Foreign Body in Rectum

The majority of people with an object in their rectum may have no signs or symptoms. This can make the diagnosis very difficult, especially in children and in psychiatric patients.

• The rectum is that part of the bowel immediately inside the anus.
• Any object may be inserted or present in the rectum or anus.
• It should be removed to prevent serious complications.

A vibrator in the rectum. The battery pack is clearly visible on X-ray, and the outline of a vibrator in the rectum can be seen. It was still vibrating when this person came to the emergency department.

The majority of objects have been introduced through the anus. But sometimes a foreign body may be swallowed, pass through the digestive tract, and eventually get stuck in the rectum.

Common examples of foreign objects in the rectum include:

• Fruits and vegetables
• Bottles
• Candles
• Objects designed to be placed in the anus (such as vibrators or dildos)

Foreign objects in the rectum also may be found in the following circumstances:

• In children
• In psychiatric patients
• In victims of assault
• As a result of an injury caused by medical professionals (examples would be a broken rectal thermometer and broken enema catheter tips)
• As a result of an object used for sexual gratification

The majority of people with an object in their rectum may have no signs or symptoms. This can make the diagnosis very difficult, especially in children and in psychiatric patients.

In some cases, especially if there has been a delay in seeking medical attention, a complication may have occurred, which gives rise to symptoms. In this case, these are the symptoms most likely to be experienced by the patient:

• Abdominal pain
• Nausea and vomiting
• Fever
• Rectal bleeding

The examination may be equally unrevealing. But if the patient has a complication such as peritonitis (inflammation of the inner lining of the abdominal wall) then he or she will have a very tender abdomen.

If you know you have a foreign body in your rectum, or think you do, seek medical help to remove it as soon as possible.

It is likely that most doctors will not have all the equipment in their offices that may be required to safely remove a rectal foreign body. A hospital's emergency department may be the best place to go.

Seek emergency medical help if you think you have a foreign object in your rectum and you have abdominal pain, bleeding, or fever.

Most doctors will take a careful history. They will do this in a nonjudgmental way, but out of necessity will have to ask some very personal questions.

Doctors will particularly want to know these details:

• Exactly what the object is (or could be in the case of children or psychiatric patients who cannot give a history)
• How long it has been there
• What attempts may have been made already to try to remove it

The doctor will also want to know about abdominal pain, fever, and whether there has been any evidence of rectal bleeding.

An examination will follow. This will include a careful examination of the abdomen and a rectal examination.

• The doctor will position the patient on his or her side, and examine the anal region for evidence of tears or cuts, or bruising.
• A digital rectal examination will be performed. The doctor will use a gloved finger.
• Sometimes the doctor will use an object called a proctoscope, which is passed into the anus. This instrument is a short, hollow tube that allows the doctor to look inside and actually see the object. Obviously, if the object is very fragile for example, a light bulb, the proctoscope will be performed with a great deal of care, if it is done at all.
• Following the examination, the doctor may perform an X-ray or CT scan of the abdomen to see exactly where the foreign body is located. The doctor will also be looking to make sure that there is no "free air" in the abdomen. This is found if there has been a perforation of the bowel. If the patient has abdominal pain, bleeding, or fever, then an IV line would be started and the patient would have some blood tests drawn.

As a general rule, most people who have a foreign object in their rectum that cannot be seen or felt outside the anus need to seek medical attention. Many people, probably through embarrassment or fear of ridicule, will attempt to remove the item themselves. This is often very difficult and can only be accomplished by a doctor.

Most laxatives are too slow in onset to be effective. If a rectal foreign body is present, the sooner it is removed the better.

In some cases, the foreign object is close enough to the anus that it can be removed in the emergency department. There are a variety of ways for health care professionals to accomplish this. One of the big problems with trying to remove rectal foreign bodies is that there is a strong degree of suction between the object and the walls of the rectum.

• Sometimes a tube is passed between the object and the wall of the rectum to try to equalize the pressure as the object is removed. This is uncomfortable, and the patient will be sedated for the procedure.
• If the object is far into the rectum, it may be necessary for the patient to undergo surgery in order to have a general anesthetic to enable the object to be removed.
• If the patient has evidence of infection in the abdomen, a hole in the bowel, or heavy bleeding from the anus, they may need emergency surgery. In this case, the patient would be admitted to the hospital.

In all cases, after the foreign body has been removed, the doctor will perform an examination called a flexible sigmoidoscopy. The doctor uses a long, narrow tube (about 16-18 inches long and a little less than an inch wide) to look inside the anus and rectum. This is done in order to be sure that there has not been any damage to the lining of the bowel, either from the initial insertion of the foreign body or from attempts - both by the person at home and at the hospital - to remove the item.

• In the case of children, an examination should nearly always be performed under anesthesia. This is also true for uncooperative psychiatric patients.
• People who are victims of sexual assault should have very careful examinations performed, to be absolutely sure that there has been no injury to the wall of the bowel. Depending upon the patient, this may be best done under general anesthesia.

• The vast majority of people with a foreign object in their rectum will have more injury to their pride than anything else and will suffer no long-term complications or problems.
• A small number of people will have significant injuries. This is seen particularly in cases where the diagnosis is difficult - in the very young and psychiatric patients - or where the person has delayed seeking treatment.
• Complications may also be present when a violent sexual assault has occurred. These people may develop significant and severe abdominal injury and infection. As a result, they may require a colostomy (where the bowel is brought up to the skin surface and the stool is passed into a bag). Or they may require a long stay in the hospital and antibiotics.
• In very rare cases, the injury may be so severe that the person dies of the complications
• If individuals engage in erotic play, use a vibrator or erotic toy designed for the purpose of insertion into the rectum. These items usually come with a flange to prevent them from slipping into the anus.

Return to the doctor's office or emergency department if the patient develop these complications:

• Abdominal pain
• Fever
• Rectal bleeding

There should be no limitations on general activity, unless the patient was sedated in order to remove the object. If so, the patient should not drive or make critical decisions for 24 hours afterward. Further rectal insertions should be avoided for a few days to allow bruising and swelling to resolve.