Glycerin Suppository Prescription Guidelines for Adult Constipation

Critical Pre-Treatment Assessment

The American College of Gastroenterology recommends performing a digital rectal examination to rule out fecal impaction and assess for possible bowel obstruction in adult patients with constipation 2, 3, 1
The National Comprehensive Cancer Network suggests checking for contraindications including neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis before prescribing glycerin suppositories 3, 1
Evaluate for other causes of constipation, such as hypercalcemia, hypokalemia, hypothyroidism, diabetes mellitus, or constipating medications, as recommended by the American Gastroenterological Association 1
Ensure the patient does not have symptoms of intestinal obstruction before administering the suppository, as advised by the American College of Gastroenterology 1

Glycerin suppositories are appropriate when constipation has persisted for several days despite conservative measures, such as increased fluids, dietary fiber, and exercise, according to the American Gastroenterological Association 1
The National Comprehensive Cancer Network recommends using glycerin suppositories when the rectum is full on digital rectal examination 4
The American College of Gastroenterology suggests using glycerin suppositories when first-line prophylactic measures, such as stimulant laxatives like senna or polyethylene glycol, have been insufficient 3

The American College of Gastroenterology recommends inserting one glycerin suppository (2-3 grams) rectally as needed, with the suppository retained for 15-30 minutes if possible to maximize effectiveness 1, 4
Glycerin works through local rectal irritation and by drawing water into the rectum, which softens stool and facilitates evacuation, as explained by the American Gastroenterological Association 1, 4

The National Comprehensive Cancer Network suggests reassessing for cause and severity of constipation and ruling out bowel obstruction again when the glycerin suppository is insufficient 2, 1
Add other agents, such as bisacodyl suppository, polyethylene glycol, lactulose, or magnesium hydroxide, as recommended by the American College of Gastroenterology 2, 1
Consider sodium phosphate, saline, or tap water enema to dilate the bowel, stimulate peristalsis, and lubricate stool, as suggested by the National Comprehensive Cancer Network 3
Avoid sodium phosphate enemas in patients at risk for renal dysfunction and limit to maximum once daily, as advised by the National Comprehensive Cancer Network 3

The National Comprehensive Cancer Network recommends prescribing a prophylactic stimulant laxative, such as senna, or polyethylene glycol for ongoing prevention after acute resolution with glycerin suppository 3
Do not prescribe docusate as prophylaxis, as it has not shown benefit and is not recommended, according to the National Comprehensive Cancer Network 3
Maintain adequate fluid intake and dietary fiber, and encourage exercise if feasible, as suggested by the American College of Gastroenterology 2, 3, 1