What is the role of a suppository in a bowel regimen?

From the Guidelines

Suppositories are a preferred first-line therapy for bowel regimen, particularly when a digital rectal examination (DRE) identifies a full rectum or fecal impaction, as they can increase water content and stimulate peristalsis to aid in expulsion 1. When considering suppository use, it's essential to choose the right type and dosage.

• Glycerin suppositories are a good first-line option, typically working within 15-30 minutes by drawing water into the rectum to stimulate bowel movements.
• Bisacodyl suppositories (10 mg for adults) provide stronger stimulation and work within 15-60 minutes by irritating the intestinal lining to increase peristalsis.
• For severe constipation, docusate sodium suppositories (100 mg) can soften stool while stimulating evacuation. To use any suppository, remove the wrapper, apply water-based lubricant to the tip, insert the rounded end into the rectum while lying on your side, and push it about 1 inch past the anal sphincter. However, it's crucial to note that suppositories may not be suitable for all patients, such as those with neutropenia or thrombocytopenia, and should be used with caution in patients at risk for renal dysfunction 1. It's also important to address underlying causes of constipation through proper hydration, fiber intake, and physical activity, rather than relying solely on suppositories for bowel management. Additionally, other treatment options, such as stimulant laxatives, osmotic laxatives, and peripherally acting mu opioid receptor antagonists, may be considered if constipation persists 1.

From the FDA Drug Label

Directions adults and children 12 years of age and over 1 suppository in a single daily dose. Peel open plastic. Insert suppository well into rectum, pointed end first. Retain about 15 to 20 minutes Use for relief of occasional constipation (irregularity) this product generally produces bowel movement in 15 minutes to 1 hour

The recommended dosage for a bowel regimen using bisacodyl suppository is:

• 1 suppository per day for adults and children 12 years of age and over
• 1/2 suppository per day for children 6 to under 12 years of age
• Not recommended for children under 6 years of age The suppository is expected to produce a bowel movement in 15 minutes to 1 hour 2 2

From the Research

Suppository for Bowel Regimen

• The use of suppositories for bowel regimen has been studied in various contexts, including spinal cord injury and constipation treatment 3, 4, 5, 6.
• A study published in 1998 found that polyethylene glycol-based bisacodyl suppositories can stimulate reflex defecation sooner and shorten the total bowel care time compared to hydrogenated vegetable oil-based bisacodyl suppositories in persons with spinal cord injury 3.
• Another study published in 2021 discussed the use of over-the-counter laxatives, including suppositories, for treating childhood constipation, and found that osmotic laxatives like polyethylene glycol 3350 are effective and safe for both long and short-term treatment 4.
• A 1997 study compared the effectiveness of polyethylene glycol-based bisacodyl suppositories with conventional hydrogenated vegetable oil-based bisacodyl suppositories for bowel care in myopathy patients, and found that the polyethylene glycol-based suppositories reduced bowel care time by about half 5.
• A 2020 study found that a combination of bisacodyl suppository and 1 L polyethylene glycol plus ascorbic acid is a non-inferior and comfortable regimen compared to 2 L polyethylene glycol plus ascorbic acid for bowel preparation before colonoscopy 6.

Key Findings

• Polyethylene glycol-based bisacodyl suppositories can reduce bowel care time and stimulate reflex defecation sooner than hydrogenated vegetable oil-based bisacodyl suppositories 3, 5.
• Osmotic laxatives like polyethylene glycol 3350 are effective and safe for treating childhood constipation 4.
• The combination of bisacodyl suppository and 1 L polyethylene glycol plus ascorbic acid can provide equivalent bowel-cleansing outcomes with reduced patient discomfort compared to 2 L polyethylene glycol plus ascorbic acid 6.