A suppository is a solid medicine inserted into one of the body's cavities most commonly the rectum, the vagina or the urethra. Once inserted, body heat melts the suppository, releasing the medicine into the surrounding tissue or bloodstream. Suppositories are used when a patient cannot swallow tablets, when faster absorption is needed or when the medicine is intended to act locally.

Types of Suppositories

Different types of suppositories are:

• Rectal suppositories: The most common type, torpedo-shaped and used for constipation, pain, fever, haemorrhoids and seizures

• Vaginal suppositories (pessaries): Inserted into the vagina and used for vaginal infections (candidiasis, bacterial vaginosis) and local hormonal therapy

• Urethral suppositories: Inserted into the urethra mainly in men; they are less commonly used and are most often prescribed to treat erectile dysfunction.

Why Suppositories Are Used Instead of Tablets or Injections

They are used when:

• The patient cannot swallow like infants, young children, unconscious patients and patients with severe nausea or vomiting; this is one of the most common reasons suppositories

• When faster action is needed as rectal absorption bypasses much of the liver, making rectal suppositories useful for medicines like diazepam where speed matters

• When local treatment is the goal like for haemorrhoids, rectal inflammation or vaginal infections, suppositories deliver medicine directly where it is needed.

Common Medicines Available as Suppositories

They are:

• Paracetamol: Widely used in India for fever and pain in patients who cannot take oral medicine and available in strengths of 125 mg, 250 mg and 500 mg

• Bisacodyl: Stimulant laxative for constipation and bowel preparation; onset of action 15 to 60 minutes

• Glycerine suppositories: Widely available in India; a mild laxative safe for infants and elderly patients

• Diazepam rectal gel: Used in children with epilepsy to terminate prolonged seizures at home; also used in hospital for status epilepticus

• Mesalazine (5-ASA) suppositories: Used for proctitis in ulcerative colitis

• Clotrimazole vaginal pessaries: Used for vaginal candidiasis (thrush).

How a Rectal Suppository Works in the Body

After insertion, body heat (approximately 37°C) melts the suppository's base (most commonly cocoa butter or Witepsol), releasing the active medicine into the rectal mucosa. The medicine enters the blood vessels beneath the rectal lining; these vessels drain partly into the systemic circulation without passing through the liver, which is why some drugs work faster when given rectally than orally. For locally acting suppositories such as glycerine or bisacodyl the medicine works directly on the rectal wall without systemic absorption.

Step-by-Step Guide: How to Insert a Suppository Correctly

Steps are:

• Wash your hands thoroughly with soap and water before handling the suppository

• Remove the wrapper just before insertion; if the suppository has a pointed end, insert that end first

• For a rectal suppository lie on your left side with the lower leg straight and the upper knee bent toward your chest; gently push the suppository approximately 2 to 3 cm into the rectum using a finger; a small amount of water-based lubricant on the tip makes insertion more comfortable; do not use petroleum jelly/Vaseline as it can damage the suppository base

• After insertion, gently press the buttocks together for 1 to 2 minutes and remain lying down for at least 15 minutes.

What to Expect After Inserting a Suppository

After inserting a suppository you might feel:

• A brief sensation of pressure or fullness in the rectum that is normal and usually resolves within a few minutes

• For laxative suppositories a strong urge to open the bowels usually occurs within 15 to 60 minutes; leave the suppository in for at least 15 minutes before using the toilet.

Side Effects to Watch For

Common side effects are:

• Local rectal irritation: Mild burning, stinging, or discomfort around the rectum after insertion; usually settles within a few minutes

• Allergic reactions: Some patients are allergic to the suppository base (cocoa butter, soy derivatives); symptoms include severe itching, redness or rash around the rectum

• Systemic side effects: Medicines absorbed from rectal suppositories can cause the same side effects as oral medicines; for example, diazepam suppositories can cause drowsiness and paracetamol suppositories can cause liver toxicity if the dose is exceeded.

Storage and Handling Tips (Temperature Matters)

Suppositories melt at body temperature (37°C) and can also melt in warm storage conditions that is a real concern in India, where ambient temperatures can exceed 40°C in summer.

• Store suppositories in a refrigerator (2°C to 8°C)

• Do not store suppositories in the bathroom as bathrooms are warm and humid; a cool bedroom drawer is preferable if refrigerator storage is not possible

• If a suppository has softened place it (still in its wrapper) in the refrigerator for 15 to 30 minutes to re-firm it; it is still effective if none of the contents have leaked out

• Keep suppositories out of the reach of children.

Suppositories for Children - What Parents Should Know

Suppositories are frequently used in children because young children cannot swallow tablets. Key points for parents:

• Paracetamol suppositories: Widely available in India for children who are vomiting with fever; dose based on weight (15 mg per kg every 4 to 6 hours); do not exceed the prescribed dose

• Glycerine suppositories: Widely used for constipation in infants and young children; can be used from birth under medical advice

• Diazepam rectal gel: Prescribed to parents of children with epilepsy to use at home when a seizure lasts more than 5 minutes; parents should be trained by their paediatric neurologist in the correct dose and technique.

When Suppositories Are Preferred Over Oral Medicine

They are preferred when:

• Persistent vomiting: When a patient cannot keep oral medicine down; rectal paracetamol or antiemetic suppositories are valuable during fever or gastroenteritis

• Local rectal or vaginal disease: Suppositories deliver medicine directly to the affected tissue at concentrations that oral medicine cannot achieve

• Patients with swallowing disorders (dysphagia): Stroke patients and elderly patients who cannot swallow tablets.

FAQs

1. What is a suppository and what is it used for?

   A suppository is a solid medicine inserted into the body through the rectum, vagina or urethra. Once inside, body heat melts it and releases the medicine directly into the surrounding tissue or bloodstream. Common examples include glycerine suppositories for constipation, paracetamol suppositories for fever in children and clotrimazole pessaries for vaginal thrush.

2. Why would a doctor prescribe a suppository instead of a tablet?

   A doctor prescribes a suppository instead of a tablet when the patient cannot swallow, when the medicine causes nausea by mouth, when faster absorption is needed or when the medicine is intended to act directly on the rectum or vagina. They are also commonly prescribed for children who cannot swallow tablets and for patients after surgery.

3. How do you insert a suppository correctly?

   Wash your hands; if the suppository is soft, chill it in the refrigerator for 15 to 30 minutes. Lie on your left side with the upper knee bent and gently push the suppository pointed end first approximately 2 to 3 cm into the rectum using a finger; press your buttocks together for 1 to 2 minutes and remain lying down for at least 15 minutes. A small amount of water-based lubricant on the tip makes insertion more comfortable.

4. Do suppositories hurt or cause discomfort?

   Inserting a suppository correctly should not be painful. Most patients feel a brief sensation of pressure or fullness in the rectum, which settles within a few minutes. Some patients experience mild burning or stinging; in patients with haemorrhoids or anal fissures, a well-lubricated suppository inserted gently with the little finger may reduce discomfort.

5. How long should you hold a suppository in before it dissolves?

   Remain lying down for at least 15 minutes after insertion. For laxative suppositories wait until the urge to open the bowels is strong usually 15 to 45 minutes. For medicine suppositories (paracetamol, diazepam) lie down for at least 30 minutes.

6. Can suppositories be used for children?

   Suppositories are frequently used in children because young children cannot swallow tablets; paracetamol suppositories treat fever and pain, glycerine suppositories treat constipation and diazepam rectal gel terminates seizures. The dose must be calculated by weight and insertion is done using a clean little finger while a parent holds the child still.

7. What happens if a suppository melts before you can insert it?

   If a suppository has softened before insertion place it (still in its wrapper) in the refrigerator for 15 to 30 minutes until it firms up; as long as none of the contents have leaked out it remains effective. If the suppository has melted completely with contents leaking, discard it and use a new one. Store suppositories in the refrigerator to prevent this.

8. Can a suppository be used if you have haemorrhoids or anal fissures?

   Yes suppositories can generally be used if you have haemorrhoids or anal fissures; some are specifically designed to treat haemorrhoids, containing anaesthetics or anti-inflammatories that reduce pain, swelling and bleeding. Insertion should be done gently using a well-lubricated suppository; consult a doctor if insertion causes significant pain or bleeding.

9. How quickly do rectal suppositories work compared to oral tablets?

   Rectal suppositories generally work faster than oral tablets because they bypass the stomach. Laxative suppositories (bisacodyl) work within 15 to 60 minutes, compared to 6 to 12 hours for oral bisacodyl tablets. Diazepam rectal gel reaches therapeutic blood levels within 2 to 10 minutes fast enough for seizure emergencies.

10. Do you need to use the bathroom before inserting a suppository?

    Try to empty the bowels before inserting a rectal suppository if possible, as an empty rectum allows the suppository to be absorbed more effectively. This is not always possible particularly for patients who are constipated and inserting a laxative suppository because they cannot pass a motion; simply try if convenient.

References

1. Nair A, Bhatt DK, Jacob S. Rectal drug delivery: a comprehensive review. Curr Drug Deliv. 2019;16(7):611–39. https://doi.org/10.2174/1567201816666190725125833

2. Bhatt KK, Sanghavi DK. Suppository — a novel drug delivery system. Int J Pharm Sci Res. 2015;6(3):975–84. https://doi.org/10.13040/IJPSR.0975-8232.6(3).975-84

3. van Hoogdalem E, de Boer AG, Breimer DD. Pharmacokinetics of rectal drug administration, Part I. Clin Pharmacokinet. 1991;21(1):11–26. https://doi.org/10.2165/00003088-199121010-00002

4. Saeedi M, Akbari J, Saeedi N. Rectal formulations for paediatric use. Recent Pat Drug Deliv Formul. 2018;12(3):161–9. https://doi.org/10.2174/1872211312666180717094440

5. Lindblad AJ, Kolber MR. Rectal diazepam for paediatric seizures. Can Fam Physician. 2014;60(6):567. https://pubmed.ncbi.nlm.nih.gov/24925962