What does 'place rectally' mean?: A Guide to Rectal Drug Administration

The term 'place rectally' refers to the administration of medication through the rectum, a route that can provide rapid drug absorption for both local and systemic effects. For patients unable to take oral medications due to nausea, vomiting, or other issues, this method offers a viable and effective alternative.

Quick Summary

This article explains the meaning and mechanism of rectal drug administration, detailing why it is used and the types of medications involved. It provides step-by-step instructions for inserting suppositories and outlines the benefits, drawbacks, and specific considerations for this method of drug delivery.

Key Points

• Definition: 'Place rectally' means to insert medication into the rectum for absorption.

• Mechanism: The rectum's blood vessels absorb medication, which then enters the bloodstream, partially bypassing the liver's first-pass metabolism.

• Benefits: It's an alternative for patients with nausea, vomiting, or difficulty swallowing, and can provide a rapid onset of action.

• Common Forms: Rectal medications include suppositories, enemas, and foams.

• Risks: Absorption can be inconsistent, and potential side effects include discomfort and local irritation.

• Proper Technique: Administration requires proper patient positioning and the use of a water-soluble lubricant to ensure effective absorption and retention.

• Contraindications: The route should be avoided in patients with active rectal bleeding, severe diarrhea, or certain anorectal diseases.

The Rectal Route: A Mechanism for Systemic and Local Effects

To place rectally means to deliver medication by inserting it into the rectum, the final section of the large intestine. The rectum's highly vascularized walls allow for the rapid and effective absorption of certain medications directly into the bloodstream. This method is particularly significant in pharmacology because it can partially or entirely bypass the 'first-pass effect,' a metabolic process where drugs absorbed orally are processed by the liver before entering general circulation. Bypassing this process can lead to higher bioavailability, meaning a greater concentration of the drug reaches its target more quickly.

Why Doctors and Pharmacists Advise Rectal Administration

Rectal administration offers several key benefits that make it a crucial option for patients with specific needs. These include:

• Overcoming gastrointestinal issues: It is an ideal alternative for patients experiencing intractable nausea, vomiting, or who have difficulty swallowing (dysphagia).
• Rapid action: The rich blood supply in the rectum allows for faster onset of action for certain medications compared to the oral route. This is particularly useful in emergency situations, such as administering anticonvulsants for seizures.
• Unconsciousness or altered mental state: For patients who are unconscious, sedated, or have a decreased mental status, the rectal route ensures medication delivery without the need for oral intake or an intravenous line.
• Localized treatment: It can deliver high concentrations of medication directly to the site of inflammation or disease in the rectum and lower colon, effectively treating conditions like ulcerative proctitis.
• Avoiding liver metabolism: Bypassing a significant portion of the hepatic portal system allows for greater bioavailability of certain drugs that would otherwise be heavily metabolized by the liver.

Common Rectal Medication Formulations

Rectal medications come in several forms, each designed for effective delivery and absorption:

• Suppositories: These are solid, cone-shaped or torpedo-shaped preparations designed to melt or dissolve at body temperature after insertion. The active ingredients are then released for either local or systemic effects. Examples include glycerin for constipation or acetaminophen for fever.
• Enemas: A liquid preparation injected into the rectum, usually in a single-use, pre-filled container. Enemas can be used for delivering medication or for bowel cleansing.
• Foams: Similar to enemas, foam preparations are delivered via an applicator and are often used to treat inflammatory conditions like colitis in the lower bowel.
• Micro-enemas: Small volumes (typically less than 10 mL) of a liquid medication injected into the rectum.

Step-by-Step Guide to Administering Rectal Medications

Proper administration is key to ensuring the medication is absorbed effectively and to minimize discomfort. Always follow the specific instructions from your doctor or pharmacist, but here is a general guide:

1. Prepare: Wash your hands thoroughly with soap and water. If the suppository is too soft, chill it in the refrigerator for a few minutes while still in its wrapper.
2. Position: Lie on your left side with your lower leg straightened and your upper leg bent forward towards your stomach. This position, known as Sims' position, uses gravity to your advantage. For caregivers, placing a child on their stomach with knees to their chest is also effective.
3. Lubricate: Use a water-soluble lubricating jelly on the tip of the suppository and your gloved finger to ease insertion. Avoid petroleum jelly, as it can prevent the suppository from melting.
4. Insert: Gently separate the buttocks to expose the anus. Push the suppository, typically with the rounded end first, using your index finger. Insert it beyond the anal sphincter (the muscular opening), about 1 to 1.5 inches for an adult, or less for a child. This prevents it from being expelled.
5. Relax and Retain: Remain lying down for at least 5 to 15 minutes to allow the suppository to dissolve and be absorbed. For children, you may need to gently hold their buttocks closed.
6. Clean Up: Wash your hands again with soap and warm water.

Comparing Oral and Rectal Drug Administration

Feature	Oral (Pill, Liquid)	Rectal (Suppository, Enema)
Speed of Absorption	Can be slower, as the medication must pass through the stomach and small intestine.	Can be faster due to direct absorption into the vascular system.
First-Pass Metabolism	High. Significant drug metabolism occurs in the liver before reaching systemic circulation.	Partially or completely bypasses the liver, resulting in higher bioavailability.
Suitability for Patients	Requires patients to be conscious and able to swallow without nausea or vomiting.	Excellent for patients who cannot swallow or are unconscious. Also useful for local rectal conditions.
Absorption Consistency	Generally more consistent, though affected by food intake and gastric emptying rate.	Often erratic and unpredictable, as it can be impacted by the presence of stool or hydration.
Comfort/Acceptance	Widely accepted and convenient for most patients.	Some patients may experience discomfort or feel embarrassed; acceptance is generally lower.
Drug Types	Broad range of drugs formulated for oral use.	Limited to drugs that are effectively absorbed via the rectal mucosa.

Important Considerations and Potential Drawbacks

While a valuable tool in medicine, rectal drug administration isn't suitable for everyone and has certain limitations:

• Contraindications: The rectal route should be avoided in patients with active rectal bleeding, severe diarrhea, low platelet count (thrombocytopenia), or certain inflammatory or anorectal diseases.
• Efficacy: The effectiveness can be variable and unpredictable due to factors like the presence of fecal matter, hydration, and differences in formulation.
• Local irritation: Some drugs may cause local irritation or discomfort, which can lead to a sensation of needing to defecate.
• Patient compliance: Privacy concerns and social stigma can sometimes affect patient acceptance and willingness to use this method.
• Retention issues: A suppository may be expelled prematurely, leading to an incomplete dose.

Conclusion

In conclusion, 'place rectally' is a critical phrase in pharmacology, defining a route of medication administration that serves as an effective alternative to oral intake, particularly when patients are unable to swallow due to illness or unconsciousness. It leverages the rectum's unique vascular system to facilitate rapid drug absorption and higher bioavailability by partially avoiding the liver's metabolic processes. While highly beneficial in certain medical contexts, it is not without drawbacks, including variable absorption rates and potential patient discomfort. As with all medical treatments, proper technique and adherence to professional medical advice are essential for safe and effective use.

For more detailed information on specific medications or alternative administration methods, it's always best to consult a healthcare professional. You can also explore reputable health resources such as the National Institutes of Health.

Frequently Asked Questions

What is the difference between placing a suppository and an enema rectally?

A suppository is a solid, often bullet-shaped medication that melts inside the rectum, while an enema is a liquid solution delivered via an applicator. The choice depends on the medication and desired effect.

Does medication placed rectally work faster than oral medication?

Yes, in many cases, drugs administered rectally can have a faster onset of action than oral medications. This is because they are absorbed directly into the systemic circulation, avoiding the metabolic first-pass effect in the liver.

Are there any side effects from placing medication rectally?

Yes, potential side effects can include local irritation, discomfort, or a sensation of needing to defecate. Proper technique, including lubrication, can help minimize these issues.

Can children receive medication rectally?

Yes, rectal administration is often used for children, especially infants and toddlers, who cannot take oral medication due to vomiting or other reasons. Different insertion depths and techniques apply based on the child's age.

How far should a suppository be inserted?

For adults, a suppository should be inserted about 1 to 1.5 inches, or past the anal sphincter muscle. This prevents it from slipping out. For children, the distance is shorter depending on their size.

What if the suppository comes out?

If a suppository is expelled, it may not have been inserted far enough to clear the anal sphincter. You may need to insert another one, ensuring it is pushed past the muscle. For laxative suppositories, expulsion is the desired outcome.

Should I use petroleum jelly to lubricate a suppository?

No, you should use a water-soluble lubricant like K-Y Jelly. Petroleum jelly is not water-soluble and can prevent the suppository from melting and releasing its medication.