Medical treatments for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease, run the gamut: Oral pills, injections, enemas, infusions — and we can’t forget good old rectal suppositories.
Suppositories are a form of medication that are inserted directly into the rectum. Yeah — it doesn’t sound pleasant. But one helpful way they are used is to treat mild-to-moderate UC and sometimes Crohn’s disease. In this case, they typically contain an aminosalicylate medication, which means it contains mesalamine, according to the Crohn’s and Colitis Foundation. Mesalamine can help reduce inflammation, prevent complications, and for some with UC, even lead to or help you maintain remission from your condition.
As someone living with UC, I've been using suppositories daily for the past three years to help treat my proctitis, or inflammation in the rectum. If you've never been on them before, suppositories can be difficult to get used to, to say the least. But fear not — I’ve put together my tips and tricks for acquainting yourself with this form of treatment to hopefully make the experience a little bit easier for you.
The basics: How to use a rectal suppository
First thing’s first: How the heck do you do this? Most importantly, you always want to follow your doctor’s instructions — as well as those from the suppository manufacturer, which are typically included in the package.
To insert the suppository, per the Mayo Clinic, you want to remove the wrapper, wet the suppository in cold water, and get into a comfortable position (more tips on this below!). Then you can push the suppository up into your rectum.
A few simple steps, but it’s trickier than it sounds. Keep reading for my top tips on how to make the process easier.
Find a position that's comfortable for you
Inserting suppositories yourself is not fun — I don't want to sugarcoat it. The first time you do it, it can feel demoralizing and extremely uncomfortable. My recommendation? Get super comfortable before you insert it. Seriously — turn on some music, lie down, and practice deep breathing to help your body and mind become more comfortable and relaxed. Breathing exercises are a great way to reduce stress and tension throughout your entire body, according to experts.
Some suppository manufacturers recommend lying down on your side to insert. But you should find a position that's comfortable for you. For me, simply bending over is the most comfortable. But don't be afraid to lie down or try other positions — it's about making it work for you. It may take a couple of times to figure out what works best.
Consider underwear protection
Suppositories can leave stains in your underwear after you insert them. If you wind up passing gas, some of the remaining coating from the suppository can come out and leave something similar to a grease stain. I've had this happen before, and once, the residue even went through my underwear and stained my jeans. Whether you're male or female, you might want to consider some underwear protection. I recommend wearing a pad or panty liner and adjusting it a little farther back in your underwear to cover up your rear.
Try to have a BM before you take your suppository
To the best of your capability, try to have a bowel movement right before you insert your suppository. There's nothing worse than inserting one, and then having to poop right away, which pushes out that medicine. Try to make sure you're empty beforehand, and if you do have a BM after you insert, take another suppository. Sometimes the act of inserting the suppository itself can make you feel like you need to have a BM, but take a minute or two to see if you can hold it in before heading to the toilet. Usually, the urge passes.
Take your suppository right before bed, if you can
Taking my suppository is the last thing I do before I crawl into bed for the night. It can be uncomfortable to insert a suppository first thing in the morning and then try to go about your day. There have been times when I've had to use suppositories in the morning and at night, and I've managed, but now that I only take them once a day, I try to make it the very last thing I do. That way, I can go to sleep and forget about it. It also gives the medicine more time to stay in place and help treat the affected area.
Use caution when passing gas
Like I mentioned earlier, you should be careful about passing gas after taking a suppository. You could stain your underwear or lose control and have a BM. The morning after you insert your suppository, try to head to the toilet first thing, and pass any gas you might've built up overnight. This way, the remains of the coating can go directly into the toilet, and all you're left to do is wipe and go about your day.
Chill your suppositories and use them as directed
Most suppositories need to be chilled, so make sure that you keep them in the fridge. Keeping them chilled prevents them from getting too soft, which can make it hard to insert, per the Mayo Clinic. I actually keep mine in the crisper.
Beyond chilling them, make sure you’re following the other directions your doctor has given you. Suppositories can be uncomfortable, but use them as directed to avoid being on them for even longer. They work the same way as antibiotics — just because you're starting to feel better, that doesn't mean they're done working.
Know that your stool may change color
Some suppositories, like Canasa, can turn any blood coming out during a BM from bright red to black. When you have IBD, this can be normal, but it doesn't hurt to check in with your gastroenterologist if you notice something that seems off compared with your normal symptoms. But most of the time, it's a side effect of the medicine in the suppository combining with blood.
Trust me: Suppositories really aren't that bad
When I was first prescribed suppositories, I thought my life was over. I was so embarrassed I had to use them, it was painful to insert them, and I would work myself into a panic before I had to take one.
But after three years, I can honestly say they aren't that bad. Using them has become a key part of my care plan, and they truly help reduce my UC symptoms and make my BMs pain free.
So while you might be a bit nervous to start taking suppositories, I hope you find this guide useful — and soon enough you’ll have adjusted to your new routine.