RECTAL SUPPOSITORIES AND PESSARIES

Drugs or medicines can be administered through a variety of routes, the most common of which are oral and topical routes. Rectal or vaginal routes are less commonly used but are important when the normal routes are less suitable or inaccessible. These two main rules of administration drugs are by making the drug either in the form of a suppository or pessary.

Suppository is a medicated solid dosage form intended for insertion into the body orifices. The medicament is incorporated into a base, which either melts at body temperatures or dissolves in the mucous secretions and exerts localized or systemic action.

Suppositories are commonly employed in the rectal, vaginal and occasionally, urethera. They come in various sizes and shapes, which facilitate their insertion and retention in the cavity. Adult rectal suppositories weighed about 2g while those for children is about half the weight. Vaginal suppositories (pessaries) are usually oviform or coned shaped whereas urethral suppositories (bougies) are slender and pencil shaped.

Suppositories or pessaries are suited particularly for the following purposes:

1. To produce a local action, such as anti-inflammatory and anaesthetic effect for haemorrhoidal conditions. Preparations for haemorrhoids usually contain astringents, local anaesthetic and anti-inflammatory components. Suppositories with local irritants are employed as laxatives. Pessaries, intended for localized action are employed as contraceptives, antiseptics and as specific agents to combat invading pathogens.

2. To facilitate emptying of the lower bowel such as laxative preparations (delivered to the site of action).

3. To produce a systemic effect. Mucous membranes of the rectum and vagina allow the absorption of many drugs. Although the rectum is often used as the site of systemic absorption, the vagina is not as frequently used.

Using rectal administration to achieve systemic activity is preferred when the drug is destroyed in the gastrointestinal tract, irritant to the stomach, if oral administration is not possible because of vomitting or if patient is unconscious or incapable of swallowing oral formulation (e.g. in an infant or sick patient ).

Rectal suppositories have been employed in a variety of conditions such as fever, asthma nausea bacterial infections and constipation. Most of these preparations are available from pharmacies, either as over-the-counter products or prescription items.

As much as suppositories are useful, there are some disadvantages of using them too. They are:

1. May not be preferred as it is inconvenient

2. Absorption of drugs can be erratic and unpredictable.The vagina especially, is a physiologically and anatomically dynamic organ that causes the surrounding aqueous media pH (acid or basic) and membrane permeability to change over time

3. Some suppositories ‘leak’ or are expelled after insertion

Vaginal tablets are now more widely used than pessaries. They are more stable and less messy to handle. They normally contain the same types of anti-infectives and hormonal agents as the pessaries and are intended to disintegrate within the vagina, releasing their contents. Among other preparations available rectally and vaginally are ointments, creams, aerosol foams and enemas.


How to use rectal suppository:

1. If necessary, go to the toilet to empty your bowels.

2. Wash your hands.

3. Remove any foil or plastic wrapping from the suppository.

4. Either squat or lie on your side with one leg straight and the other bent.

5. Gently but firmly push the suppository, tapered end first, into the rectum (back passage). Push far enough so that it does not slip out.

6. Close your leg and sit still for a few minutes. Avoid emptying the bowels for at least one hour (unless suppository is a laxative ).

7. Wash your hands again.
   
   
   

How to use a pessary:

1. Wash your hands.

2. Remove any foil or plastic covering from the pessary or applicator.

3. If an applicator is supplied, load it with the pessary. If you are pregnant, DO NOT use the applicator provided, but instead insert the pessary using your finger.

4. While lying down with knees bent and spread apart , gently insert the applicator (or pessary) into the vagina as far as it will comfortably go.

5. Press the plunger to deposit the pessary into the vagina and withdraw the applicator.

6. Wash your hands again.
   
   
   

Some other helpful tips:

1. Patients are usually advised to quickly dip a pessary or suppository in water before insertion.

2. Suppositories should be stored according to instructions on product leaflets. Normally, a cool condition is necessary.

3. Suppositories stored in refrigerator should be allowed to warm to room temperature before insertion.

4. When the patient only needs to use half a suppository, the suppository should be cut lengthwise, with a clean razor blade.

5. Pessaries should be inserted high into the vagina.

6. Should there be a worry of leakage with pessaries, the usage of a sanitary napkin is recommended.

7. Any irritation, burning sensation or signs of allergic reactions should be reported to the physician.

If you have any questions about your rectal suppositories, pessaries or other preparations, consult your pharmacist for help.