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Purpose
A suppository is a ‘solid or semi-solid, bullet-shaped pellet’ (Lister et al, 2020) that is a mix of medication and a ‘wax-like’ substance that melts following insertion into the rectum (Galbraith et al, 2013). Suppositories are used for a local or systemic effect to empty the bowel prior to surgery, investigations or examinations, to administer medications, to soothe and treat haemorrhoids or anal pruritus (Lister et al, 2020). Suppositories may also be considered when oral medications cannot be used, in palliative care, if a patient has swallowing difficulties or has severe nausea and cannot retain oral medication.
Most commonly, suppositories are used to empty the bowel to relieve constipation when other less invasive treatments have failed. Constipation is defined by the National Institute for Health and Care Excellence (NICE, 2023) as a symptomatic disorder that describes unsatisfactory defecation due to infrequency or difficulty in passing stools that is less frequent
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Assessment
There are various types of suppositories used for constipation. Nurses must be aware of any potential harm associated with their practice and reduce this whenever possible (Nursing and Midwifery Council (NMC), 2018). Nurses should understand how each type of suppository works, the anatomy of the rectum and only administer medicines within their training and competence (Peate, 2015; NMC, 2018).
There is currently no conclusive evidence to support the most effective way to insert a suppository. Therefore, it is important that nurses always follow the manufacturer's instructions and local policies.
Glycerine suppositories
Glycerine suppositories work as a lubricator, softener and a weak stimulant by lowering the surface tension of faeces, allowing water to penetrate and soften the stool (Lister et al, 2020; NICE, 2023). They can be used for both hard and soft stools and are licensed for occasional use only (NICE, 2023). Glycerine suppositories should be moistened before use
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Equipment
Elimination is a sensitive issue and must be handled respectfully at all times by the nursing team. The privacy and dignity of the patient must be respected and it is essential that the procedure is clearly explained to ensure informed consent is granted (NMC, 2018). Nurses should ensure that a moving and handling risk assessment is completed prior to treatment to establish if additional equipment such as hoists are required.
Before administration of suppositories, it is essential to correctly assemble all the necessary equipment. This should include:
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a prescription written for the patient
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the suppository (correct dose should be calculated)
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gloves and apron
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a protective cover (incontinence sheet)
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lubrication
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gauze squares
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care plan
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commode or bedpan in case of premature ejection of the suppositories (Peate, 2015)
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Procedure
Administration of suppositories is an invasive technique. Nurses need to carry out a full assessment of the patient prior to this procedure and only administer a suppository if they have the appropriate knowledge and skills. Respect for the patient's privacy and dignity should be maintained at all times and a full reassessment must take place following the procedure.
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Confirm the patient's identity, explain and discuss the full procedure
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Assess the patient's specific requirements and the reason for intervention. If the patient is constipated a full physical, psychological and social assessment should be completed (NICE, 2023)
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If a medication suppository is administered, it is best to do this after the bowels have been emptied to enable absorption by the rectal mucosa and prevent premature expulsion of the suppository (Lister et al, 2020)
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Wash hands and put on apron and gloves. This is to ensure that hygiene and infection control measures are
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 2: Procedures for the planning, provision and management of person-centred nursing care
3.4 take appropriate action to ensure privacy and dignity at all times
6. Use evidence-based, best practice approaches for meeting needs for care and support with bladder and bowel health, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
6.5 administer enemas and suppositories and undertake rectal examination and manual evacuation when appropriate
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Resources
Joint Formulary Committee. Bisacodyl drug information. 2020. https://bnf.nice.org.uk/drug/bisacodyl.html (accessed 10 January 2024)
Lister S, Hofland J, Grafton H. The Royal Marsden Manual of clinical nursing procedures: professional edition. 10th edn. Chichester: Wiley-Blackwell; 2020:253-253
National Institute for Health and Care Excellence (NICE). Constipation: definition. 2023. https://cks.nice.org.uk/topics/constipation/#!backgroundSub (accessed 10 January 2024)
Nursing and Midwifery Council (NMC). The Code. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (accessed 10 January 2023)
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