Rectal Pain

Rectal fissures can occur in anyone, resulting in sharp, cutting, burning pain, especially with bowel movements.

Ulcerative Colitis (UC) can cause pain in the rectum via inflammation, whereas a complication of Crohn Disease involves overt perianal abscesses due to fistula and subsequent infection.

Obstruction

Rectal foreign body obstructions can originate from the upper GI tract due to ingested foreign bodies (e.g., fish or chicken bones) or gallstones that have passed successfully into the duodenum.

Fecaliths, stone-like hardened feces, are not technically foreign bodies, but they are indistinguishable from foreign bodies in the pain and obstruction they can cause.

The inability to have a bowel movement may be due to obstruction or a desperate fear of the pain it will cause. Taking opioids for the pain can worsen the problem due to constipation.

In fact, the obstruction can occur from the fecal impaction of severe constipation in opioid abusers.

Rectal foreign bodies due to intentional sexual misadventures can usually be determined by a history.

Typically, the patient is unusually forthright and truthful when it comes to this type of an emergency, because not only is it insufferably painful, but no one bargains for this type of disaster when being experimental. (Lessons learned!)

Rectal Abscess

Rectal abscesses are abscesses adjacent to the anus, arising from an infection at one of the anal sinuses or from infected fissures or hemorrhoids. Penetration of the wall of the rectum from a foreign body or infection due to fistulas from Crohn's disease can result in abscesses. They can cause bloody stool or even rectal bleeding.

Hemorrhoids

Hemorrhoids are varicose veins around the anus. Straining increases the pressure against which these draining veins must overcome to prevent swelling, infection, and bleeding. As such, constipation with straining and occupying the toilet-seat in prolonged sittings, in which the central hole does not support the central buttocks (anal/rectal region), creates or worsens hemorrhoidal problems. They can rupture and bleed, usually seen as bright red bloody streaks on the stool.

Infected hemorrhoids can cause bleeding and a clinical picture indistinguishable from foreign bodies or abscesses without internal investigation, which should await transport to the appropriate facility.

Management

Management of foreign body complications in the rectum should be the same as any obstruction in the GI tract, focusing on

• strict attention to BSI and PPE,
• ABC (airway, breathing, and circulatory support),
• IV fluid replacement,
• medication administration, as well as
• transport to definitive care and pain management.