Glycerin Suppositories

Glycerin suppositories belong to a class of drugs that treat constipation by acting as irritants to the body. There are both generic brands as well as nationally-known manufacturers of these laxatives including G&W Laboratories, Walgreens, Fleet, Pedia-Lax, CVS, Colace and others. In addition, this medication is available around the world with India having an extensive list of manufacturers [1].

Uses of glycerin suppositories

Glycerin suppositories are typically used to treat occasional constipation. In other instances, a medical professional might recommend the use of glycerin suppositories in order to empty and cleanse the bowels before a rectal examination or other medical procedure involving the intestines. There might also be other times that a physician recommends that their patient use this product as well. These uses, however, tend to be less common than the above-noted reasons.

Mechanism of action

The bowel movement begins after the peristaltic mass movement propels stools into the rectum. The ensuing stretching of the rectum’s walls by the entering stools activates the rectal stretch receptors. In turn, these specialized nerves stimulate the urge to move bowels, and signal the anal canal to open up (dilate) to allow stools to leave the body. If you don’t suppress this process [the urge to move the bowels] by tensing the pelvic muscles and, in effect, “closing” the anal canal, the bowel movement proceeds to complete.

The suppression of the urge to move bowels may be conscious because of the circumstances (you are driving, in the meeting, away from the bathroom, etc.), or unconscious because of pain related to large or hard stools, enlarged hemorrhoids, anal abrasion, fissure, or fistula, or any other pathology. A routine suppression of bowel movements leads to the enlargement, hardening and drying out of stools that weren’t allowed to exit. This, in turn, necessitate straining because large, hard, or dry stool can’t pass the anal canal on its own. The ensuing straining is a primary cause of hemorrhoidal disease, anal bleeding, fissures, fistulas, rectal prolapses, and other pathologies.

Anorectal nerve damage affects the sensitivity of the rectum and anus, and inhibits the urge to move bowels. It can be related to the conditions described above, or to the disorders that affect the functioning of the nerve such as diabetes, paralysis, stroke, and similar others. Medicine for pain relief, particularly opioids (legal and illicit alike) are just as “effective” at suppressing the urge to move bowels as they are successful at suppressing pain. For patients with no or partial nerve damage, glycerin suppositories act as artificial stimulants of the urge to move bowels. The downside of this action is that this stimulation leads to straining, and in patients with enlarged stools, a constricted anal canal (due to enlarged hemorrhoids), may cause even more damage.

How glycerin suppositories work

A glycerin suppository is typically a torpedo-shaped solid that includes a number of inactive ingredients in addition to the glycerin that is its active ingredient. Electrolytes are also added to the formulations of these medications. Designed to be used rectally only, glycerin suppositories work by irritating the intestinal lining causing the body to eject that irritant which is liquid glycerin in this case [2]. In many cases, a bowel movement occurs within 15 to 60 minutes.

Glycerin suppositories and their safety for children

Young children -- typically those five years of age and under -- do not yet possess the ability to rationalize events. This means that these youngsters could perceive their parents' use of suppositories as a method of punishment because they did not move their bowels as expected. This perception can lead to the child withholding excavation of the stool which, in turn, simply makes constipation worse. It is this unhealthy physical and psychological cycle that leads a number of experts to advise against using glycerin suppositories on children under the age of five.

When glycerin suppositories are used on children, their bodies often react much more strongly to its irritating and stimulating effects. This is because their bodies are more sensitive to these properties of glycerin suppositories than adults who often have a prolonged history of constipation and/or nerve damage. Children's bodies tend to eject glycerin suppositories before they are able to produce the action that was intended.

Pregnant and/or breastfeeding women and glycerin suppositories

Glycerin suppositories have earned a Category C rating from the United States Food & Drug Administration (FDA) [3]. This means that studies using animals have been shown glycerin suppositories to have a negative effect on the fetus. However, there are no well-controlled studies that have been completed on humans.

Despite the potential risks, this category states that the benefits of pregnant women using glycerin suppositories could outweigh the potential risks if her medical care provider deems its use necessary [4]. Similarly, it has not yet been determined if the use of glycerin suppositories can harm a nursing baby or if it can pass into a mother's breast milk [5].

Patients who should not use glycerin suppositories

There are some patients who should not use glycerin suppositories. These include the following:

• Those with abdominal pain that has not been diagnosed;
• Patients with a blockage of some type in their digestive system;
• People who are allergic to any of the ingredients that are present within glycerin suppositories;
• Persons who have other bowel problems, including -- but not limited to -- hemorrhoids and ulcerative colitis;
• If there has been a sudden change in bowel habits that has lasted for longer than two weeks;
• Or if it is necessary to use a laxative of any sort for longer than one week;

Medication interactions with glycerin suppositories

There are 253 drugs that are comprised of 926 generic and brand names that are known to interact with glycerin suppositories [6]. These are divided into moderate and mild interactions. A partial list of those medications that can interact unfavorably with glycerin suppositories includes albuterol, amoxicillin, anagrelide, aspirin, caffeine, Z-Pak (azithromycin), Zoloft, Prinivil, fosinopril, fluconazole and numerous others.

Side effects from using glycerin suppositories

Some common side effects that might be experienced while taking glycerin suppositories are often not deemed serious enough to notify medical personnel unless they continue to persist or become bothersome [7]. These include gas, a burning sensation, diarrhea, stomach cramps, anal irritation and nausea.

However, the presence of difficulty breathing, hives, swelling of the tongue, face or lips, rectal bleeding and chest tightness require the immediate advice of medical personnel.

User reviews of glycerin suppositories

Some people who have used glycerin suppositories have noted that they have experienced extreme pain, weakness, nausea and sweating while taking this product. These users include those who have been diagnosed with irritable bowel syndrome (IBS) and those who have had prior bowel surgery.

Other users of glycerin suppositories complained of embarrassing fecal leakage as well as pruritus ani -- also known colloquially as "itchy bottom."

Glycerin suppositories and the elderly

The elderly tends to self-medicate with laxatives, including over-the-counter glycerin suppositories, at an alarming rate. The usage of such medications is the second most commonly used by this segment of the population. While a third of the elderly use such products at least once a week on their own to help with constipation, 74 percent of nursing home patients and 76 percent of the hospitalized elderly are prescribed some type of laxative product by medical personnel [8].

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