Fomentation in Hydrotherapy Methods, Types, Benefits

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Fomentation is the method of application of heat to the body surface using the cloths wrung out of boiling water. This is the easiest and most cost-reliable method of hydrothermal remedies. Fomentation is also a major inclusion in the Hydrotherapy set of treatments used as a part of Nature Cure Therapies. 

Fomentation

Fomentation means local application of moist heat to the body surface. The fomentation pad is usually made up of blanket material which is made up of 50% wool (to retain heat) and 50% cotton (to retain moisture and be more durable).

Fomentation is much like a compress. Most compresses are applied and left to cool, while fomentations are usually kept warm.

To keep it simple – ‘Fomentation can be thought of as a hot pack’.

Fomentations include herbs as used in Ayurvedic treatments. But fomentations don’t have to include herbs as a rule. They can be made with hot water, oils, hydrosols and vinegars too.

Some herbalists consider alternating hot and cold compresses to be an important part of the fomentation process.

Physiological effects

Fomentation enhances blood supply to the skin. By doing so, it relieves internal congestion.

It increases elimination of wastes and toxins from the body by promoting sweating process. Therefore it can be included in sweating therapies. In Ayurveda, Swedana therapy also uses the same principle. Fomentation can be included under Swedana Chikitsa of Ayurveda.

It relieves muscle pain and spasm by increasing circulation and by releasing the tension in the muscles.
Fomentation also removes pain from the muscles and joints. This is done by the decongestion and counter-irritation action of fomentation.
It promotes increase in circulating white blood cells
Fomentation helps in relieving the pain from the internal organs.
Fomentation stimulates or sedates the body or the area which is fomented depending on the temperature applied.

Indications and uses

Fomentation can be done in the below mentioned conditions (and thus fomentation also relieves the below mentioned conditions) –

• Joint pains, Arthritis
• Muscle pain and tensions
• Strains, sprains, cramps
• Any sort of inflammations
• Neuralgia
• Pain in Neuritis
• Nervous tension
• Sleeplessness
• In chest conditions having active congestion i.e. in colds, influenza, bronchitis, pleurisy
• Stress
• Cerebral congestion
• Meniere’s Disease
• Delirium – a state of mental confusion and excitement
• Tetany
• Torticollis
• Bell’s Palsy
• Tic (spasmodic muscular condition)
• Cough, congestion
• Indigestion
• Colic (colon pain)
• Constipation
• Sluggish liver
• Chronic dysentery
• Urine suppression
• Edema
• Hernia
• Acne
• Menstrual pain
• Malaria (over the liver and spleen area)

Also –

• To warm up the tissues as a part of preparation for the massage
• To produce sweating
• To prepare for the cold procedures
• To numb the pain in the spine (acts as sedative)

Contraindications and Cautions

Fomentation shall be avoided in the below mentioned conditions –

• Loss of skin sensation (due to diabetes, paralysis or unconsciousness etc)
• Hemorrhagic disorders (tendency to bleed)
• Feet edema
• Varicose veins
• Advanced vascular disorders
• Stomach and duodenal ulcers
• Malignancy etc

Materials required

Equipments needed for various forms of Fomentations

• Large woolen blanket
• Sheet
• Pillow
• Large buckets
• Towels
• Fomentation pads and covers
• Large kettle or canning kettle
• Basin of ice water
• One or two compress cloths
• Friction mitts
• Blood pressure cuff and stethoscope
• Water thermometer
• Oral thermometer

Different fomentation methods

Different methods of Fomentation
Boiling Water Method
Give a lengthwise twist to a large (folded) bath towel as much as possible.
Place the middle ¾ part into the boiling water. Allow it to become thoroughly soaked.
Once the cloth is soaked, lift it out of water.
Pull the cloth as hard as possible to wring out all the excess water from the cloth.
After wringing, drop one end of the cloth and allow the cloth to untwist while holding the other end in one hand.

Now place the hot cloth over the patient’s body. If the towel is very hot, place another towel over the patient’s body and lay the wet (hot) cloth over it. If the cloth is not too hot, place the hot towels on the skin surface of the patient and quickly remove it to avoid burning. Keep inquiring the patient and lift it off if the patient is not tolerating the heat. The towel will cool off rapidly.

When the towel gets cool, remove it and replace it with another hot towel.
Repeat this procedure 3-4 times.

In between the hot towels (in the time gap between removing the cold towel and replacing it with hot towel), wipe the body surface briskly with ice-cold cloth and blot the moisture quickly. It is the moisture that actually burns the skin and one should be careful about this while doing fomentation. Therefore the skin must be completely dry before the next hot application.

Steaming Method
Take 5 large bath towels or fomentation pads.
Soak them completely in water, remove and wring them thoroughly.
Place the towels or pads on the grid of a large canner (32 qts or litres)
Place enough water in the canner below the grid.
Boil it for 20 minutes.
Take care that the towels or pads should not touch the water.
These bath towels or fomentation pads which are steamed should be used for fomentation.

Micro-wave Method
Take a large bath towel soaked in cold water.
Wring out all the excess water as much as possible.
Place the single towel in a black plastic garbage bag or other strong plastic bag.
Place the bag in the micro-wave oven and turn to high for 4 minutes approximately (or until steaming)

Now, quickly remove the towel and use it on the body surface.
If the towel is very hot, place a dry towel on the skin and apply the hot towel over it.

Fomentation procedure

What to consider before fomentation?
There are a few things which need to be focused upon and noted before implementing fomentation. They are as below mentioned –

Before starting the fomentation, the general condition of the patient and the status of the disease should be properly known and documented. It should be confirmed that the patient is fit to undergo fomentation. The patient should have been intimated about the therapy in detail and consent taken.

The room should be kept warm before the treatment starts. Security of the patient should be given importance.

The patient should always be properly draped.

Keep inquiring the patient during fomentation. Keep asking if the fomentation is too hot. If the fomentation is hot, lift it, dry the skin and add another towel between the patient and the fomentation.

One should be very careful while providing fomentation to aged people, children and thin people.
One should take care to avoid chilling in between fomentations.
One should take care not to spread infection.

Moisture increases the chance of burning. Therefore the towels used for fomentations should be kept dry.
Generally the parts of the body wherein the bone is close to the skin are prone to get burnt while fomentation is being done. Therefore extra towels should be kept ready to protect these areas if necessary.

Fomentations applied for stimulation should be done for short periods, approximately 3-5 minutes. They should be very hot. After hot fomentation cold fomentation should be given immediately. Alternatively cold applications should be given between hot fomentations.

Fomentations applied for sedation (as sedative) should be used for longer duration, approximately for 6-10 minutes, but not longer than 20 minutes. Mild heat shall be used in this type of fomentation.

When fomentation is given for stroke patients (CVA), the fomentation shall be warm and not hot. Fomentation should be given for less than 20 minutes and should be followed with cold administration.

Water in the hot foot bath should be tolerably hot and should not be too hot. If it is too hot, it will burn the feet of the patient.

Preparation of patient

The patient should be instructed to remove clothing, drape with sheet.
One should make sure that the patient’s feet are warm. If the heat is not ordered (as in diabetes, arteriosclerosis etc), the feet should be covered with warm blanket.

For patients who are in post-operative care, cover all dressings with plastic protector before fomentation has been administered.

If cerebral congestion may occur, have cold compresses to apply to the neck as well as to the head. In heart disease or with pulse of 130 or more, place an ice bag over the heart.

Fomentation Therapy

Check all the equipments according to the procedure adopted and keep them ready.

Temperature, pulse, respiration rate and blood pressure should be recorded.

The patient should be disrobed.

Cover the table with blanket. A sheet shall be spread over the blanket.

The patient should be allowed to sleep on the sheet.

A blanket should be wrapped around the patient completely such that only head is exposed.

Procedure of fomentation

• Cover the part to be treated with bath towel.
• Use the intensity of heat as indicated by the patient’s condition and to desired effect.
• Apply fomentation to the area which needs to be fomented, as indicated.
• Foment a large area to relieve congestion. For local effect (local fomentation), apply fomentation to limited area as decided.
• Apply one fomentation under the patient’s back.
• Apply 2 fomentations across the chest, leave for 3-5 minutes. Change when the fomentation becomes comfortable.
• Protect sensitive parts from fomentation, including bony areas. Cover these areas with as many towels as necessary.
• If the fomentation is unbearably hot, lift the fomentation and rub hand firmly over the towel to remove the moisture. If needed, place another towel between fomentation and patient.
• In severe pain, see that the fomentation is as hot as can be tolerated.

Importance of cold compress

Importance of Cold compress and keeping dry

• To the head or neck – apply cold compress, keep changing once in 2-3 minutes. Use ice bag to heart if needed, to protect these organs from excess heat.
• Three fomentations should be given (if it is not indicated otherwise). Apply cold mitten friction to the area between each application. Dry the part well before applying another fomentation.
• After the last fomentation, rub the area with cold compress and dry thoroughly.
• Cool the patient with cold mitten friction to the entire body.
• Be sure to leave the patient with dry body, gown, sheets and blankets.
• Any dampness will cause chills and make the condition worse.
• In extreme pain like pleuritic pain, renal colic or dysmenorrhoea, cold should be omitted.
• Warm alcohol may be used to get astringent effect and also to cool the patient.

Need more sweating?

If further sweating is required, finish with Blanket Wrap.

Hot Foot Bath

• For this, prepare the water in the bucket and keep its temperature at 40 degree.
• Fill half bucket with hot water.
• Place your hands under the patient’s feet. Lower his feet into the water.
• Completely wrap the bucket and the legs with the sheet and the blanket.

Post-operative, finishing the treatment,

• Leave the patient comfortable and free of perspiration
• Encourage him to rest for at least half hour before he gets dressed up
• Remove all equipments.
• Leave the area tidy.
• Record the treatment, frequency and length of application (document them).
• Report the effect of treatment, the patient’s reaction and any deviations of results of therapy
• Make sure that the patient is not sweating in his clothing

Just Before Finishing –
This article covers in detail, the procedure of fomentation, which can be compared to swedana or drava sweda (ardra sweda) as explained in Ayurveda, along with its benefits, types, principles and procedure of conducting the therapy.
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