A rectal tube is a flexible catheter inserted through the anus into the rectum, and its most common modern role is managing fecal incontinence in critically ill hospital patients. Beyond that primary use, rectal tubes serve in bowel decompression, medication delivery, diagnostic imaging, and pediatric bowel care. The devices come in several designs and go by different names depending on the clinical context, but the underlying concept is the same: a soft tube that channels stool, gas, fluid, or contrast material into or out of the lower bowel in a controlled way.
Managing Fecal Incontinence in the ICU
The scenario where rectal tubes see the heaviest use today is the intensive care unit. Patients who are sedated, on mechanical ventilation, or receiving certain medications frequently develop diarrhea they cannot control. Left unmanaged, liquid stool pools against the skin around the buttocks and perineum, creating a cascade of problems: skin breakdown, wound contamination, and an enormous burden on nursing staff who must clean and reposition the patient repeatedly. Fecal management systems, as these devices are formally called, divert stool through a tube and into a sealed collection bag, keeping the patient’s skin dry and the bedding clean.
A retrospective review of 50 patients who received fecal management systems found that diarrhea was the indication in about six out of ten cases, followed by burn injuries and existing pressure ulcers. Most patients in that review had the device in place for an average of roughly 17 days, though the range stretched from a single day to over two months.1PubMed Central. A retrospective review of outcomes using a fecal management system in acute care patients The devices work well enough that they have become a standard tool in critical care units worldwide, though they are not without complications, a point worth exploring in its own right.
How Rectal Tubes Protect Skin and Prevent Infections
One of the strongest arguments for using a rectal tube in a bedridden patient is what it prevents on the skin surface. Incontinence-associated dermatitis is a painful, reddened breakdown of skin caused by prolonged exposure to stool, and it significantly raises the risk of pressure injuries. A meta-analysis of twelve randomized trials found that fecal collection devices substantially reduced the incidence of this dermatitis across every device subtype tested, whether the design used an external pouch, an internal catheter, or a suction-assisted system.2PubMed. The effectiveness of faecal collection devices in preventing incontinence-associated dermatitis in critically ill patients with faecal incontinence: A systematic review and meta-analysis A separate review of six studies echoed those findings, concluding that intra-anal bowel management devices provide a viable option for reducing both dermatitis and pressure injuries.3PubMed. Do Intra-anal Bowel Management Devices Reduce Incontinence-Associated Dermatitis and/or Pressure Injuries?
The infection-control benefit deserves separate attention. In hospitals, Clostridioides difficile (C. diff) is a persistent and dangerous pathogen that spreads through environmental contamination, particularly via fecal matter on surfaces and hands. An in vitro study comparing stool management systems showed that these devices can limit or prevent environmental contamination with C. diff spores, which is a meaningful advantage in units where outbreaks are a constant threat.4PubMed. Stool management systems for preventing environmental spread of Clostridium difficile: a comparative trial For patients with open wounds, surgical incisions, or burns near the perineum, the ability to keep stool sealed inside a collection system rather than spread across bedding is more than a convenience; it can be the difference between healing and a serious secondary infection.
Decompressing a Twisted or Obstructed Bowel
A completely different use for rectal tubes involves bowel emergencies, particularly a condition called sigmoid volvulus, where a loop of the large intestine twists on itself and traps gas and stool. The trapped contents balloon the bowel, cut off blood supply, and can lead to tissue death if not resolved. Traditionally, a rigid or flexible scope is passed into the rectum to untwist the bowel, followed by placement of a transanal decompression tube that sits in the colon to keep it open while the swelling settles.
A Japanese study of 106 decompression procedures for sigmoid volvulus found that transanal decompression tubes were used in the vast majority of cases, and all insertions were completed without procedural complications. Among patients managed conservatively (without surgery), the tube stayed in place for a median of five days. Recurrence of the volvulus was tied primarily to whether the patient had a previous episode, not to the tube itself.5PubMed Central. Transanal Decompression Tube Placement for Treatment of Sigmoid Volvulus This type of rectal tube is quite different from a fecal management catheter: it is often larger, stiffer, and designed to vent gas and decompress a dilated colon rather than collect ongoing diarrhea. The two devices share a name but occupy different clinical spaces.
Delivering Medications and Fluids
Rectal tubes also serve as a route for getting drugs and fluids into a patient when swallowing is impossible and intravenous access is not available. The lower rectum has a rich blood supply, and medications placed there can be absorbed into the bloodstream for both local and systemic effects.6PubMed Central. Physiological and Pharmaceutical Considerations for Rectal Drug Formulations Common examples include anticonvulsant medications for children in active seizures, pain medications when a patient is vomiting, and certain antibiotics when oral dosing is not feasible.
Rectal infusion of fluids, sometimes called proctoclysis, has a long history in medicine that fell out of favor as intravenous equipment improved. There has been renewed interest in the technique, however, because it requires minimal equipment and can be performed in resource-limited settings, disaster scenarios, or situations where IV placement is technically difficult. A recent review noted that rectal infusion of both fluids and medications is a feasible alternative when intravenous access is delayed, contraindicated, or unnecessary, and that the technique shows potential for reemergence given current challenges in healthcare systems.7Current Emergency and Hospital Medicine Reports. Current Updates in Rectal Infusion of Fluids and Medications In palliative care, for instance, a patient at home who can no longer swallow may receive hydration through a small rectal catheter rather than being transferred to a hospital for an IV.
Uses in Imaging and Pediatric Care
In diagnostic radiology, a rectal catheter is a routine part of CT colonography, the imaging technique sometimes marketed as a “virtual colonoscopy.” A small catheter is inserted into the rectum, and carbon dioxide is gently pumped through it to distend the colon so that polyps and other abnormalities show up clearly on the scan.8PubMed Central. Transitioning barium enema preparation protocols to CT colonography in the modern imaging era The catheter used here is usually narrow and has a small inflatable tip to hold it in place. It is removed as soon as the scan is complete, so insertion time is measured in minutes rather than days.
In pediatric surgery, rectal tubes take on yet another role. Children born with Hirschsprung disease, a condition where nerve cells are missing from part of the large intestine, often require rectal irrigations to keep the bowel decompressed before surgery. In a review of bowel management practices for these children, all patients without a surgical stoma were prepared for their definitive repair using rectal irrigations, and transanal irrigation also supported early recovery after the procedure.9PubMed Central. Bowel Management in Hirschsprung Disease—Pre-, Peri- and Postoperative Care for Primary Pull-Through The catheter used for irrigations in infants is much smaller than an adult fecal management device, and the technique requires careful training of parents who often perform it at home.
Risks and Complications
Rectal tubes are generally safe when used for short periods, but the devices are not without risks, especially when they stay in place for extended durations. The most serious reported complication is rectal ulceration. The retention balloon that holds a fecal management catheter in place exerts pressure against the rectal wall, and over time this pressure can damage the tissue, leading to ulcers and, in rare cases, perforation. Case reports have documented bleeding rectal ulcers caused by fecal management devices, with the mechanism traced to continuous pressure from the inflated balloon and sometimes to stool buildup above the catheter adding further strain to the bowel wall.10PubMed Central. Rectal ulcers: a complication from stool management system use 11PubMed Central. The Traumatic Tube: Bleeding Rectal Ulcer Caused by Flexi-Seal Device
Duration matters. In the retrospective review of 50 patients mentioned earlier, about three-quarters experienced no complications at all. Among those who did, the issues included overinflation of the retention balloon (without mucosal injury), temporary loss of anal muscle tone, and stool leaking around the device. Critically, the complication rate for patients who had the device in for 17 days or longer was significantly higher than for those with shorter durations, roughly 44 percent versus 15 percent.12PubMed Central. A retrospective review of outcomes using a fecal management system in acute care patients Most manufacturers recommend periodic reassessment and temporary deflation of the balloon to relieve pressure. Nursing protocols increasingly call for checking the device every shift and removing it as soon as possible rather than leaving it in as a default.
Why Balloon Pressure Varies Between Devices
Not all fecal management catheters exert the same pressure on the rectal wall, and the differences between devices can be clinically meaningful. A study that tested three commercially available stool management systems in healthy volunteers measured the pressure the retention cuff applied in various body positions and at different fill volumes. One device consistently produced pressures at least twofold lower than the other two. For example, when subjects lay on their left side, the lower-pressure device averaged 25 mmHg while the others averaged roughly 67 to 79 mmHg. When the balloons were overfilled by 15 mL, the gap widened further.13PubMed. Retention cuff pressure study of 3 indwelling stool management systems: randomized study of 10 healthy subjects
These numbers matter because higher cuff pressure over time is the mechanism behind balloon-related rectal ulcers. Clinicians choosing between devices have good reason to consider not just cost and availability but also how much pressure the retention system exerts during normal use. Overfilling the balloon beyond the recommended volume, which happens easily if staff are not attentive, amplifies the problem regardless of the device brand. For bedside nurses, the practical takeaway is straightforward: inflate to the minimum volume that keeps the catheter seated and stops leakage, check the fill level regularly, and never assume more air or water in the balloon means better performance.
Cost Savings for Hospitals
Hospital administrators often want to know whether the cost of a fecal management system is justified compared to the traditional approach of frequent diaper changes, skin cleansers, barrier creams, and linen replacements. The evidence consistently says yes. A study comparing a novel fecal management device to standard care estimated the total cost per patient at roughly $1,120 (including the device) for the device group, compared to about $1,900 per patient for traditional management once the added costs of treating skin breakdown and pressure injuries were included.14PubMed Central. Clinical and Health Economic Evaluation of a Novel Device for Fecal Management in Bedridden Patients
A budget impact analysis from two Canadian hospitals painted an even starker picture. Daily material costs per ICU patient dropped from about $144 to $94 for average-weight patients, and from roughly $476 to $151 for bariatric patients with wounds, when a modern fecal management system replaced traditional methods. Extrapolated across all eligible patients at each hospital, projected annual savings ranged from around $57,000 at the smaller facility to over $627,000 at the larger one.15Wound Management & Prevention. A Budget Impact Analysis Comparing Use of a Modern Fecal Management System to Traditional Fecal Management Methods in Two Canadian Hospitals The savings come partly from materials and partly from nursing time. Cleaning an incontinent patient can take two or more staff members multiple times per shift, and in an ICU already stretched thin, those hours add up fast.
When a Rectal Tube Is Not the Right Tool
Despite their versatility, rectal tubes have real limitations. Patients with recent rectal or colorectal surgery, active rectal bleeding of unknown cause, or conditions that make the rectal wall fragile (such as radiation proctitis or severe inflammatory bowel disease flares) are generally not good candidates. The retention balloon, however low its pressure, still presses against tissue, and in a compromised rectum even mild pressure can cause harm.
There is also at least one application where rectal tubes looked promising on paper but turned out to be unreliable in practice: measuring intra-abdominal pressure. A validation study tested whether a balloon-tipped rectal catheter could serve as an alternative to the standard bladder-based method for detecting dangerously elevated abdominal pressure. The results were discouraging. Rectal pressure readings were consistently higher than bladder readings, the correlation between the two was poor and statistically insignificant, and the repeatability of the rectal measurements was unreliable. The researchers concluded that estimating intra-abdominal pressure via a rectal catheter is not feasible because the numbers simply cannot be trusted.16PubMed Central. Is it feasible to measure intra-abdominal pressure using a balloon-tipped rectal catheter? Results of a validation study The finding is a useful reminder that a tube already sitting in the rectum is not automatically a window into everything happening in the abdomen.
What Patients and Families Should Know
If you or a family member is in a hospital and a rectal tube is recommended, it helps to understand a few practical points. First, the device is not placed as a permanent solution. It is a bridge, meant to manage an acute problem while the underlying condition is being treated. The goal is to remove it as soon as the diarrhea resolves, the bowel heals, or the patient can begin managing their own continence. Second, discomfort varies. Some patients barely notice the device, particularly if they are sedated. Others find it uncomfortable, and sedation or positional adjustments can help. Third, asking the nursing team how often they are checking the balloon and when they plan to remove the device is entirely reasonable. The evidence is clear that shorter duration means fewer complications.
For parents of children with conditions like Hirschsprung disease, rectal irrigation catheters are a different experience altogether. These are used intermittently, often at home, and require hands-on instruction from the surgical team. The technique can feel intimidating at first, but pediatric centers typically provide detailed training and ongoing support. The catheter sizes used in infants and toddlers are much smaller than adult devices, and the procedure, once learned, becomes part of the daily routine until surgical correction resolves the underlying problem.
In the broader landscape of hospital care, rectal tubes occupy a niche that is easy to overlook until you or someone you know needs one. They are not glamorous medical technology, but they solve real problems: protecting damaged skin, containing dangerous pathogens, decompressing a blocked bowel, and delivering medications when other routes fail. The evidence base supporting their use in fecal incontinence management has grown steadily, and the devices themselves have evolved from simple rubber tubes to engineered systems with soft silicone walls, low-pressure retention cuffs, and antimicrobial coatings. Understanding what they do, and what they should not be expected to do, puts patients and families in a better position to participate in their own care.