, and reduces pain. The water also gently cleanses the area without the friction of wiping.
Fill a sitz bath basin or your bathtub with a few inches of comfortably warm water. You want it warm enough to be soothing but not hot enough to burn already-irritated skin. If it feels too hot on the inside of your wrist, let it cool. Soak for 10 to 20 minutes, two to four times a day, especially after bowel movements when discomfort tends to peak.
Epsom Salt
Epsom salt (magnesium sulfate) is the most commonly recommended additive. Some people find it provides additional relief from soreness and swelling, though the evidence that it adds meaningful benefit beyond warm water is limited. If you want to try it, a typical ratio is about 2 level teaspoons per quart (4 cups) of water. For a bathtub with several inches of water, follow the package instructions and scale up accordingly. Dissolve the salt completely before sitting down to avoid granules irritating the skin.
Baking Soda
Baking soda is a useful option if itching is your main complaint. It creates a mildly alkaline environment that can calm irritated skin and reduce the urge to scratch, which is important because scratching inflamed hemorrhoids makes everything worse. Use half a tablespoon to one tablespoon in a sitz bath basin of lukewarm water. Soak for 10 to 15 minutes. Baking soda is gentle and unlikely to cause a reaction for most people.
Witch Hazel: Better as a Topical
Witch hazel is one of the most effective natural remedies for hemorrhoid symptoms, but it works best applied directly to the skin rather than diluted in bathwater. It contains natural compounds called tannins that constrict blood vessels, reduce swelling, and stabilize fragile capillary walls. That’s why it helps with minor bleeding, itching, and burning.
The most practical way to use witch hazel is through pre-soaked medicated pads (like Tucks) or by dabbing it onto the area with a cotton pad after your sitz bath, when the tissue is clean and soft. Adding it to a full basin of water dilutes it to the point where you lose most of those astringent benefits. Save it for after the soak.
What to Avoid Adding
Essential oils like tea tree or lavender are popular suggestions online, but they’re risky for this particular use. The skin around the anus is thinner and more permeable than skin elsewhere on the body, making it more vulnerable to chemical irritation. Oils, fragrances, bubble bath, and soap can all trigger inflammation or allergic reactions in tissue that’s already damaged. Cleveland Clinic specifically warns against adding these substances unless your healthcare provider has directed you to.
Hydrogen peroxide, rubbing alcohol, and vinegar also fall into the “skip it” category. They can sting, dry out tissue, and delay healing. The simpler you keep the bath, the less likely you are to make things worse.
Cold Versus Warm for Swelling
If your hemorrhoids are severely swollen, you might wonder about cold water instead. A 2025 randomized controlled trial comparing ice packing to warm sitz baths after hemorrhoid surgery found that cold therapy was actually better at reducing swelling and pain in the first 24 hours. Nearly 77% of the ice group had no or mild swelling at that point, compared to 56% in the warm sitz bath group.
For everyday hemorrhoid flare-ups (not post-surgical recovery), warm water is still the standard recommendation because of its muscle-relaxing effects. But alternating between a warm sitz bath and a cold compress applied externally can give you the benefits of both: relaxation from the heat, swelling reduction from the cold. Apply a cloth-wrapped ice pack for 10 to 15 minutes at a time, never directly on the skin.
After the Soak
How you dry off matters almost as much as the bath itself. Pat the area gently with a soft, clean towel or use a hair dryer on a cool, low setting. Rubbing with a towel creates friction that can re-irritate swollen tissue. Once the area is dry, that’s a good time to apply any topical treatments: witch hazel pads, a zinc oxide barrier cream, or an over-the-counter hemorrhoid ointment. The clean, softened skin absorbs these products more effectively.
Keep the basin or tub clean between uses. Rinse it with hot water and let it air dry. If you’re using a plastic sitz bath that fits over the toilet, check it periodically for cracks where bacteria could accumulate.