In the world of portals into our bodies, the anus would seem to have fascinated and entertained us since we first slithered from the primaeval swamp and thought…
“Gosh.. that hole has got to be more useful than merely pooping…what can I stick up it?”
And as they say “the rest is history”… Talking of which, the first recorded rectal foreign bodies go back to the 16th Century. It is inconceivable that the practice..and practice makes perfect..hasn’t been commonplace wherever humans have walked on the planet.
Why do we, and I use we in its wider sense, do it...?
Firstly, I guess it is because we can! Sexual gratification as a giver or receiver using an erect penis is a given sexual practice, as indeed is the historic use of phalluses and dildos. The oldest known dildo dates back at least 28,000 years. I love a pun, and it was found in the Hohle Fels Cave (Germany) in 2005…you couldn’t make it up.
We have to remember that consensual practice is generally the norm, but we must remember, and from a medical perspective always consider, that it may not be. Anal rape, sexual assault, and physical abuse are not uncommon, and awareness and reporting are essential parts of medical practice. Sometimes it can be part of a mental health issue, sometimes as part of a psychotic illness where thought disorders or hallucinations can drive an atypical insertion. It’s called Polyembolokoilamania…easy for me to write, but not to say.
Criminal activity, voluntary or coerced, is not uncommon with drug or other ‘mules,’ as they are known, inserting objects to be smuggled such as drugs in condoms, balloons, or clingfilm packages.
Historically, there have been some horrific torture implements involving insertions. Imagine being lowered onto a spike slowly and with occasional ‘jolts’…doesn’t bear thinking about. I’d be confessing shortly after saying “You’re going to do WHAT?” That’s mediaeval, but there is a reported history of a thing called ‘rectal feeding’ where foodstuffs and other ‘stuffs’ are inserted to extract confessions…and that’s modern-day…google it!
Apparently, the Greeks used radishes as a punishment for adultery in the 4th-5th century BC. That’s Rhaphanidosis…I’m not sure if it was simply painful, caused irritation like a chilli pepper, or as an obstruction, thus causing pain... there's some research.
One also has to consider a variety of other causes such as self-medication. There is an example of someone using a corn cob to relieve ano-rectal itching but going too far…literally, and needing a medical ‘harvest’ delivery of said object. Hence much thanksgiving! With due irreverence but always considering the potential (and actual) harm one can inflict, we reflect in this podcast on some of the more ‘interesting’ inserted and invariably stuck items, what are the potential risks and how can they be removed safely.
So what nuggets can we share? Here are some facts:
The incidence of presentation in emergency rooms is rising, mainly in urban populations. Whatever happened to singing around the piano?
The average age of presentation is 44.
Mostly men and 42% are glass bottles…not necessarily beer..although beer may be involved!
There are loads of other objects. The old medical joke is of someone presenting with a vibrator stuck and asking if, instead of removal, could the batteries be changed!
Odd things include toy cars, light bulbs, chair legs, screwdrivers, and firecrackers…unlit. In the podcast, Prof Sackier tells the tale of a hand grenade, live and with a pin removed being inserted - brave surgeon removing that one! The bomb (bum) squad had to be part of removing a WW2 shell from one guy….poor chap ‘fell on it’ apparently.
What are the dangers? There is the immediate danger of stretching and tearing of muscle and mucosa (internal lining) and repeated stretching causing incontinence.
The obvious dangers from glass or sharp objects are tears, perforations, and bleeding.
Obstruction of the bowel can cause ileus, i.e., blocking the bowel and the problems that arise. Perforation of the bowel can ensue, as indeed can death! Mules carrying drugs can have catastrophic ruptures of condoms with a massive overdose and fatal consequences.
Removal methodologies are legion. If objects can be reached from below, then great. But not uncommonly, open abdominal surgery is required with the inherent risks. Jonathan tells a tale of removing endless condoms in the podcast.
The literature is full of reports of assorted objects but most importantly their removal safely. I am grateful to the Annals of the Royal College of Surgeons for examples and a schoolboy opportunity for humour!
There is considerable ingenuity from filling hollow objects with plaster of paris to prevent fragmentation, using catheters, pushing beyond the obstruction, inflating the balloon and pulling gently, and a variety of forceps, hooks, clamps, and suction caps. Magnets are great for ferrous objects and an attractive option.
The removal of foreign bodies costs the NHS about £350 K.
So what do we conclude…prevention is better than cure, consider the consequences when considering inserting that attractive vase or bottle…safe sexual practices between consenting adults is fine, of course, and we all make occasional mistakes or get carried away! If we are consulted, as indeed we should be if there is a problem, everyone is treated with dignity and respect.
All doctors and health professionals, however, have a duty to protect the vulnerable and abused and will always be aware and alert to that risk.
