Editing Haemorrhoids (section)

=== '''Strangulated     internal haemorrhoid (sometimes called thrombosed)''' ===

** Irreducible haemorrhoids,      but shouldn't cause too much pain due to less somatic innervation. Still      sometimes can cause pain with necrosis.
** Can become necrotic and      bloody
** If no necrosis, attempt      manual reduction and treat with sitz baths, ice and analgaesia; but      better not to attempt reduction if there is necrosis
** High-risk for stricture      formation to do a haemorrhoidectomy in this setting, therefore most      surgeons won't do it. If you are operating, be very careful with tissue      planes, internal sphincter preservation, and haemostasis. Preserve as      much anoderm and mucosa as possible, to prevent stricture formation.
** Ideally, manage      conservatively until fully settled, then offer haemorrhoidectomy
** Those with incarceration,      strangulation and necrosis should have a haemorrhoidectomy