I first learned how to best insert a suppository during pharmacy school. As student pharmacists, a key teaching point for patients was to ensure that the outer plastic or foil wrapping was completely removed from the suppository. This seemed rather obvious.
This week my “obvious” assumptions about suppositories were torpedoed. Twice.
The study asks a simple question. For torpedo-shaped suppositories, which end should be inserted first?
As shown in the image, these suppositories have two ends; the pointed tapered end (A) and the blunt end (B).
The Lancet study claims that in contrast to the commonsense practice of inserting the pointed (A) end first, the blunt (B) end should be inserted first. Blunt-end-first (BEF) was more comfortable and led to less suppository expulsions.
A review article from 2006 addresses this fundamental question. The authors identify and summarize an even older study from 1982, in which 19 students were given aspirin suppositories. Yet again, the BEF technique was found to be less irritating.
Albeit fraught with limitations, these studies made me question the obvious advice I’ve dispensed to my patients.
So here’s my revised thinking on how to best insert a suppository.
- Insert the suppository with blunt-end-first (BEF)!
- Consider inserting the suppository with the pointed end first, only if you feel discomfort or experience leakage after attempting the insertion with BEF.
Better yet, if you don’t want to dirty your finger, consider using a suppository applicator.
I’ll admit that up until this week, I had no idea rectal suppository applicators even existed.
One of these applicators is called Sephure. This device is billed as being more comfortable because it allows any trapped air to be expelled, and for deeper insertion of the suppository into the rectum.
I am not aware of any scientific studies to back-up these claims. But, I’ve had two revelations this week that challenge what I learned in pharmacy school, so I’m keeping an open-mind.
When studies and new medical devices are brought to my attention, it’s necessary that I reconsider my assumptions.
For parents and healthcare professionals with first-hand experience, what’s your advice on the best way to insert suppositories?