Modern medicine quite properly abandoned the idea that patients must be morally deserving before we treat them.
You do not have to prove that you made a sensible decision before an anaesthetist will put you to sleep, a surgeon will operate on you, or an Operating Department Practitioner will prepare the equipment required to retrieve whatever unfortunate object has disappeared somewhere it was never designed to go.
That is a good thing.
But somewhere between bodily autonomy, sexual liberation, human rights and the increasingly fashionable idea that every personal choice must be validated, we appear to have lost the ability to say something very simple:
You are free to do remarkably stupid things to yourself.
That does not make them sensible.
Rectal foreign bodies are perhaps the purest possible test of that proposition.
They are simultaneously a surgical problem, an ethical question, a study in personal responsibility and, occasionally, an extraordinary insight into the human capacity to look at a bad idea and think:
“What happens if I push it a little further?”
Not a New Problem
People have been inserting foreign objects into the rectum for centuries.
Medical literature contains accounts dating back to the sixteenth century, and a major review published in 1986 identified 182 previously reported cases.
That figure is often used to demonstrate that the phenomenon is not new.
Strictly speaking, that is correct.
But the modern numbers are nevertheless extraordinary.
In England alone, around 3,500 rectal foreign-body removals were recorded between 2010 and 2019.
A later UK analysis reported almost 5,000 removals over roughly a decade.
American surveillance studies have estimated tens of thousands of emergency-department presentations over a similar period.
So while it would be wrong to claim that nobody did this fifty or one hundred years ago, it is equally difficult to pretend that modern healthcare is encountering the problem on anything resembling the historical scale suggested by the published literature.
There is an important caveat.
The 182 historical cases were cases appearing in medical publications.
Modern figures come from hospital coding systems and national surveillance databases.
A bottle removed from someone’s rectum in 1947 did not automatically become an internationally searchable statistic.
Many cases would simply never have been published.
But that still does not explain everything.
Modern studies have themselves demonstrated increasing incidence over relatively short periods where the method of recording remained broadly similar.
So something has changed.
The interesting question is what.
Perhaps People Are Simply More Willing to Turn Up
One obvious explanation is that society has become considerably less judgmental about unusual sexual behaviour.
Historically, someone with a retained rectal foreign body might have attempted repeated self-extraction, delayed attending hospital, invented an improbable explanation or simply stayed at home.
Modern surgical literature still describes embarrassment, delayed presentation and misleading histories.
But attitudes towards anal sex, homosexuality, sex toys and unconventional sexual practices have changed enormously over the last half-century.
In many respects that change has been positive.
Nobody should die from bowel perforation because they are too frightened or ashamed to seek medical attention.
Nobody presenting with rectal bleeding, abdominal pain or sepsis should be humiliated by the people responsible for treating them.
But reduced stigma inevitably alters presentation behaviour.
If people know that healthcare professionals will treat them confidentially and without moral condemnation, they are more likely to seek help.
It is entirely plausible that modern medicine is therefore seeing cases which, generations ago, would have remained hidden.
Some patients in earlier eras may even have died at home from perforation, peritonitis, haemorrhage or sepsis without the underlying cause ever becoming part of the medical literature.
That possibility cannot be quantified.
But it should not be ignored.
Has the Behaviour Changed Too?
Possibly.
Sex toys are easier to obtain.
Pornography is ubiquitous.
The internet exposes people to sexual practices previous generations might never have encountered.
Devices designed specifically for anal use are readily available.
Ironically, despite the existence of purpose-designed equipment, hospital series continue to contain remarkable numbers of ordinary household objects.
And this is where the subject becomes particularly interesting.
Because the problem is not simply that people are putting things into their rectums.
It is what they are choosing to put there.
What Actually Gets Stuck?
Across published case series, sex toys and smooth cylindrical household objects dominate.
Modern studies repeatedly identify:
dildos,
vibrators,
butt plugs,
glass bottles,
wine bottles,
beer bottles,
plastic bottles,
jars,
aerosol cans,
deodorant containers,
candles,
torches,
pens,
brushes,
fruit,
vegetables,
and various improvised household objects.
One European hospital series found that around 41 percent of retained objects were specifically sex toys such as dildos and butt plugs.
The remainder consisted mainly of cans, bottles, candles and food.
Other published series have found bottles and drinking glasses to be among the most common non-sex-toy objects.
One American national surveillance study identified more than one hundred different products.
Massage devices and vibrators formed the largest individually identifiable group.
The sheer variety, however, is remarkable.
The Hospital Inventory From Hell
One published series of only fifteen patients included:
four body-spray cans,
four bottles,
two dildos,
an aubergine,
a brush,
a tea glass,
a ballpoint pen,
and a wishbone.
Another series contained:
six dildos,
three vibrators,
two bottles,
a drinking glass,
a deodorant container,
an apple,
a thermometer,
broken glass,
and razor blades.
A British series documented:
sex toys,
roll-on deodorant bottles,
a wine glass,
a hand torch,
a cream tube,
a plastic bottle,
a perfume bottle,
a pepper grinder,
a glass candle holder,
an air-freshener canister,
a bathroom-sealant applicator,
a deodorant can,
a bingo marker,
a tennis ball,
an electric toothbrush,
a bottle cap,
an apple,
a cucumber,
and concealed drugs.
The pepper grinder deserves particular recognition.
Human civilisation has produced purpose-designed anal toys with wide bases specifically to prevent proximal migration.
And somebody still selected the pepper grinder.
The Truly Extraordinary
The medical literature then moves beyond merely unusual and enters territory where one begins to question the limits of human creativity.
Published reports include:
a dumbbell,
bidet components,
axe handles,
broom handles,
light bulbs,
fluorescent tubes,
Christmas decorations,
mobile phones,
tennis balls,
razor blades,
broken glass,
and various pieces of sporting and household equipment.
Mobile phones are not even unique.
I have personally been involved in a case involving an escorted prisoner with a retained mobile telephone.
There are many possible motivations for rectal insertion beyond sexual stimulation, including concealment of contraband, psychiatric illness, assault and attempts to transport drugs.
But sexual experimentation remains one of the dominant reasons reported in the literature.
My Own Collection
Having spent many years working in operating theatres, I have encountered a few additions of my own.
There was what the patient referred to as a:
“Black Mamba.”
This turned out to be a large black dildo approximately the size of my forearm and hand.
It had migrated sufficiently far proximally to be located around the descending colon.
Having required hospital treatment for its recovery, the patient then asked whether they could have it back.
There have been cocktail-stick-style swizzle sticks.
There have been numerous beer and wine bottles.
There has been the previously mentioned mobile phone.
And then there were the eggs.
Three hard-boiled eggs.
Still in their shells.
The medical question is straightforward.
How do you remove them without causing injury?
The philosophical question is considerably more interesting.
Once the first egg became stuck, what new information entered the decision-making process that made inserting eggs two and three appear likely to improve the situation?
One failed experiment might reasonably be described as misfortune.
Repeating it twice begins to look like methodology.
Food Appears Surprisingly Often
Food deserves its own category.
Published reports include:
cucumbers,
aubergines,
carrots,
apples,
squash,
pumpkins,
and other fruits and vegetables.
It is not difficult to understand mechanically why some of these objects are selected.
They may be smooth.
They may be elongated.
They may be relatively rigid.
They are readily available.
Unfortunately, those properties also make them capable of moving proximally once inserted.
The human rectum is not a storage compartment.
Nor is it particularly interested in returning your property simply because you have changed your mind.
Why Some Objects Get Lost
There is a surprisingly consistent mechanical pattern amongst retained objects.
They tend to be:
smooth,
cylindrical or elongated,
rigid,
easy to insert,
and lacking any kind of retrieval flange.
That last point matters.
Purpose-designed anal toys normally have a base significantly wider than the shaft.
There is a reason for this.
Once an object passes through the anal sphincter and moves into the rectal ampulla, the combination of anatomy, muscular contraction, lubrication, shape and repeated attempts at manipulation may push it increasingly proximally.
Smooth objects become difficult to grip.
Large objects can become impacted.
Hollow objects can produce suction effects.
Sharp objects can tear the bowel.
And glass can break.
At which point a situation that began as sexual experimentation can become a genuine surgical emergency.
Glass Is Where the Joke Stops
Beer bottles, wine bottles, drinking glasses and other glass objects appear repeatedly in published series.
They are particularly concerning.
Attempts at self-removal may cause breakage.
Broken glass can cause rectal laceration, haemorrhage, perforation and contamination of the peritoneal cavity.
The patient may ultimately require laparotomy, bowel repair, resection or formation of a stoma.
Some may develop peritonitis or sepsis.
At that point there is very little humorous about the situation.
That distinction matters.
The behaviour may be ridiculous.
The medical consequences are not.
Human Rights Do Not Repeal Anatomy
An adult with capacity has a very broad right to determine what happens to their own body.
That principle is fundamental to modern healthcare.
People smoke.
They drink alcohol.
They climb mountains.
They ride motorcycles.
They engage in extreme sports.
They refuse medical treatment.
They take risks which clinicians may regard as unwise.
They are entitled to do so.
But autonomy is frequently misunderstood.
A right to make a decision is not the same thing as a declaration that the decision is sensible.
Nor does respecting someone’s dignity require healthcare professionals to pretend that every behaviour is equally rational.
If someone smokes heavily, we explain the risk of cancer and cardiovascular disease.
If someone drinks excessively, we discuss liver disease.
If someone ascends rapidly to altitude, we explain HACE and HAPE.
And if somebody plans to put an object into their rectum, there is equally straightforward medical advice:
Use something designed for the purpose.
Use something with a wide flared base.
Avoid glass.
Avoid sharp objects.
Avoid improvised household objects.
Stop if there is pain or bleeding.
And if something becomes retained, seek medical help rather than spending six hours converting a straightforward extraction into a bowel perforation.
That is not sexual judgment.
It is harm reduction.
Duty of Care
Once the patient arrives at hospital, the professional responsibility is clear.
Assess them.
Find out what was inserted.
Determine how long it has been there.
Establish whether attempts have already been made to remove it.
Look for perforation.
Provide analgesia.
Arrange imaging when appropriate.
Attempt safe removal.
Escalate to theatre when necessary.
Protect the bowel.
Prevent sepsis.
Preserve dignity.
Document what actually happened.
And discharge the patient with appropriate advice.
The duty of care exists regardless of how the injury occurred.
A person does not cease to deserve competent healthcare simply because their decision-making was spectacularly poor.
That is one of the strengths of modern medicine.
But compassion should not require intellectual dishonesty.
Three statements can coexist perfectly comfortably:
You had the right to do it.
We have a professional duty to treat you.
It was still an astonishingly stupid thing to do.
Has Tolerance Become Validation?
This is where the wider social argument becomes more interesting.
Western society has rightly become more tolerant of consensual adult sexual behaviour.
The removal of shame surrounding homosexuality and many aspects of sexuality was a genuine social advance.
People should not be frightened to speak honestly to healthcare professionals.
But tolerance and validation are not synonyms.
Neither are autonomy and wisdom.
There is an enormous difference between saying:
“You should not be ashamed to seek help.”
and saying:
“Your original decision cannot be criticised.”
Modern discourse sometimes appears uncomfortable making that distinction.
Personal autonomy has gradually become intertwined with a language of rights in which criticism of behaviour itself can be interpreted as criticism of the person.
Medicine cannot operate like that.
If an action carries predictable physical risk, clinicians must be able to say so.
The rectum has no political opinions.
The sigmoid colon has no interest in identity.
A perforation does not care whether the behaviour that caused it was socially accepted.
Anatomy remains stubbornly intolerant of ideology.
The NHS and Personal Responsibility
There is also a resource question.
A complicated rectal foreign-body case may involve:
emergency-department staff,
radiographers,
surgeons,
anaesthetists,
Operating Department Practitioners,
scrub practitioners,
recovery staff,
ward staff,
theatre time,
hospital beds,
antibiotics,
and occasionally critical care.
If laparotomy becomes necessary, the resource implications increase considerably.
None of that means the patient should be denied treatment.
The NHS treats disease and injury caused by personal behaviour every day.
Smokers get cancer treatment.
Drinkers get treated for liver disease.
Motorcyclists receive trauma care.
Mountaineers are rescued.
People make mistakes.
Universal healthcare cannot reasonably operate as a moral rewards system.
But there is an important difference between providing treatment without judgment and pretending individual choices carry no wider consequences.
An emergency theatre dealing with an avoidable injury is still an emergency theatre that cannot simultaneously deal with somebody else.
Resources are finite.
Human rights do not make them infinite.
The Historical Question
And this brings us back to those historical numbers.
A major review in 1986 was able to identify 182 previously published cases stretching back through centuries of medical literature.
Modern Britain can record thousands in a decade.
Modern American surveillance systems can estimate tens of thousands.
It would be scientifically dishonest to claim that the difference represents a direct multiplication of underlying behaviour.
Recording has improved enormously.
Emergency medicine has improved.
Anaesthesia is safer.
Surgery is safer.
Antibiotics exist.
Imaging exists.
People are less ashamed to present.
Some cases which previously might have ended in silence, sepsis and death are now successfully treated.
That is progress.
But modern datasets also suggest genuine increases in presentations within recent decades.
It is therefore entirely reasonable to ask whether we are seeing a combination of:
greater experimentation,
greater availability of sexual devices,
greater cultural exposure to unusual sexual practices,
reduced stigma,
greater willingness to seek treatment,
and perhaps a broader cultural expectation that modern healthcare will rescue us from almost any consequence of our personal choices.
That last proposition is harder to measure.
But it is worth discussing.
Rights and Responsibility
The right to bodily autonomy is enormously important.
So is the right to receive compassionate medical care.
But neither requires us to abandon the concept of personal responsibility.
Freedom includes the freedom to make terrible decisions.
Healthcare exists partly because human beings have always made terrible decisions.
The ethical challenge is not deciding whether those people deserve treatment.
They do.
The more interesting question is whether modern society can still simultaneously say:
“You have the right to make that decision.”
and:
“That was an extraordinarily poor decision.”
Because perhaps the lesson of the rectal foreign body is not really about sex.
It is about the increasingly complicated relationship between freedom, consequences and responsibility.
At what point does personal autonomy cease to be an argument and simply become the explanation for why the colorectal surgeon has been called?
Patients deserve dignity.
They deserve confidentiality.
They deserve competent treatment.
They deserve not to be humiliated while frightened or in pain.
But they do not require clinicians to suspend common sense.
Perhaps that is the distinction modern healthcare sometimes struggles to articulate.
Human rights protect your freedom to make choices about your own body.
Medicine protects you when those choices go badly wrong.
Personal responsibility lies somewhere between the two.
Because ultimately you may have the right to stick something up your arse.
But anatomy retains an absolute veto on whether you are getting it back out again.
And if egg number one becomes stuck, there remains very little medical evidence supporting the insertion of eggs two and three.
