How common are emergency room visits for rectal foreign bodies and what causes most of them?
Executive summary
Emergency department visits for retained rectal foreign bodies are rare in the context of all ED care — the NEISS review found an incidence of 0.0013% across 2012–2021 — but on a national scale they amount to thousands of visits: researchers estimated 38,948 ED presentations among adults from 2012–2021, and rates rose over that decade [1] [2] [3]. The predominant causes are intentional anal insertion for sexual gratification (autoeroticism) with smaller but important contributions from concealment/body‑packing, assault, accidental ingestion, and an increasing share of iatrogenic device migrations [4] [5] [6].
1. How common: tiny proportion, meaningful absolute numbers
Counting every ED visit, retained rectal foreign bodies are an uncommon diagnosis — the NEISS analysis identified 1,806 qualifying visits in the database and calculated an incidence of 0.0013% of ED encounters from 2012–2021 [1] — yet epidemiologic weighting and other methods produce a different lens: a national estimate based on 885 reviewed cases produced an estimated 38,948 adult ED visits for rectal foreign bodies over the same period, meaning roughly several thousand U.S. adults annually presented with this problem [2] [3].
2. Trends: the numbers appear to be increasing
Multiple datasets and reviews report an upward trend in presentations over the last decade, with NEISS counts rising year‑to‑year and national estimates documenting increases for both sexes from 2012 to 2021, a signal that either behavior, reporting, or health‑care seeking is changing [1] [2] [3] [5].
3. Who shows up in the ED: demographic patterns
The clinical literature consistently describes a predominance of adult males in reported series and national data, with symptomatic cases “most commonly in young adult males” in reviews and cohorts, though both males and females present and population‑level studies show presentations among all adults ≥15 years [6] [4] [2] [3].
4. What causes most cases: sexual insertion leads, but it’s not the only reason
Autoerotic insertion for sexual gratification is cited across sources as the single most common motivation for retained rectal objects; other documented causes include deliberate concealment or “body‑packing” of drugs, sexual assault or nonconsensual placement, accidental impaction of swallowed items that traversed the gut, and iatrogenic migration of medical devices such as capsule endoscopes or feeding tubes, the latter noted as an increasing contributor in clinical reviews [4] [5] [6] [7].
5. Clinical course and care: most are retrieved in ED but some require surgery
Most retained objects can be removed transanally in the ED or under anesthesia, yet a minority require operative intervention: studies describe bedside manual or endoscopic extraction as common, but note that some patients need exam under anesthesia, endoscopic retrieval, or laparotomy for complications such as migration, obstruction, severe bleeding, or perforation [8] [1] [5].
6. Why delays and underreporting matter
Embarrassment and stigma often delay care-seeking and blunt accurate histories, which increases complication risk; multiple reviews emphasize that many patients attempt home removal before presenting and may be initially vague or misleading about the mechanism, a factor that complicates surveillance and may cause official counts to underestimate true incidence [9] [8] [10].
7. Conflicting claims and limitations in the reporting
Not all sources align: one online EM primer asserts that retained rectal objects account for “approximately 5–10% of all ED visits,” a figure orders of magnitude higher than national database estimates and inconsistent with NEISS‑derived incidence — this discrepancy highlights variation in methodology, possible miscitation, and the limits of single‑site series versus weighted national data; the large studies themselves rely on coding searches and narrative review and therefore have known surveillance limitations [11] [1] [2] [3].
Conclusion: direct answer
Emergency department visits for rectal foreign bodies are uncommon as a fraction of all ED care (about 0.0013% in NEISS data) but translate to thousands of presentations nationwide over a decade (an estimated 38,948 adult visits from 2012–2021), with most cases resulting from intentional anal insertion for sexual gratification and meaningful contributions from body‑packing, assault, accidental ingestion, and iatrogenic device migration; most objects can be removed without laparotomy, but delays and stigma increase the risk of complications and hospitalization [1] [2] [3] [4] [5] [6] [8].