Rectal Injury
Damage to the rectum, the last part of the large intestine
Quick Facts
- Type: Gastrointestinal injury
- Common causes: Pelvic trauma, foreign objects, procedures
- Main signs: Rectal bleeding, pain, fever
- Risk: Serious infection if the wall is torn
Overview
The rectum is the final section of the large intestine, just above the anus, where stool is held before a bowel movement. A rectal injury is damage to this part of the bowel. It can range from a minor tear or scrape to a full-thickness hole (perforation) that allows stool and bacteria to leak into the surrounding tissues or abdomen.
Because the rectum sits deep in the pelvis near many other structures, serious rectal injuries often occur with other pelvic trauma. A torn rectum can lead to severe infection, so these injuries are taken seriously and often need urgent treatment. Minor injuries, such as small tears, may heal with simpler care.
Symptoms
Symptoms vary with the severity of the injury and may include:
- Rectal bleeding or blood in the stool
- Pain in the rectum, anus, lower abdomen, or pelvis
- Difficulty or pain with bowel movements
- Passing of gas or stool from an unexpected opening, such as the vagina or a wound
- Fever, chills, and feeling unwell if infection develops
Heavy bleeding, severe abdominal pain, high fever, or signs of shock such as dizziness and a racing heartbeat are emergencies and need immediate care.
Causes
Rectal injuries result from force, objects, or procedures affecting the lower bowel. Common causes include:
- Pelvic trauma: Crashes, falls, and pelvic fractures, especially when bone fragments injure the rectum.
- Penetrating trauma: Stab or gunshot wounds, or impalement injuries.
- Foreign objects: Objects inserted into the rectum.
- Medical procedures: Colonoscopy or other instrument-based procedures can rarely tear the rectum.
- Childbirth and sexual assault: Can cause tears of the rectum and surrounding tissue.
If a rectal injury results from assault, you are not to blame, and medical care along with confidential support is available.
Risk Factors
- Major pelvic trauma or pelvic fracture
- Penetrating abdominal or pelvic injury
- Procedures such as colonoscopy
- Difficult childbirth
- Conditions that weaken the bowel wall
Diagnosis
Doctors diagnose rectal injuries with examination and imaging:
- Physical and rectal exam: Checking for blood, tenderness, and obvious tears.
- Proctoscopy or endoscopy: Looking directly inside the rectum to find the injury.
- CT scan: To assess the extent of injury, air or fluid outside the bowel, and other pelvic damage.
- Blood tests: To check for blood loss and signs of infection.
Determining whether the tear is partial or full-thickness, and whether it is above or below the pelvic floor, guides treatment.
Treatment
Treatment depends on the location and severity of the injury and on other injuries present.
- Minor injuries: Small, superficial tears may heal with rest, wound care, antibiotics, and a temporary change in diet.
- Surgical repair: Full-thickness tears are often repaired surgically.
- Diverting colostomy: In serious injuries, a temporary opening (stoma) may be created so stool bypasses the healing rectum; it is usually reversed later.
- Antibiotics: Used to prevent or treat infection from leaked stool.
- Treating other injuries: Pelvic fractures and bleeding are managed at the same time.
With prompt treatment, many rectal injuries heal well, though serious injuries may require a staged recovery over weeks to months.
Prevention
- Wear seatbelts and protective equipment to reduce pelvic trauma
- Avoid inserting objects into the rectum
- Choose experienced providers for procedures such as colonoscopy
- Seek skilled care during childbirth to reduce severe tears
- Get prompt care for any significant pelvic or rectal injury
When to See a Doctor
Seek emergency care for a rectal injury with:
- Heavy rectal bleeding
- Severe abdominal or pelvic pain
- High fever, chills, or feeling very unwell
- Dizziness, pale skin, or a racing heartbeat, which may signal shock
- Passing gas or stool from the vagina or a wound
Even seemingly minor rectal injuries should be checked, because a hidden tear can lead to serious infection. Get prompt care after any pelvic trauma, foreign-body injury, or unexpected rectal bleeding.
Frequently Asked Questions
What causes a rectal injury?
Causes include pelvic trauma and fractures, penetrating wounds, foreign objects, procedures such as colonoscopy, and difficult childbirth. The severity ranges from a small tear to a full hole in the bowel wall.
Why is a torn rectum dangerous?
A full-thickness tear lets stool and bacteria leak into the tissues or abdomen, which can cause severe infection such as peritonitis. This is why rectal injuries are taken seriously and often need urgent treatment.
How is a rectal injury treated?
Minor tears may heal with rest, antibiotics, and wound care. Larger injuries are often repaired surgically, and serious ones may need a temporary colostomy to divert stool while the rectum heals. Antibiotics help prevent infection.
What is a diverting colostomy?
It is a temporary opening on the abdomen through which stool passes into a bag, bypassing the injured rectum so it can heal. It is usually reversed with a later operation once healing is complete.
When is a rectal injury an emergency?
Heavy bleeding, severe abdominal or pelvic pain, high fever, signs of shock, or passing stool from the vagina or a wound are emergencies. Seek immediate care, and have any rectal injury after trauma evaluated even if it seems minor.
References
- American College of Surgeons. Trauma to the Rectum and Anus.
- Mayo Clinic. Pelvic trauma and bowel injuries.
- MedlinePlus, U.S. National Library of Medicine. Rectal injury.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Bowel and rectal disorders.