From the Guidelines
For a patient with headache, vertigo, and hemorrhoids with slight bleeding following a witnessed assisted fall, I recommend close monitoring and a multi-faceted approach, prioritizing the patient's safety and symptom management. The patient should be evaluated by a healthcare provider to rule out concussion or other head injury, despite stable vitals and no apparent injuries. For the headache, acetaminophen (Tylenol) 500-1000 mg every 6 hours as needed is appropriate, avoiding NSAIDs like ibuprofen which may worsen bleeding 1. For vertigo, rest in a quiet environment with limited head movements is advised, along with meclizine 25 mg every 6 hours as needed. The hemorrhoids with slight bleeding can be managed with sitz baths 2-3 times daily, topical preparations containing hydrocortisone 1% for inflammation, and fiber supplementation (psyllium husk 1 tablespoon daily) with increased water intake to soften stool, as suggested by the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1. According to the anorectal emergencies: wses-aast guidelines, there is no clear recommendation for the role of surgery in patients with bleeding hemorrhoids, but it is suggested that the decision between non-operative management and early surgical excision for thrombosed hemorrhoids should be based on local expertise and patient’s preference 1. If bleeding persists beyond 1-2 days or if headache worsens, immediate medical attention is necessary. Some key points to consider in management are:
- Monitoring for potential complications from the fall, as vertigo and headache could indicate a mild traumatic brain injury requiring further assessment
- Avoiding NSAIDs to prevent worsening of bleeding
- Using topical preparations and fiber supplementation to manage hemorrhoid symptoms
- Considering the patient's preference and local expertise in decision-making for hemorrhoid management.
From the Research
Treatment for Hemorrhoids
- For the treatment of hemorrhoids, several options are available, including suppositories and creams 2, 3, 4, 5.
- A combination of tribenoside and lidocaine (Procto-Glyvenol®) is a medical preparation for the local treatment of hemorrhoids, delivered as a suppository or rectal cream, and has been shown to be effective in relieving symptoms caused by hemorrhoids 3.
- Recombinant streptokinase (rSK) suppositories have also been shown to be effective in the treatment of acute hemorrhoidal disease, with a significant advantage over hydrocortisone acetate suppositories 4.
- Proctosedyl has been used to treat hemorrhoids in pregnant women, with excellent results and good tolerability 5.
Treatment for Vertigo
- Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness in the elderly, and can be treated with repositioning maneuvers 6.
- The use of a motorized turntable can be helpful in performing the repositioning maneuvers accurately and safely, especially in frail elderly patients 6.
Recommended Treatment
- For the patient with headache, vertigo, and hemorrhoids with slight bleeding, a combination of tribenoside and lidocaine (Procto-Glyvenol®) or recombinant streptokinase (rSK) suppositories may be recommended for the treatment of hemorrhoids 3, 4.
- For the treatment of vertigo, repositioning maneuvers may be recommended, and the use of a motorized turntable may be considered 6.
- It is essential to monitor the patient's vitals and adjust the treatment plan as needed.