Surgical intervention is recommended, especially in the presence of severe discomfort. The treatment depends on the time of presentation after the appearance of the haematoma.
1. Within 24 hours of onset. Perform simple aspiration without local anaesthetic using a 19 gauge needle while the haematoma is still fluid.
2. From 24 hours to 5 days of onset. The blood has clotted and a simple incision under local anaesthetic over the haematoma with deroofing to remove the thrombosis is recommended. Removal of the haematoma reduces the chances of the development of a skin tag, which can be a source of anal irritation.
3. Day 6 onwards. The haematoma is best left alone unless it is very painful or (rarely) infected. Resolution is evidenced by the appearance of wrinkles in the previously stretched skin.
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