Rectal Foreign Bodies in Older Men: a Novel Challenge and Humanistic Care for the Society

Abstract Background: In recent years, rectal foreign bodies are a common proctological emergency in the male population, especially in Chinese elderly men that often requires the intervention of the surgeon due to its complications. The aim of this review is to describe the epidemiology and clinical characteristics of rectal foreign bodies in elderly men and its possible challenge to clinicians and society. Methods: A comprehensive literature search was conducted in English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (CNKI, Wan Fang, VIP, Chinese biomedical database) from January 2000 to December 2020. All rectal foreign bodies relevant studies were considered, if they reported the purpose for a foreign body in the rectum and related treatment measures. Contemporaneous rectal foreign bodies cases data from our center were also analyzed. Two authors independently extracted the data and reviewed the quality of the included research. According to the differences in population background, we divided the elderly Chinese male group and the elderly non-Chinese male group, the parameters of the two groups were analyzed by statistical methods.Results: A total of 159 literatures were preliminarily retrieved in initial literature search with rectal foreign body as the search term, including 86 Chinese literatures and 73 English literatures. A total of 582 patients were the elderly male patients, included 276 Chinese patients and 307 non-Chinese patients. In older men, the sources of foreign bodies can be divided into three categories: the ones that are inserted from the anus, the ones that are swallowed and thereafter become stuck in the rectum, the other that are caused by improper medical practices. The most common purpose for a foreign body in the rectum was insertion for erotic purposes. In the foreign body type, the daily articles account for the majority. Sexual articles are mainly found in pleasure seekers. There was no significant difference in foreign body sources, size, type, treatment selection and outcome between the two groups.Conclusions: In older men, there is an increasing number of cases of rectal foreign body emergency visits for erotic purposes and sexual needs. Although the source, size and type of foreign body are different, and patients can get a better recovery after active and appropriate clinical treatment, the sexual needs are social problem we should pay attention to in older men. Treatment of sexual issues is a multidimensional task that should be implemented as a collaborative effort and older people should get more humanistic care in this regard.