Suitable for non-sharp objects that are in the distal rectum
Consider IV sedation and analgesia for larger<unk>  bodies
Perianal block may be useful to help relax anal sphincter
In lithotomy position, suprapubic pressure with DRE and valsalva may deliver object without instrumentation.
May also attempt removal in prone knee-to-chest position with the patient bearing down
Anoscope utilization and direct lighting will often improve visualization of the object if low lying
If obstetric forceps needed, patient should bear down as object is extracted.
Large bulbar objects can create a vacuum-like effect
Break vacuum by passing foley behind object, inject air and pull foley out (balloon up)
Can introduce multiple foley catheters from different angles beyond the object, inflate the balloons, and slowly retract the foleys - using the force to help extract the object.
Break vacuum by passing foley behind object, inject air and pull foley out (balloon up)
Can introduce multiple foley catheters from different angles beyond the object, inflate the balloons, and slowly retract the foleys - using the force to help extract the object.
Consult surgery for OR removal if:
Size, shape, or location of object has potential to injure anal sphincter during removal
Attempts at removal in ED fail
Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)
Size, shape, or location of object has potential to injure anal sphincter during removal
Attempts at removal in ED fail
Risk of ischemia, perforation, or if excess manipulation required (risk of bacteremia)
Consider GI consult for sigmoidoscopy after removal for:
Prolonged retention
Object with sharp corner(s)
Toxic appearing patient
Prolonged retention
Object with sharp corner(s)
Toxic appearing patient
Ingestion of illicit drugs while pursued by law enforcement; usually small quantity
Consider activated charcoal
Consider whole bowel irrigation if develop toxicity
Consider discharge if do not develop toxicity after 4hr obs
Rectal foreign body
Anal fissure
Anal fistula
Anal malignancy
Volvulus 
Anal tags
Volvulus
Anorectal abscess