What are suppositories used for?

What Suppositories Are Used For

Suppositories are solid dosage forms inserted into the rectum that serve two primary purposes: delivering medication for local treatment of rectal and colonic disease (especially ulcerative proctitis), and providing rapid bowel evacuation in constipation or fecal impaction. 1, 2

Primary Clinical Indications

Ulcerative Proctitis (Most Common Medical Use)

• 5-ASA (mesalamine) suppositories at 1 gram once daily are first-line therapy for ulcerative proctitis, superior to both oral mesalamine and topical corticosteroids 1, 3
• They achieve markedly higher mucosal drug concentrations in the rectum compared to oral formulations, resulting in faster symptom control 2
• Suppositories are preferred over enemas for proctitis because they deliver medication specifically to the rectum and are better tolerated and retained 1
• Corticosteroid suppositories (prednisolone 5 mg or budesonide 2-4 mg) are reserved for patients who fail or cannot tolerate 5-ASA suppositories 1

Constipation and Fecal Impaction

• When digital rectal examination reveals a full rectum or fecal impaction, rectal suppositories are first-line therapy because they deliver medication directly to the site of obstruction 2, 4
• Bisacodyl suppositories produce a bowel movement within 30-60 minutes by converting to an active metabolite that directly stimulates colonic peristalsis 2
• Glycerin suppositories work through mild rectal irritation and achieve bowel movements in the same 30-60 minute timeframe 2
• This is dramatically faster than oral bisacodyl, which requires 6-12 hours 2

Systemic Drug Delivery

• Suppositories can deliver analgesics, antibiotics, anticonvulsants, and other medications when oral administration is not feasible (nausea, vomiting, inability to swallow) 5, 6, 7
• The lower rectum drains directly into systemic circulation, partially bypassing hepatic first-pass metabolism for high-clearance drugs 7

Critical Contraindications

Suppositories are absolutely contraindicated in the following situations:

• Mechanical bowel obstruction or paralytic ileus – they cannot reach the obstruction site, may stimulate inappropriate peristalsis, raise intraluminal pressure, and risk perforation 4
• Severe neutropenia or thrombocytopenia – heightened infection and bleeding risk 2, 4
• Recent colorectal/gynecologic surgery, recent anal trauma, severe colitis, or recent pelvic radiotherapy 4

Before using any suppository, exclude bowel obstruction through abdominal examination (distention, absent bowel sounds) and imaging if clinically indicated 4

Management Algorithm When Suppositories Fail

If no bowel movement occurs within 60-90 minutes after bisacodyl suppository insertion:

1. Administer a small-volume enema (saline or tap-water) 2
2. If refractory to both suppositories and enemas, manual disimpaction under anesthesia may be necessary 2

Important Clinical Considerations

• Adequate retention is essential – patients with active rectal disease may experience discomfort preventing retention, which delays or abolishes therapeutic effect 2
• For ulcerative proctitis, combining topical mesalamine suppositories with oral mesalamine is more effective than either alone 1
• Many proctitis patients respond promptly and prefer intermittent suppository use during flares rather than continuous maintenance therapy, which is safe given the low colorectal cancer risk in isolated proctitis 1
• Suppository administration is an intimate procedure requiring a professional, sensitive approach to minimize patient embarrassment 5, 6