The use of suppositories dates back to about 460 bce. Hippocrates recommended the use of cylindrical suppositories of honey smeared with ox gall (Hurst et al. [105]). The torpedo‐shaped suppositories commonly used today came into being in 1893, when it was recommended that they were inserted apex (pointed end) first (Moppett [150]).

This practice was questioned by Abd‐el‐Maeboud et al. ([2]), who suggested that suppositories should be inserted blunt end first. The rationale for this is based on anorectal physiology; if a suppository is inserted apex first, the circular base distends the anus and the lower edge of the anal sphincter fails to close tightly. The normal squeezing motion (reverse vermicular contraction) of the anal sphincter therefore fails to drive the suppository into the rectum. These factors can lead to anal irritation and rejection of the suppository (Moppett [150], Pegram et al. [197]). The research study by Abd‐el‐Maeboud et al. ([2]) was very small and remains the only research evidence supporting this practice. Following this, Bradshaw and Price ([34]) performed a further search of the literature and no further evidence was available. This remains the case. A distinction can be made between suppositories administered for constipation, requiring a local effect, and those given to achieve a systemic effect.

In the management of constipation, a suppository placed against the bowel wall, rather than within faecal matter, enables body heat to soften the suppository. This requires an accurate insertion technique, which may be better achieved by inserting the suppository apex first (Kyle [117]). However, Kyle ([117]) suggests that patients may find it more acceptable to self‐administer suppositories blunt end first as the sucking action means there is no need to insert the finger into the anal canal. Suppositories for systemic use are best absorbed by the lower rectum. Here, venous drainage avoids the portal circulation moving to the inferior vena cava quickly, resulting in a more rapid therapeutic effect (Kyle [117]). There is a need for further research in this area but until such work is carried out, expert opinion such as that of Kyle ([117]) and manufacturers’ guidelines should steer practice (Peate [193]).

There are several different types of suppository available. Retention suppositories are designed to deliver drug therapy, for example analgesia, antibiotics and non‐steroidal anti‐inflammatory drugs (NSAID). Those designed to stimulate bowel evacuation include glycerine, bisacodyl and sodium bicarbonate. Lubricant suppositories, for example glycerine, should be inserted directly into the faeces and allowed to dissolve. They have a mild irritant action on the rectum and also act as faecal softeners (BNF [30]). However, stimulant types, such as bisacodyl, must come into contact with the mucous membrane of the rectum if they are to be effective as they release carbon dioxide, causing rectal distension and thus evacuation.