The most common concomitant site of injury following a penetrating anorectal injury is the genitourinary tract. In anorectal penetrating injuries, other organ injuries must be thoroughly evaluated. In the presence of concomitant rectal and posterior bladder injury, consideration should be given to omental interposition between the surgically repaired organs to prevent fistula formation. Fecal diversion may be required depending upon the integrity of the anal sphincters. Combined rectal and genitourinary trauma from stab wounds or impalement is rare, and requires an interdisciplinary approach utilizing the collaborative expertise of both trauma surgical and urology teams to optimize the intraoperative and postoperative care of the patient.