In the vast majority of cases, rectal foreign bodies are inserted during erotic activity. The objects are typically dildoes or vibrators, although almost any object can be seen, including light bulbs, candles, shot glasses, and odd or unusually large objects such as soda bottles or beer bottles.

Less commonly, foreign bodies are inserted rectally in an attempt at concealment. Typically, these objects are drug packets; less often, they are weapons, such as knives or guns. Some psychiatric patients will purposefully conceal sharp objects in their rectums in an attempt to injure the examining provider when he or she performs a rectal examination. Finally, more commonly in older patients, rectal foreign bodies used for prostatic massage or to break up fecal impactions may be lost during this activity.

Some rectal foreign bodies are initially swallowed and then transit through the gastrointestinal (GI) tract. Examples of the latter include toothpicks, popcorn, bones, sunflower seeds, [8, 9] and, in more recent years, camera pills used in gastrointestinal studies (see the image below). Rectal foreign bodies can also be the result of assault, including child abuse. The weapon used in the assault is typically a blunt object but may be any object. [10]

The patient swallowed a camera pill that became lodged in the rectum at a prior surgical anastomosis site and had to be removed via sigmoidoscopy. View Media Gallery

Rectal foreign bodies can be classified as high-lying or low-lying, depending on their location relative to the rectosigmoid junction. This distinction is important. Objects that are above the sacral curve and rectosigmoid junction are difficult to visualize and remove, and they are often unreachable with rigid proctosigmoidoscopy. Low-lying rectal foreign bodies, however, are normally palpable on digital examination and are candidates for ED removal.

Frequently, delays in presentation and multiple attempts at self-removal lead to mucosal edema and muscular spasms, which further hinder removal. Rectal lacerations and perforations may occur but are less common than other complications.