Conventional wisdom suggests that suppositories should be placed apex (pointy end) first. After all, don’t torpedoes go pointy end first? What about arrows? And don’t forget the fencing sabre. It would seem that the rule of pointy end first is all around us. A universal constant.
In Cairo, Egypt, 1991, the dogma was challenged. KH Abd-el-Maeboud et al published this Lancet paper:
Rectal suppository: commonsense and mode of insertion
They first surveyed a group of over 600 people (medical, non-medical, Egyptians and Non) as to which way they would place a suppository. All but two responded apex first. The gauntlet was down and it was time to disprove the collective unconscious. 100 unwitting subjects, including kids and adults, had suppositories placed by both methods. And when I say unwitting, I refer to the subjects’ blinding to the study design, not unwanted suppository placement.
The results were striking: 83% of the apex first insertions required placement of a finger into the anal canal to push the suppository all the way in, compared to only 1% of the blunt end first. An 82% difference! As a bonus, the rate unwanted suppositoral expulsion was also lower in the blunt end group. No complications were reported in either group, although there I’m not sure the study was designed to capture adverse outcomes.
Since that fated day in 1991, there have been no follow-up studies to validate or refute the evidence supporting blunt end first. For me, it’s a no brainer. There are some who caution against defying the manufacturer insert, which advises apex first, out of medicolegal concerns in the event of complication. There’s no fault in that, after all we’re only talking about suppositories. But my take is blunt end first and let data prevail.