A suppository is a solid dosage form of medication designed for insertion into a body cavity, most commonly the rectum. These medications have a base, often cocoa butter or gelatin, that melts or dissolves at normal body temperature. Once liquefied, the base releases the active drug for absorption, providing either a local treatment effect or a systemic effect throughout the body. Suppositories are used for patients who cannot take oral medications due to nausea, vomiting, or difficulty swallowing, such as infants, elderly individuals, or post-operative patients. Proper administration technique is a significant factor in ensuring the medication is effective.
Preparing for Safe Administration
Thorough hand washing using soap and warm water is the first step to maintain hygiene. If the suppository feels soft, it is best to hold it under cool water or place it in the refrigerator for a few minutes while still in its wrapper to make it firm enough for insertion. A firm suppository is easier to handle and less likely to deform during placement.
A water-based lubricating jelly should be applied to the tapered tip of the suppository to facilitate smoother insertion. Petroleum jelly is not recommended because it can prevent the suppository base from melting and releasing the medication. Before insertion, a comfortable position should be adopted, such as lying on the left side with the right knee bent toward the chest. Alternatively, some people find it easier to stand with one foot raised on a chair.
Proper Insertion Technique and Depth
The primary goal of insertion is to place the suppository past the internal anal sphincter, the muscular ring that controls the opening of the rectum. If the suppository is not pushed beyond this muscular barrier, the body’s natural reflexes may cause it to be expelled immediately. The most common guidance suggests inserting the suppository with the narrow, tapered end first to guide it into place.
For an adult, the suppository needs to be pushed approximately one inch to 1.5 inches into the rectum. A simple way to judge this distance is by inserting the suppository until it is completely past the anal opening and the tip of the finger that is doing the pushing. This depth ensures the medication rests in the lower rectum, where it can dissolve and be absorbed without being pushed out by the sphincter.
For infants and small children, the required depth is significantly less, typically about half an inch. In older children, the insertion distance may range from half an inch to one inch, depending on their size. The finger is used to gently but firmly push the suppository into place, past the sphincter muscle. Once the suppository is beyond the sphincter, the muscle closes behind it, which helps to hold the medication in the correct position for absorption.
Orientation Guidance
Some medical professionals suggest inserting the blunt end first, which is thought by some to reduce the likelihood of the suppository being pushed back out. However, the most widely accepted and instructed method remains inserting the tapered end first. The specific product’s packaging should always be consulted for any manufacturer-specific guidance on orientation.
Ensuring Retention After Placement
After successfully inserting the suppository, the next step is to ensure it remains in place long enough for the medication to be absorbed. The body’s warmth causes the suppository to melt or dissolve, releasing the drug. Staying still immediately after insertion maximizes the retention time.
It is generally recommended to lie or sit with the legs closed for about 15 to 20 minutes following placement. This period allows the suppository base to fully melt and prevents the drug from being prematurely expelled. If the suppository is a non-laxative medication, avoid having a bowel movement for at least one hour.
A minor sensation of discomfort or a slight urge to expel the medication is a common feeling. If the urge is strong, gently clenching the buttock muscles together for a few minutes can help to control it. If the suppository is expelled completely, it may indicate it was not pushed far enough past the internal sphincter and a new one may need to be inserted. Any subsequent leakage of the melted base or medication is normal, and a small pad can be worn to manage this.