Forceful noniatrogenic injuries of the anorectum in children are rare. The majority are caused by falls at play or by a child molester. Local tissue and sphincteric destruction and, in addition, peritoneal penetration with associated organ involvement, hallmark these potentially life-threatening injuries. The configuration of the offending object, the force and direction of its penetration, and the resting point of its tip will dictate the nature and extent of the injuries. These in turn will suggest the therapeutic approaches. Classification of anorectal impalement injuries based on the site of penetration (anal vs perineal) and its final target (intra- vs extraperitoneal), will provide a rational schema of treatment.