Safe methods of suppository insertion and minimising discomfort of enemas Medications administered via the rectum are absorbed through the rectal mucosa. Reasons for choosing this route include: n Oral administration contraindicated because of obstruction or swallowing difficulty n Medication irritates the stomach mucosa n Severe nausea or vomiting n Patient fasting n Altered consciousness level n Constipation. Suppositories conventionally have been inserted pointed end first. However, proposed reasons for inserting blunt end first are: n The external sphincter opens more easily when a large area is pressed against it. n The suppository is more likely to be rejected with the blunt end pressing against the internal sphincter. Manufacturers’ instructions should be consulted and the end to be inserted first should be lubricated with 5ml water-soluble lubricant. Using one finger, the suppository should be advanced 5cm past the anal sphincter to ensure that it reaches the rectum. If the patient has been given the suppository to relieve constipation he or she should retain it for 15-20 minutes. If it has been given for other reasons the patient is unlikely to feel the urge to expel it. When giving enemas the air should be purged from the tube and the end lubricated with water-soluble lubricant. The tube should be gently inserted into the anus and advanced 10cm. The fluid should be administered by rolling up the tube. Reports of cramping or pain by the patient may indicate that the fluid is being administered too quickly. Warming the enema to body temperature in a bowl of water before installation may also help prevent discomfort. Pegram A, Bloomfield J, Jones A (2008) Safe use of rectal suppositories and enemas with adult patients. Nursing Standard. 22, 38, 38-40. Some simple steps to alleviate the discomfort of restless leg syndrome Restless leg syndrome (RLS) is a common movement disorder that remains underdiagnosed and under-treated. It can affect people of any age but is more often seen in middle-aged and older people. The neurological cause of RLS is unknown and no anatomical pathology has yet been linked to the condition. However, studies indicate changes in the neuronal excitability of the motor cortex in that the motor cortex is disinhibited. The key feature is akathisia – an uncontrollable urge to move the legs. This may be accompanied by deep pain, which may be perceived as throbbing, bubbling, a ‘creepy crawly’ sensation, or an itch with no evidence of rash or other skin disorder. Symptoms are worst at rest and relieved by movement. Sleep quality is poor and may be associated with jerking limb movements when asleep. Around 40 per cent of patients have a family history of the condition and 25 per cent have iron deficiency anaemia. Other clinical associations include renal failure, diabetes and rheumatoid arthritis. RLS is worsened by caffeine or excessive alcohol consumption, and by medicines including antidepressants, beta blockers, antihistamines and anticonvulsants. Treating iron deficiency anaemia by aiming for a ferritin concentration above 45μg/l can ameliorate RLS. Frequent and vigorous exercise also reduces symptoms. Rubbing the legs may be useful and a perception of heat can be improved by cold bathing. Drug therapy with a dopamine agonist, in doses much lower than that used to treat Parkinson’s disease, is needed in only 20-25 per cent of cases. Pergolide, ropinirole, pramipexole and cabergoline alleviate symptoms in most patients. Lakasing E (2008) Exercise beneficial for restless leg syndrome. The Practitioner. 252 1706 43-45.