The Humble Suppository Trivia Quiz

Answer: False

Although most of us (including myself after an appendectomy) are more familiar with the common use of suppositories to clear the bowel directly, they can also be used to deliver many medicines usually taken orally which are absorbed by the gut, including painkillers and anaesthetics. The French are quite enthusiastic about taking their medicine in that way as a cultural preference.

Answer: A pessary is usually for vaginal use

A pessary has the same function as a suppository, dissolving medicine into a body cavity, but delivers vaginal specific medicine, normally for fungal and bacterial infections which can be quite common, partly due to the proximity of the vagina to the anus and the consequent transfer of germs, and sexually transmitted pathogens.

They can also be designed for urethral use in a similar way for male impotence but are now mainly replaced by simpler oral medication. They come in a variety of shapes for both, but that is not specific to either.

Answer: Glycerin

Glycerin is a natural and effective laxative, and also used for other treatments including throat lozenges. It is made from glycerol, an alcohol hydrocarbon joined with sugar, and gelatin. Using stronger irritants directly in the gut would be too stressful to the digestive system.

Answer: An enema is liquid, a suppository is solid

It is very important for a user to know the actual difference between an enema and a suppository, as if the doctor prescribes one or the other you need to know what to expect. Unlike suppositories nearly all enemas are used as laxatives and are only used rectally.

Normally the enema liquid is meant to be held in for a short time to deliver its full effect. It is also helpful to have an enema administered by another person, ideally with some training, rather than have to do it directly until you are totally familiar with the procedure.

Answer: Leakage

Although absorption is not always as reliable through the rectal wall as oral delivery, the simple logistic nature of putting something in the anus is things normally come out rather than go in. This means all rectal medication can either be expelled soon after insertion, especially for people with any type of muscular weakness such as a prolapse, and then may also leak partially as they dissolve for the same reasons.

They are not at all difficult to use once you've got the hang of it, although they can occasionally cause allergic or similar reactions to people sensitive to certain ingredients.

Answer: Local treatment for a body cavity

All are good and genuine reasons for using a suppository, but the commonest is for direct medical treatment required in the rectum or vagina. As well as not having to travel the entire length of the alimentary canal to get there from oral use, the medicine will also not be broken down in any way in the stomach, which is why some others are injected rather than taken orally. Pessaries in the vagina are the commonest use of direct medication as the various antibiotics and similar treatments can be easily delivered and contained and dissolve exactly where they are needed and not absorbed in the entire body as well as would oral agents.

Of course some children will not take their medicine, so it can be taken as a suppository to make sure it goes in and stays in, and is also often used in animals for the same reasons. For example when a dog has epilepsy a diazepam enema is a common treatment for a seizure where the owner can deliver it to quickly calm it down. But this is a far rarer application than laxative or antibiotic delivery. Certain medicines can also irritate the stomach and may cause vomiting, so can be administered by suppository instead. But many patients on general 'nil by mouth' orders for whatever reason are given intravenous drips for many requirements rather than suppositories.

Answer: Cocoa butter

Cocoa butter is used as it is safe and easy to insert with relatively little pain, and dissolves at around body temperature so it can melt and free the active constituents. A small amount of wax depending on the location can be added to adapt to local temperature variations to try and keep them solid during storage. Polyethylene glycol, a long chain hydrocarbon, is also used more for the body of pessaries, and dissolves in water from the body fluids rather than melting from heat.

Answer: Defecation

If you think about it, if you may need to empty the bowel soon afterwards, any medicine inserted with a suppository will be expelled as well. Therefore the standard instructions on a non-laxative suppository will be 'insert after defecation', much like similar instructions on oral medicine with regard to eating or not first, depending on how the medicine reacts in the body.

Answer: All of these

Suppositories were used by physicians in all three of the great ancient cultures, and described in some detail by the Greek physician Soranus, who amazingly enough was yet another appropriately named individual, like the much more recent Thomas Crapper who made toilets, who wrote at some length on them in his medical treatises. The most common use then was as a contraceptive pessary for women, using various natural materials, even though they were not that certain how or even whether they worked, and were meant mainly as a barrier method. In fact the oil often used as an active constituent did work in another way as it was a basic spermicide, which was probably more from luck than judgement.

In Egypt a number of original papyri have long tracts describing their medical treatment, including both suppositories and enemas, having worked out long before conventional laboratories that medicinal materials could be introduced directly to any suitable body cavity.

Answer: Cooling it

Because suppositories are designed to melt, if it's a warm day then it's quite likely it may be too soft to insert. The instructions will then tell you to either run it under the cold tap or put it in the freezer for a while to make it harder and easier to insert smoothly. If they were designed to melt at a higher temperature they would not be able to melt where they are supposed to in the body, so they have to have a careful balance built in. That is why different proportions of wax can be added depending upon which area they are likely to be distributed to.

Suppositories are sterile when sold, but you must certainly wash your hands before insertion, and is on all the instructions. I did not include unwrapping as a suggestion as I think that was a given. I hope.