Patients may present with isolated rectal trauma or associated injuries like pelvic fractures or penetrating abdominal, buttock or thigh injuries that are potentially life threatening. If severe, these lesions have a 50% mortality rate. Bone fragments may induce rectal wall laceration. While inquiring about the history of the disease, the physician must obtain information about any pain, tenesmus, incontinence and associated genitourinary and abdominal symptoms [1]. In military injuries, type, trajectory, and velocity of the penetrating foreign body must be known in order to understand potential lesions [2].

In selected cases, careful clinical examination (inspection, sphincter tonus assessment) followed by digital evaluation should be performed, although controversy exists regarding the utility of the latter method [3] [4]. However, it can detect gross rectal blood loss and laceration [5] [6]. In sexual assault, the physician should keep in mind that disruption of the rectal wall is likely and document evidence if the patient is stable. Prostate evaluation in men is useful if concomitant lesions of the urethra are suspected. Examination should also assess vital signs according to the Advanced Trauma Life Support protocol defined by the American College of Surgeons. Peritonitis and pelvic fracture signs should be looked for. If a perineal penetration wound is noticed, entry and exit signs should be documented. Women should also undergo vaginal bimanual and speculum examination with focus on the posterior wall.

• Perineal Pain

  Cochrane Database of Systematic Reviews Background Perineal pain from a tear and/or surgical cut (episiotomy) is a common problem following vaginal birth. [cochranelibrary.com]

  Some women chose not to speak with their doctors because they believed that anal incontinence was a normal consequence of childbirth. 6, 12 The scope of life-disrupting morbidities Perineal pain and dyspareunia may persist for years Perineal pain can [mdedge.com]

  Available from: A 38-year-old male presented to emergency department complaining of rectal bleeding accompanied by dull pelvic and perineal pain. [onlinejets.org]

• Weight Gain

  At the moment defecation takes place 2-3 times a day, growth and weight gain are quite normal. [ncbi.nlm.nih.gov]

• Recurrent Pulmonary Embolism

  Two of the 20 patients (10 percent) died, one after a prolonged septic course and one from recurrent pulmonary embolism. Rectal trauma continues to be a challenging injury. [ncbi.nlm.nih.gov]

• Fecal Incontinence

  The management of fecal incontinence is a struggle to maintain patient hygiene and limit the transmission of nosocomial infections. Intrarectal devices that cause diversion and collection of the fecal stream have been used with increasing frequency. [ncbi.nlm.nih.gov]

  The safety and efficacy of the artificial bowel sphincter for fecal incontinence: results from a multicenter cohort study. Dis Colon Rectum 2002; 45 (9) 1139-1153 33 Wexner SD, Baeten C, Bailey R, et al. [thieme-connect.com]

  incontinence NOS, Gallstones, GERD, Germ cell tumor, Hemangioma, Hiatal hernia, Hirschsprung's disease, Hydrocele, Hyperhidrosis NOS, Idiopathic thrombocytopenic purpura, Inguinal hernia, Intestinal obstruction, Irritable bowel syndrome, Neuroblastoma [mayoclinic.org]

  She goes on to discuss the various surgical and non-surgical treatments for fecal incontinence and other complications. Dr. [patientpower.info]

  FECAL INCONTINENCE Fecal incontinence is the inadvertent passage of flatus, liquid or solid stool. [aafp.org]

• Rectal Pain

  Both result in gastrointestinal inflammation and rectal pain. [verywell.com]

  Rectal pain is the symptom of pain in the area of the rectum. [en.wikipedia.org]

  On presentation, the patient complained of peri-anal pruritis but denied rectal pain, hematochezia and dyschezia. [academic.oup.com]

  An unexpected source of acute onset rectal pain One of my patients called our office, and insisted on making an appointment for her 14-year-old daughter for evaluation of a rectal tear. [clinicaladvisor.com]

  They may present with rectal pain, bleeding, abdominal pain, obstipation or even peritonitis (Shah et al, 2002; Cohen and Sackier, 1996; Crass et al, 1981). [nursingtimes.net]

• Tenesmus

  While inquiring about the history of the disease, the physician must obtain information about any pain, tenesmus, incontinence and associated genitourinary and abdominal symptoms. [symptoma.com]

  A common symptom of proctitis is called tenesmus. Tenesmus is a frequent urge to have a bowel movement. Inflammation and irritation of the rectum and rectal lining cause tenesmus. [healthline.com]

  Epidural anesthesia Anesthesia: epidural may be necessary to reduce peristalsis and tenesmus. This can be achieved using lidocaine Lidocaine, but xylazine Xylazine may be preferred as it causes less ataxia and weakness. [vetstream.com]

  Despite tenesmus and the urge to stimulate herself digitally, she was unable to produce stool. The patient reported no recent vomiting, diarrhea, weight loss, or history of rectal instrumentation or trauma. [mdmag.com]

• Blood in Stool

  Blood in stool after car accidents is one of the colon trauma symptoms. Diagnosis of Colon and Rectal Trauma The diagnosis of trauma to the colon and rectum is usually found at the time of surgery. [autoaccident.com]

• Dyschezia

  On presentation, the patient complained of peri-anal pruritis but denied rectal pain, hematochezia and dyschezia. [academic.oup.com]

Clinical evaluation should be followed by blood workup and imaging studies. The complete blood cell count may show acute posthemorrhagic anemia. Rigid or flexible proctoscopy or sigmoidoscopy offer valuable information [7] in penetrating and blunt injuries [8] [9], but they should be performed carefully and gently by an experienced doctor in order to prevent further injury. Despite the fact that they are the gold standard in detecting rectal damage [5], if other imaging methods offer reliable information, they can be excluded from the workup. However, sigmoidoscopy can sometimes fail to identify wounds and may have up to 31% false negative results [10].

Computer tomography can be used in rectal trauma, but if associated bowel injury is suspected, evaluation can prove difficult [11] and oral, intravenous or rectal contrast should be used, if appropriate, in order to increase sensitivity and specificity [12]. Bladder lesions can also be evaluated by this method. Triple-contrast helical computed tomography has higher accuracy if combined with contrast enema [13] [14]. This latter method can also be applied by itself.

Guaiac testing is another complementary diagnosis method. It has acceptable sensitivity (69%), but low specificity (33%) [15].

• Rectal Ulceration

  Injury is most likely to occur because of traumatic removal or rectal ulceration secondary to pressure necrosis. [ncbi.nlm.nih.gov]

  ulcer syndrome, Ulcerative colitis, Umbilical hernia, Wilms' tumor more see full list in profile [mayoclinic.org]

  Karger AG, Basel Introduction Solitary rectal ulcer syndrome (SRUS) is a chronic, benign disorder of defecation. [karger.com]

1. Hellinger M. Anal trauma and foreign bodies. Surg Clin North Am. 2002; 82(6):1253–1260.
2. Burch J, Feliciano D, Mattox K. Colostomy and drainage for civilian rectal injuries: is that all? Ann Surg. 1989;209(5):600-610.
3. Esposito T, Ingraham A, Luchette F, et al. Reasons to omit digital rectal exam in trauma patients: no fingers, no rectum, no useful additional information. J Trauma. 2005;59(6):1314–1319.
4. Porter J, Ursic C. Digital rectal examination for trauma: does every patient need one? Am Surg. 2001;67(5):438–441.
5. Morken J, Kraatz J, Balcos E, et al. Civilian rectal trauma: a changing perspective. Surgery. 1999;126:693-700.
6. Mangiante E, Graham A, Fabian T. Rectal gunshot wounds: management of civilian injuries. Am Surg. 1986;52:37-40.
7. Fry R. Anorectal trauma and foreign bodies. Surg Clin North Am. 1994; 74(6):1491–1505.
8. Ferraro F, Livingston D, Odom J, et al. The role of sigmoidoscopy in the management of gunshot wounds to the buttocks. Am Surg. 1993;59(6):350–352.
9. Ross G, Dodd O, Lipham J, et al. Rectal perforation in unstable pelvic fractures: the use of flexible sigmoidoscopy. Injury. 2001;32(1):67–68.
10. Grasberger RC, Hirsch EF. Rectal trauma: a retrospective analysis and guidelines for therapy. Am J Surg. 1983;145:795-798.
11. Butela S, Federle M, Chang P, et al. Performance of CT in detection of bowel injury. AJR Am J Roentgenol. 2001;176(1):129–135.
12. Anderson S, Soto J. Anorectal trauma: the use of computed tomography scan in diagnosis. Semin Ultrasound CT MR. 2008;29(6):472–482.
13. Rubesin S, Levine M. Radiologic diagnosis of gastrointestinal perforation. Radiol Clin North Am. 2003;41:1095-1115.
14. Shanmuganathan K, Mirvis S, Chiu W. Triple-contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laparotomy. Am J Roentgenol. 2001;177:1247-1256.
15. Levine H, Simon R, Smith T, et al. Guaiac testing in the diagnosis of rectal trauma: what is its value. J Trauma. 1992 Feb; 32 (2):210-212.