Most Common Suppository for Constipation and Dose
Bisacodyl 10 mg rectal suppository is the most commonly used and evidence-based suppository for constipation, with onset of action within 30-60 minutes. 1
Standard Dosing
The standard adult dose is one 10 mg bisacodyl suppository inserted rectally as a single daily dose. 2 The suppository should be:
- Inserted well into the rectum, pointed end first 2
- Retained for approximately 15-20 minutes 2
- Expected to produce bowel movement within 30-60 minutes 1
For children 6 to under 12 years, the dose is half a suppository (5 mg) as a single daily dose; bisacodyl suppositories should not be used in children under 6 years. 2
Clinical Context and Guideline Support
Bisacodyl suppositories are recommended as first-line therapy when digital rectal examination identifies a full rectum or fecal impaction. 1 The 2023 AGA-ACG guidelines note that while bisacodyl oral formulations (5-10 mg) are effective for chronic idiopathic constipation, the rectal suppository formulation provides rapid relief and is particularly useful for rescue therapy. 1
The mechanism of action involves direct stimulation of colonic mucosa to promote peristalsis and secretion through conversion to the active metabolite BHPM (bis-(p-hydroxyphenyl)-pyridyl-2-methane). 1 Importantly, the laxative effect of bisacodyl suppositories occurs through direct local rectal action rather than systemic absorption, which explains the rapid onset compared to oral formulations. 3, 4
Alternative Suppository Options
Glycerin suppositories are another appropriate option, particularly for adolescents and when a gentler approach is preferred. 5 Glycerin works through local irritation and by drawing water into the rectum to soften stool. 5 However, bisacodyl remains the most commonly used stimulant suppository with the strongest evidence base. 1
Important Contraindications
Bisacodyl suppositories should not be used in patients with: 1
- Ileus or intestinal obstruction
- Severe dehydration
- Acute inflammatory bowel conditions
- Neutropenia or thrombocytopenia 1
- Recent colorectal or gynecological surgery 1
- Recent anal or rectal trauma 1
Clinical Pearls
- Suppositories work significantly faster than oral laxatives (30-60 minutes vs 6-12 hours for oral bisacodyl), making them ideal for acute relief. 1
- The most common adverse effects are diarrhea and abdominal cramping, though these are less frequent with rectal administration compared to oral dosing. 1
- Bisacodyl suppositories are recommended for short-term or rescue therapy rather than chronic daily use. 1
- Always assess for fecal impaction before initiating treatment, as suppositories are particularly effective in this scenario. 1