Chronic use of suppository can result in a spectrum of anorectal injuries that can be quite serious.



(1) ergotamine

(2) NSAID (paracetamol/acetaminophen, other)

(3) salicylate

(4) dextropropoxyphene

(5) codeine


Epidemiologic features:

(1) often involves middle-aged women

(2) history of migraine headaches or other chronic pain condition

(3) addicted to codeine or other component

(4) psychiatric disorder


Clinical findings:

(1) anal pain

(2) fecal incontinence

(3) anal discharge and/or bleeding

(4) tenesmus (painful straining at stool)

(5) bowel obstruction


Anorectal lesions:

(1) proctitis

(2) anal and/or rectal ulcerations, typically in a "butterfly" pattern

(3) partial or total anorectal stenosis, sometimes sufficient to necessitate bowel diversion


Differential diagnosis:

(1) anal carcinoma

(2) syphilis

(3) amebiasis

(4) Crohn's disease


To read more or access our algorithms and calculators, please log in or register.