Bottoms up! An overview of rectal foreign bodies

In a previous blog I looked at the practice of urethral manipulation where men insert objects into their urethra for sexual stimulation. Another similar sexual practice is the insertion of ‘foreign bodies’ into the rectal passage. Most of what is known academically and clinically is from people (almost always male) who turn up to hospital emergency department requiring treatment (i.e., removal of the foreign object that has become trapped inside their rectum). A 2010 review by Dr. Joel Goldberg and Dr. Scott Steele in the Surgical Clinics of North America noted that “retained rectal foreign bodies have been reported in patients of all ages, genders, and ethnicities, more than two-thirds of patients with rectal bodies are men in their 30s and 40s”.

There are dozens and dozens of papers on the topic of rectal foreign bodies and the list of objects and items that have been removed by doctors is almost as long as the number of papers and includes (but not restricted to): vegetables (e.g., potatoes, cucumbers, carrots, turnips, onions), fruit (e.g., bananas, apples), other foodstuffs (e.g., salami, hard boiled eggs), food and drink containers (e.g., glass bottles, plastic bottles, peanut butter jars, glass tumblers), sporting items (e.g., baseballs, tennis balls), household and kitchen objects (e.g., candles, light bulbs, broomstick handle, spatulas, mortar pestle), sex toys (e.g., vibrators, dildos), and improvised objects (e.g., a sand-filled bicycle inner tubing, plastic fist and forearm, shoehorn, axe handles, aluminium money tube, whip handles, soldering irons, glass tubes, frozen pigs tail). Some of these can become very dangerous (e.g., light bulbs that break with broken glass bits causing perforation of the rectum and/or colon), and in one case reported in the American Journal of Surgery led to peritonitis. Despite the many published case studies, there are no estimates of the incidence of rectal foreign body insertion among the population as almost all that is known is only based on the people that end up seeking medical intervention.

Many of the people seeking treatment are gay men although some of the literature features females who have been rectally assaulted. Object removal by the medical team can sometimes be difficult. For instance, one case in the American Journal of Proctology described an instance where a light bulb was lodged in the rectal cavity and the medical team had to improvise to remove the foreign body. They had to attach a light bulb socket to the end of a stick, insert the ‘homemade’ devise into the patient’s rectum, screw the socket onto the lodged light bulb, and then pull it out the same way as it went in. In the same paper, the authors described how they removed a glass tumbler from one man. Here, they managed to pour molten plaster into the tumbler along with some rope placed into the molten plaster. When the plaster has set and stuck to the inside of the glass, they pulled the tumbler out using the rope that had set in the hardened plaster.

There are also cases in the literature where the foreign body has remained inside the rectal cavity for long periods. For instance, one case published in the Medical Journal of Australia reported that a man had a vibrator removed after six months of it being inside him. The published papers also report the many alleged non-sexual reasons as to how such objects came to be lodged in the rectum. Common ones include accidentally falling on the specified object or item after showers or baths, and deliberate insertion of the object or item to dislodge constipated fecal mass. Some stories are a little more elaborate such as one published in the Southern Medical Journal where the man who said he had slipped on a glass jar while washing his dog in the shower. In the same paper, another man who was found to have a vibrator stuck in his rectum claimed to have been abducted and sexually assaulted by a group of men rather than admit that the incident was self-inflicted.

One of the most bizarre cases was reported in a 2004 issue of the journal Surgery. Here the authors described what they believed was the very first case of something living lodged in the rectal passage. After reporting abdominal pain, and being diagnosed with peritonitis, an X-ray revealed that the 50-year-old man had a 50cm long eel stuck inside his abdomen (claiming he had inserted it to relieve his constipation. The authors even provided all the photographic evidence in their paper. It is also worth mentioning at this point that a paper on anorectal trauma in a 1989 issue of the American Journal of Forensic Medicine and Pathology by Dr. W.G. Eckert and Dr. S. Katchis. They commented on what has now come to be called felching (and which I covered in a previous blog). More specifically they said: “A sexual practice has been mentioned recently where living rodents, including gerbils and mice, have been inserted into the rectum; the animal’s futile efforts to claw its way to safety result in mucosal tears in the rectum”. However, as I noted in my previous blog, no actual cases have ever been reported in the medical literature.

In a previous blog I wrote on klismaphilia (a sexual paraphilia in which individuals derive sexual arousal and pleasure from the receiving of enemas), I reported a case by Dr Peter Stephens and Dr Mark Taff in the American Journal of American Pathology. They wrote about a young man who turned up at the hospital complaining of rectal pain. After an examination by the doctor, it became apparent that there was a stony hard mass lodged in the man’s rectum. Upon further questioning, the patient revealed that four hours earlier, he and his boyfriend had been “fooling around” and that after stirring a batch of concrete mix, the patient had laid on his back with his feet against the wall at a 45 degree angle while his boyfriend poured the mixture through a funnel into his rectum. The concrete had set and had to be removed by the medical team. On removal, a ping-pong ball was also found. The reason a ping-pong ball was also found in the rectum was because klismaphiliacs use the ball as a plug to promote retention and increase stimulation. The use of such a device suggests the person was an experienced klismaphiliac. As Dr Anil Hernandas and colleagues conclude “as the exploration of anal eroticism increases in popularity, more and more cases of complications as a direct result of their abuse are likely to be encountered”.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Benjamin, H.B., Klamecki, B. & Haft, J.S. (1969). Removal of exotic foreign objects from the abdominal orifices. American Journal of Proctology, 20, 413-417.

Buzzard, A.J. & Waxman, B.P. (1979). A long standing, much travelled rectal foreign body. Medical Journal of Australia, 1, 600.

Byard, R.W., Eitzen, D.A. & James, R. (2000). Unusual fatal mechanisms in nonasphyxial autoerotic death. American Journal of Forensic and Medical Pathology, 21, 65-68.

Eckert, W.G, & Katchis, S. (1989). Anorectal trauma: Medicolegal and forensic aspects. American Journal of Forensic Medicine and Pathology, 10, 3-9.

Goldberg, J.E. & Steele, S.R. (2010). Rectal foreign bodies. Surgical Clinics of North America, 90, 173–184.

Graves, R.W. & Allison, E.J, Bass, R.R., et al. (1983). Anal eroticism: Two unusual rectal foreign bodies and their removal. Southern Medical Journal, 76, 677-678.

Hemandas, A.H., Muller, G.W. & Ahmed, I. (2005). Rectal Impaction With Epoxy Resin: A Case Report. Journal of Gastrointestinal Surgery, 9, 747–749

Lo, S.F., Wong, S.H. & Leung, L.S., et al. (2004). Traumatic rectal perforation by an eel. Surgery, 135, 110-111.

Memon, J.M., Memon, N.A., Solangi, R.A., & Khatri, M.K. (2008). Rectal foreign bodies. Gomal Journal of Medical Sciences, 6(1), 1-3.

Schaupp, W.C. (1981). Commentary. American Journal of Surgery, 142, 85-88.

Stephens, P. & Taff, M. (1987). Rectal impaction following enema with a concrete mix. American Journal of Forensic Medicine and Pathology, 8, 179–182.