A rectal suppository is a small, solid, cone-shaped or bullet-shaped medication dosage form designed for insertion into the rectum. This delivery method is often used when a patient cannot take oral medication, such as during severe nausea or vomiting, or when medication must be delivered to an unconscious person. Once placed inside the body, the suppository base, typically made of cocoa butter or gelatin, melts or dissolves due to body heat, releasing the active drug. The medication can then act locally, treating conditions like hemorrhoids or constipation, or it can be absorbed through the rectal lining into the bloodstream for systemic effects, such as pain or fever reduction.
Preparing for Suppository Administration
Proper preparation is important for ensuring medication efficacy and patient comfort. The first step involves thorough hand hygiene, which means washing hands with soap and water, and often donning a disposable glove or finger cot to maintain cleanliness. It is also helpful to check the suppository itself, ensuring its firmness, as some formulations may require brief chilling in a refrigerator or under cool water to prevent premature melting during handling.
The patient’s position during administration significantly impacts the ease of insertion and the medication’s retention. The recommended position for an adult is the Sim’s position, where the individual lies on their left side with the bottom leg straight and the upper knee bent toward the abdomen. This positioning helps make the rectal area more accessible and utilizes gravity to assist with the suppository’s movement into the correct anatomical space. The patient should attempt to empty their bowels before administration, especially when the medication is not a laxative, to ensure the suppository can contact the mucosal lining.
The Specific Measurement for Insertion Depth
The medication must pass the internal anal sphincter. This muscular ring acts as a gate, and once the suppository is beyond it, the muscle contracts, helping to secure the medication and prevent its expulsion. Failure to pass this sphincter will often result in the suppository being immediately pushed out by the body.
For adult patients, the standard insertion depth is generally between 1 and 1.5 inches (approximately 2.5 to 4 centimeters), the length of the distal joint of an adult’s index finger. In some clinical settings, a depth of up to 3 inches may be cited to ensure the suppository reaches the mid-rectal area for optimal systemic absorption. The rectum is highly vascular, and placing the medication high enough allows the drug to be absorbed via the superior rectal vein, which partially bypasses the liver’s first-pass metabolism.
For infants and children, anatomical structures are smaller, requiring a shallower depth of insertion. The recommended depth for this population typically ranges from 0.5 to 1 inch, or just far enough past the external sphincter to ensure retention. This depth is often achieved using the little finger or pinky finger, depending on the size of the child. Precise depth is important to avoid injury and to ensure the suppository is retained by the anal sphincter.
Proper Technique for Suppository Placement
The tip of the suppository should be lubricated using a water-soluble gel to reduce friction and ease the passage into the rectum. Avoid using petroleum-based products like petroleum jelly, as these can interfere with the suppository’s ability to melt and release the medication effectively.
The suppository should be inserted with the pointed or narrow end first, as this shape is designed to navigate the anal canal more smoothly. The gloved index finger is the appropriate tool for insertion in adults, while a smaller finger, such as the pinky, is generally used for children. The suppository must be guided gently but firmly, following the natural curve of the rectum, which is directed toward the patient’s belly button or umbilicus.
While administering the medication, the patient can be instructed to take a deep breath and exhale slowly to help relax the anal sphincter, facilitating the insertion. Once the suppository is fully inserted past the sphincter, the finger should be withdrawn smoothly. The entire process should be executed without undue force to prevent irritation or injury to the delicate rectal lining.
Post-Administration Care and Retention
After the suppository has been successfully placed, the focus shifts to ensuring the medication remains in place long enough to dissolve and be absorbed. The patient should be instructed to remain lying in the same side position for at least 5 to 15 minutes. This period allows the suppository base to melt completely and minimizes the chance of it being expelled.
In some cases, particularly with infants or restless children, it may be beneficial to gently hold the patient’s buttocks together for a few seconds immediately following insertion to encourage retention. Patients may feel a temporary urge to defecate, which is a normal response to the foreign object, but they should be encouraged to resist this urge until the sensation subsides. Unless the medication is a laxative, patients should be advised to avoid having a bowel movement for at least an hour to allow for maximum drug absorption. The final steps involve disposing of used materials and washing hands thoroughly.