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Getting to the bottom of evidence based medicine

BMJ 2008; 336 doi: (Published 03 April 2008) Cite this as: BMJ 2008;336:764
  1. Susan Bewley, consultant obstetrician
  1. 1Guys and St Thomas’ Foundation Trust, London
  1. susan.bewley{at}

“Which way up should I put the suppository?” I’ve asked this question of countless junior obstetricians over the years as we administer rectal analgesia after a caesarean section.1 Despite thinking it might be a trick question, they all want to insert the pointed end of the bullet shaped object first.2 Surely that’s how they are designed, and it would be more comfortable?

Well, no. It was Minerva herself who drew this to my attention: a trial confirms that blunt end first is preferable.3 Possibly because of the tapered shape and tone of the sphincter, fingers rarely need to be inserted into the anal canal (1% v 83%) …

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