Hydrotherapy, earlier known as hydropathy and water cure, is a system of alternative medicine and naturopathy that utilises water for healing. Various names are used for hydrotherapy interchangeably; some of them are water therapy, aquatic therapy, pool therapy and balneotherapy. The principle of hydrotherapy is that water in various forms and at various temperatures can produce different effects on different systems of the body. This principle has been exploited for the creation of therapies by many cultures and systems of traditional medicine that have been used since the dawn of civilisation. Modern-day hydrotherapy can be defined as the external or internal use of water in any of its forms (water, ice, steam) for health promotion or treatment of various diseases with various temperatures, pressure, duration and site. Even though the term therapy seems to imply the need for specialised medical equipment and the mandatory presence of a counsellor or therapist, hydrotherapy also includes seemingly inane practices like taking a hot bath or using a steam-sauna, which people can do and have been doing without supervision. However, with more specialised treatment modalities, a trained and expert instructor or therapist is indispensable to the process. An example is aquatic therapy, a form of physiotherapy where exercises are performed in water (typically a pool) for relaxation, fitness, physical rehabilitation and other therapeutic benefits. A trained aquatic therapy practitioner is in attendance throughout the session and provides guidance to the clients.

  1. Types of hydrotherapy and their uses
  2. Contraindications for hydrotherapy
  3. Complications of hydrotherapy

As hydrotherapy consists of the application and use of water in different forms, temperatures, pressures and flow rates, many techniques have been created and used with water. These methods range from simple at-home practices like taking hot baths to more specialised treatments instituted only in the care of a licensed therapist. Some types of hydrotherapy used in medical treatments are:

  • Simple use of running water: Cold running water available in taps in the kitchen or the bathroom of nearly all homes is the absolute first line first-aid treatment for many emergency situations. Examples include:
    • Burns: While ice packs, ice water or cold fomenting should not be done to a burn area due to the risk of damaging the tissue further, cold or lukewarm running water should be allowed to flow over (at medium to low pressure) the burned or singed area to cool it.
    • Acid injury: It is important to not apply an alkaline solution like soap on an area with an acid spill as the heat generated would further damage the skin. However, plenty of water (preferably cool water) should be allowed to run over the acid burnt area to remove as much of the chemical as possible and cool the region.
    • Alkali spills: Employing a similar principle as acid spills, acids should not be applied to alkali burns as the heat generated from the neutralising reaction would further incinerate the affected area. Water should be used to douse the area of the spill to remove as much of the chemical as possible and cool the injured tissue.
    • Wound irrigation: Although normal saline is regarded as the best possible fluid for irrigation, or cleansing of wounds, often it is not available at hand when a major injury occurs. Normal tap water is commonly used in everyday scenarios and is recommended to be used as soon as possible and its timely use can even prevent sepsis. The aim of timely wound irrigation with water is wound hydration and removal of debris, dead cells, pathogens and excess blood or other exudates such as pus in an open wound. It also makes visual examination better by clearing the field.
  • Wraps, compresses, packs and fomentation: The most common and easy-to-use form of hydrotherapy is the application of external packs, wraps or compresses soaked in warm or cold water (or ice), directly to the skin overlying the warm or painful area. These remedial methods help bring about targeted symptomatic relief. While these treatments have been used as common home remedies since time immemorial, they may also be prescribed by the doctor as an add-on therapeutic measure or even independently in conditions that require nothing more than hot or cold fomentation. Common examples of this form of hydrotherapy are:
    • Application of cold water wraps to the forehead while suffering from fever.
    • Application of ice packs (cold fomentation) to a swollen, tender, painful, red or bruised joint or injury.
    • Hot water fomentation for the treatment of styes (a common bacterial eye infection affecting a blocked gland in the eyelid) or chalazions (a swollen non-infectious blocked gland in the eyelid). Most chalazions even regress with simple hot fomentation, not requiring any further medical or procedural treatment.
    • Application of cold tea bags to the under eyes help constrict dilated blood vessels in the sensitive skin and reduce the appearance of dark circles.
  • Water baths: Patients suffering from certain diseases or healthy people wishing to relax can benefit from bath therapy. However, it should be noted that the world is moving away from the practice of baths and more readily adopting showers in its stead to reduce the environmental impact and conserve water.
    • Warm water baths: The most readily available option is to slip into a hot bath after a tiring day to relax muscle tension and rejuvenate one’s mind. Salts, minerals, essential oils or other ingredients can be added as per the bather’s discretion to enhance the experience. While a simple, effective and cost-effective tool of relaxation accessible to many, hot water baths may be recommended by the doctors to ameliorate certain conditions, especially those affecting the musculoskeletal system. Immersion into a hot bath leads to a more pronounced anti-inflammatory effect. This helps combat the inflammation of joints and muscles induced by disease or rigours of daily life.
    • Contrast water bath therapy: A more specialised and newly emerging form of bath based hydrotherapy is contrast water bath therapy. Essentially, the individual is first immersed into a hot water bath and then after a few minutes is immediately immersed into a cold water bath. The client is alternatingly immersed into hot and then cold water baths and may be made to do simple exercises to enhance the effect. The principle behind contrast water bath therapy is that rapid alternation between hot water and cold water immersions causes blood vessels to open (or dilate, in hot water) and close (or constrict, in cold water) in a pulsating and pumping manner, effectively increasing the blood circulation in the body. Increased blood circulation in the body helps combat muscle soreness, diminishes fatigue, reduces swelling and removes lactic acid buildup from muscles. Contrast bath therapy is carried out under the supervision and guidance of a physiotherapist or athletic trainer.
  • Sitz baths: Sitz bath is a special warm shallow bath, to which some medical chemicals (like povidone-iodine with antibacterial properties) may be added, in which the patient sits, or squats, with their pants down in order to submerge their perineum (area between the genitals and the anus) for relief from pain and itching. Baking soda or vinegar can also be added for a soothing sitz bath but perfumed soaps should not be added. The warm water increases the blood supply in the perineal region, promoting healing and relieving pain. While sitz baths are routinely recommended to patients by doctors when treating anal hemorrhoids (also known as piles), their use is not limited to it and can be easily done at home without a doctor’s prescription. If the tub used for sitz bath is not thoroughly clean there is a risk of infection, especially in those who have undergone recent surgery. Sitz bath is helpful in:
    • Surgery on the vulva or vagina
    • Recent birth giving
    • Recent hemorrhoids surgery
    • Discomfort from hemorrhoids
    • Discomfort with bowel movements (hard stools or chafing due to repeated diarrhea)
    • Baths focusing on certain areas: Similar to sitz bath targeting the perineal region, other baths can involve only immersing the feet or the head in warm or cold water to alleviate muscle soreness, pain or cramps.
  • Saunas: Saunas are small confined rooms where people sit under wet (steam) or dry heat in order to intentionally perspire and sweat out toxins. Saunas can be useful to healthy people looking to relax as well as an added therapy for people suffering from diseases (like autoimmune conditions). The benefits awarded by sauna bathing are multifold and include toxin removal, pain remediation, speeding up weight loss, and reducing inflammation. Saunas are also shown to have a positive effect on insulin resistance and are touted to have a modest impact on chronic fatigue syndrome. Saunas should strictly not be used if any of the contraindications are present.
  • Aquatic therapy: Aquatic therapy refers to rehabilitation or occupational therapy exercises that are carried out in the water (such as a pool). The water is often heated and is a popular treatment for patients with neurologic and musculoskeletal conditions. The goals of this therapy are muscle relaxation, improving joint motion and reducing pain and the buoyancy of water provides gentle resistance to regain strength after paralysis. Aquatic therapy is carried out by licensed professionals. The various forms of aquatic therapy used in physical rehabilitation are:
    • Watsu or “water shiatsu method”
    • Bad Ragaz Ring Method
    • Feldenkrais Method
    • Halliwick Method
    • Burdenko Method
  • Water circuit therapies: Different types of hydrotherapy are used one after the other, generally alternating between warm and cold water, to promote circulation and help ease symptoms. Examples include contrast water bath therapy or alternating between hot and cold saunas.
  • Immersion therapies: Immersion therapies are similar to baths and involve the immersion of individuals into the water for therapeutic purposes. Cold water immersion and warm water immersion are the two broad types of immersion therapies. Immersion therapy can be used for rehabilitation therapy but is also frequently used for relaxation and enjoyment as with hot tubs and whirlpool baths.
  • Water birth: Water birth refers to the practice of giving birth while immersed in water. While it was a traditional means of birthing, it has been adapted to use at home or facilities in special pools, generally by midwives. Although water births were earlier thought to be unsafe and pose an unnecessary risk to the mother and baby, it has now been declared fit for use in healthy mothers with uncomplicated pregnancies. A recent study has found that the practice of immersion in water during the second stage of labour at a hospital reduced the incidence of maternal perineal tears and the babies’ needs for NICU admission.

While most hydrotherapy techniques are completely safe and some absolutely vital (like wound irrigation or running cold water over a burn), certain therapies are unsuitable for people suffering from preexisting conditions. Hydrotherapy should be undertaken with proper consideration or avoided altogether in these cases. Contraindications to hydrotherapy are:

  • Heart disease: A history of heart problems makes hydrotherapy (especially heat-related) imprudent at the risk of precipitating an attack. Conditions include:
  • Unstable angina
  • Undiagnosed chest pain
  • Recent heart attack (myocardial infarction)
  • Aortic stenosis
  • Carotid artery stenosis
  • Pregnancy: Exposure to steam or immersion in hot baths can be detrimental to the baby, especially in cases of a high-risk pregnancy, and doctors do not recommend it. Water births are contraindicated in women suffering from any preexisting condition or with a complicated pregnancy. Sitz bath following recent birth is advisable for pain relief.

Contraindications to aquatic therapy: The presence of certain pre-existing factors make it important to reassess the use of aquatic therapy and may even make it impossible. Contraindications to aquatic therapy are:

Hydrotherapy is a safe treatment option when done with adherence to the recommendations, safety guidelines and under the supervision of a licensed professional (where necessary). Complications following hydrotherapy can be:

  • Infections due to improper sitz baths
  • Dizziness following hot water baths, saunas or immersion therapies
  • Syncope and fainting after prolonged steam exposure is possible in susceptible individuals
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References

  1. Mooventhan A, Nivethitha L. Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body. N Am J Med Sci. 2014;6(5):199-209. PMID: 24926444.
  2. Kim JH, Kim DH, Baik SY, Lee YP. Pain control and early wound healing effect using sitz bath with ozonised water after haemorrhoidectomy. J Wound Care. 2020 May 2;29(5):289-294. PMID: 32421480.
  3. Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R. 2009 Sep;1(9):859-72. PMID: 19769921.
  4. Alcalde GE, et al. Effect of aquatic physical therapy on pain perception, functional capacity and quality of life in older people with knee osteoarthritis: study protocol for a randomized controlled trial. Trials. 2017 Jul 11;18(1):317. PMID: 28697785.
  5. Ihsan M, Watson G, Abbiss CR. What are the Physiological Mechanisms for Post-Exercise Cold Water Immersion in the Recovery from Prolonged Endurance and Intermittent Exercise?. Sports Med. 2016 Aug;46(8):1095-109. PMID: 26888646.
  6. Sidebottom AC, et al. Maternal and Neonatal Outcomes in Hospital-Based Deliveries With Water Immersion. Obstet Gynecol. 2020 Oct;136(4):707-715. PMID: 32925614.
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