Administering a suppository: types, considerations and procedure

A suppository is a ‘solid or semi-solid, bullet-shaped pellet’ (Dougherty and Lister, 2015) that is a mix of medication and a ‘wax-like’ substance that melts following insertion into the rectum (Galbraith et al, 2013). Suppositories are used for a local or systemic effect to empty the bowel prior to surgery, investigations or examinations, to administer medications, to soothe and treat haemorrhoids or anal pruritus (Dougherty and Lister, 2015). Suppositories may also be considered when oral medications cannot be used, in palliative care, if a patient has swallowing difficulties or has severe nausea and cannot retain oral medication. For the complete list of medicines available for rectal administration as suppositories refer to the British National Formulary (Joint Formulary Committee, 2019a).

Most commonly, suppositories are used to empty the bowel to relieve constipation when other less invasive treatments have failed. Constipation is defined by the National Institute for Health and Care Excellence (NICE) (2017a) as a symptomatic disorder that describes unsatisfactory defecation due to infrequency or difficulty in passing stools that is less frequent than the individual's normal bowel pattern. Chronic constipation is defined as symptoms that present for at least 12 weeks in the last 6 months (NICE, 2017a). Complications of constipation include faecal loading or impaction, haemorrhoids, anal fissure, faecal retention, rectal distension and loss of sensory and motor function (NICE, 2017b). Early assessment and treatment of constipation are necessary to prevent long-term implications (Mitchell, 2019). Individuals with constipation often experience a reduction in their quality of life compared with the general population (Norton, 2006). In the short term individuals can experience pain, discomfort and bloating. The long-term effects of constipation can lead to diverticular disease, chronic back pain, hernia or recurrent urinary tract infections.