What is the most effective suppository?

From the Guidelines

The best suppository for constipation is glycerin, as it works quickly by drawing water into the rectum to stimulate bowel movements, and is often recommended as a first-line treatment 1. When considering the use of suppositories, it's essential to assess the cause and severity of constipation, and rule out other potential causes such as impaction, obstruction, or other medical conditions. Some key points to consider when using suppositories include:

• Proper insertion technique, lying on your side and inserting the rounded end first into the rectum about 1 inch for adults (½ inch for children)
• Holding the buttocks together briefly to prevent expulsion
• Washing hands before and after insertion
• Consulting a healthcare provider if symptoms persist or worsen after treatment Other options for constipation include bisacodyl suppositories (10mg), which work within 15-60 minutes, and can be used in conjunction with other laxatives such as polyethylene glycol, lactulose, or magnesium hydroxide. It's also important to note that suppositories and enemas are contraindicated in certain situations, such as neutropenia, thrombocytopenia, paralytic ileus, or intestinal obstruction, and should be used with caution in patients with renal impairment or other underlying medical conditions 1. In terms of specific recommendations, the most recent and highest quality study suggests that glycerin suppositories are a effective and safe option for the treatment of constipation, particularly in patients with advanced cancer 1. Overall, the choice of suppository will depend on the individual patient's needs and medical history, and should be made in consultation with a healthcare provider.

From the Research

Types of Suppositories

• Suppositories contain lipophilic fats that melt following insertion into the rectum, releasing a medicine into the body for local or systemic absorption 2
• Different types of suppositories are available to treat constipation and the method of insertion varies slightly according to the type used 2

Administration of Suppositories

• The administration of a suppository requires skill and competence on behalf of the practitioner, as well as compliance with guidelines on the administration of medicines and local drug administration policy 3
• A suppository is a medicated solid formulation prepared for insertion into the rectum to dissolve at body temperature 3

Treatment of Constipation

• Bisacodyl is a stimulant laxative that acts locally in the large bowel by directly enhancing the motility, reducing transit time, and increasing the water content of the stool 4
• Bisacodyl testing may be useful in predicting the therapeutic outcome in patients with refractory constipation 5
• Medical management, dietary modifications, and behavioral therapies are the mainstays of initial therapy for constipation 6

Medications Used in Suppositories

• Bisacodyl is a member of the diphenylmethane family and is considered to be a stimulant laxative 4
• Bisacodyl has a dual prokinetic and secretory action and needs to be converted into the active metabolite bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM) in the gut to achieve the desired laxative effect 4