How do I order a glycerine suppository for a patient with constipation?

How to Order Glycerin Suppository for Constipation

Order one glycerin suppository (2-3 grams) to be inserted rectally as needed, retained for 15-30 minutes if possible, after first performing a digital rectal examination to confirm rectal loading and ruling out contraindications. 1

Pre-Treatment Assessment Required Before Ordering

Before writing the order, ensure the following have been assessed:

• Perform digital rectal examination to confirm the rectum is full and rule out fecal impaction or bowel obstruction 2, 1
• Check for absolute contraindications: neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis 2, 1
• Rule out intestinal obstruction symptoms including absent bowel sounds, severe distention, or vomiting 2, 1
• Assess for reversible causes: hypercalcemia, hypokalemia, hypothyroidism, diabetes mellitus, or constipating medications 2, 1

When Glycerin Suppository Is Indicated

Glycerin suppository is appropriate when:

• Constipation has persisted for several days despite conservative measures (increased fluids, dietary fiber, exercise) 3, 1
• Digital rectal exam reveals a full rectum 3, 1
• First-line oral laxatives (stimulant laxatives like senna or polyethylene glycol) have been insufficient 1

Exact Order to Write

"Glycerin suppository 2-3 grams, insert one suppository rectally as needed for constipation. Patient to retain for 15-30 minutes if possible." 1

Mechanism of Action

Glycerin works through local rectal irritation and by drawing water into the rectum, which softens stool and facilitates evacuation 3, 1

If Glycerin Suppository Fails

When the suppository is insufficient after appropriate trial:

• Reassess for obstruction and severity of constipation 2, 1
• Add bisacodyl suppository (10 mg rectally) as next step 2, 1
• Consider enemas: sodium phosphate, saline, or tap water enema to dilate bowel and stimulate peristalsis 1
  • Avoid sodium phosphate enemas in renal dysfunction 1
  • Limit enemas to maximum once daily 1
• Add oral agents: polyethylene glycol, lactulose, or magnesium hydroxide 2, 1

Maintenance Prevention After Acute Resolution

After successful bowel movement with glycerin suppository:

• Prescribe prophylactic stimulant laxative (senna) or polyethylene glycol for ongoing prevention 1
• Do not prescribe docusate as prophylaxis—it has not shown benefit 1
• Maintain adequate fluid intake and dietary fiber, and encourage exercise if feasible 2, 1

Common Pitfalls to Avoid

• Never order suppositories without first ruling out obstruction—this can cause perforation 2
• Do not use in neutropenic or thrombocytopenic patients—risk of infection or bleeding 2, 1
• Suppositories work faster than oral laxatives when the rectum is full, making them preferred first-line therapy in this scenario 2, 4