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The administration of substances into the bloodstream. This may
be done in situations where it is undesirable or impossible to deliver a
medication by mouth, such as antiemetics given to reduce nausea (though not many
antiemetics are delivered by enema). Additionally, several anti-angiogenic
agents, which work better without digestion, can be safely administered via a
gentle enema. Medicines for cancer, for arthritis, and for age-related macular
degeneration are often given via enema in order to avoid the
normally-functioning digestive tract. Interestingly, some water-based enemas are
also used as a relieving agent for irritable bowel syndrome, using cayenne
pepper to squelch irritation in the colon and rectal area. Finally, an enema may
also be used for hydration purposes.
Emergency blood expansion. Emergency pre-hospital treatment of
haemorrhage requires immediate fluid replacement therapy. In mass casualty,
remote or rural settings, the lack of sterile fluids, intravenous equipment or
the knowledge to use them might limit the treatment options available. In such
situations proctoclysis remains an easy and effective way to provide fluid
replacement. It does not require sterile fluids, special equipment or complex
training, and it is useful when alternative routes are not readily available.
The topical administration of medications into the rectum, such
as corticosteroids and mesalazine used in the treatment of inflammatory bowel
disease. Administration by enema avoids having the medication pass through the
entire gastrointestinal tract, therefore simplifying the delivery of the
medication to the affected area and limiting the amount that is absorbed into
General anesthetic agents for surgical purposes are sometimes
administered by way of an enema. Occasionally, anesthetic agents are used
rectally to reduce medically-induced vomiting during and after surgical
procedures, in an attempt to avoid aspiration of stomach contents.
Administering a suppository
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A suppository is a drug delivery system that is inserted into
the rectum (rectal suppository), vagina (vaginal suppository) or urethra
(urethral suppository), where it dissolves or melts.
They are used to deliver both systemically-acting and
The alternative term for delivery of medicine via such routes is
The general principle is that the suppository is inserted as a
solid, and will dissolve or melt inside the body to deliver the medicine pseudo
received by the many blood vessels that follow the larger intestine.
Rectal suppositories are commonly used for:
laxative purposes, with chemicals such as glycerin or bisacodyl
treatment of hemorrhoids by delivering a moisturizer or vasoconstrictor delivery
of many other systemically-acting medications, such as promethazine or aspirin
General medical administration purposes: the substance crosses
the rectal mucosa into the bloodstream; examples include paracetamol
(acetaminophen), diclofenac, opiates, and eucalyptol suppositories.
Mode of insertion
In 1991, Abd-El-Maeboud and his colleagues published a study in
The Lancet, based upon their investigation into whether there was some hidden
and forgotten knowledge behind the traditional shape of a rectal suppository.
Their research very clearly demonstrated that there was, indeed,
a very good reason for the traditional torpedo shape; namely, that the shape had
a strong influence on the extent to which the rectal suppository traveled
internally — and, thus, upon its increased efficiency.
They (counter-intuitively) found that the ideal mode of
insertion was to insert suppositories blunt end first, rather than the generally
used mode of inserting the tapered end first. This conclusion was based on the
greater distance of internal travel of the suppository once inserted, which was
entirely a mechanical consequence of the natural actions of the bowel's muscular
structure and the rectal configuration.
As a consequence, and in order to guarantee the maximum optimal
efficiency, they recommended that all rectal suppositories be inserted blunt end
first. The findings of this single study have been challenged as insufficient
evidence on which to base clinical practice.
Non-laxative rectal suppositories
Four 500 mg paracetamol suppositories
Non-laxative rectal suppositories are to be used after
defecation, so as not to be expelled before they are fully dissolved and the
substance is absorbed. The use of an examination glove or a finger cot can ease
insertion by protecting the rectal wall from fingernail(s).
Vaginal suppositories are meant for introduction into the
vagina. These are generally conical, rod shaped or wedge shaped and are larger
than Rectal suppositories (4-8 g). Commonly used for local actions in the
treatment of gynecological ailments, including vaginal infections such as
Alprostadil pellets are urethral suppositories used for the
treatment of severe erectile dysfunction. They are marketed under the name Muse
in the United States. Its use has diminished since the development of oral
Some suppositories are made from a greasy base, such as cocoa
butter, in which the active ingredient and other excipients are dissolved; this
grease will melt at body temperature (this may be a source of discomfort for the
patient, as the melted grease may pass through the anus during flatulences).
Other suppositories are made from a water soluble base, such as polyethylene
glycol. Suppositories made from polyethylene glycol are commonly used in vaginal
and urethral suppositories. Glycerin suppositories are made of glycerol and
Suppositories may be used for patients in the event it may be
easier to administer than tablets or syrups.
Suppositories may also be used when a patient has a vomiting
tendency, as oral medication can be vomited out.
Drugs which often cause stomach upset, for example diclofenac
sodium (Voltaren) are better tolerated in suppository form.
Liquid suppository involves injecting a liquid, typically a
laxative, with a small syringe, into the rectum.
Administering an intramuscular injection
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