Gross Anatomy

by Mara Altman

  Before concluding this investigation, I went directly to the source—the people who have butt affinities. First, I asked my friend Josh about his butt adoration. He spoke very broadly. “I like something to hold on to,” he said. With a generic line like that, I decided he was just in poop denial and wanted smart babies.

  But next, I visited my friend Mark, a worshipper of the female behind, and he shed some new light into a dark crevasse.

  I gave it to him straight. “How do you maintain your love of the butt when we excrete from the middle?”

  “I love a hole,” Mark said. “People are obsessed with holes. I think somehow we are hardwired to like holes.”

  “I thought people liked the butt in spite of the hole,” I said. “They overlook the hole.”

  Mark was adamant that the hole was actually the draw, and the rest—the cheeks—was just decoration like a frame is to a masterpiece. “I think the hole is attractive,” he said. “And what makes it attractive? It’s a hole!”

  He went on about holes for so long my recorder almost ran out of space. “If you give a boy a little round doughnut-shaped toy,” he continued, “he’s going to stick his finger in the hole. We like holes. We like sticking things in holes!” Mark was getting too excited.

  “I get it,” I said. “You like holes.”

  Mark’s poetics about the hole brought me to my final observation: pleasure. The butt is not only a two-cheeked vessel signaling fertility or a cushion on which to rest one’s weary head; it also houses a very real erogenous zone. Many people can overlook a lot of heinous stuff—messy rooms, bad breath, the exit shoot of the intestines—in order to have orgasms.

  Ultimately, there are so many positives—both conscious and subconscious—about the tush that these factors successfully undermine the reality: Our butts, even the firmest and perkiest ones, are full of crap. In other words, “I’d love to get my hands on your septic tank” is not a pickup line that will hit the streets anytime soon.

  10

  PILEup on the “Inner” State

  I’ll always have one big regret in my life. There was a question I yearned to ask my grandfather before he passed. My mom had told me that he possessed great knowledge and experience on this particular issue, but each time I visited his home, I didn’t have the gall to bring it up. When he got sick, I knew time was running out, yet I still couldn’t muster the courage. Every time I attempted the conversation, my heart would beat hard and my face would grow hot and flushed.

  I never managed to broach the subject. In August 2011, Irvine Harold Altman, my beloved grandfather, took eighty-nine years of wisdom on the matter to his grave. No reflections on the subject were entrusted in his will. I experienced deep remorse and helplessness: I felt alone in the world, left to find the secret of how to deal with a hemorrhoid flare-up on my own.

  * * *

  When I turned twenty-six, my butthole staged a mutiny. It felt like a gang of misfits lit a bonfire in my anus. Whenever I sat, I’d swear I plopped down right on top of a demon’s trident. Wiping, that unexceptional and often forgettable activity, became a form of torture. Starving myself sounded like a great option; if I didn’t eat, I wouldn’t have to go to the bathroom. I might die, but that was okay!

  Before this happened, I had been obsessed with all things fecal. I was that friend, the one you would text when you needed to debrief about that satisfying yet unsettlingly large dump you just took. This turn of events felt ironic, like a composer going deaf.

  I didn’t know what was wrong and yet I was too terrified to find out by looking in the mirror. What if my anus was the size of a basketball? All I knew was that the pain—deep and searing—felt metastatic and quite possibly terminal.

  After weeks of shuffling around like a ninety-year-old man wearing an ill-fitting diaper, I went to the gyno under the guise of needing a Pap smear; I was too embarrassed to make an appointment solely for my butthole.

  There was something odd about the ass—especially maladies of the ass—that rendered it unspeakable. In a booklet about constipation called Let’s Get Things Moving, the authors note that when we are young, we are enthusiastically applauded for pooping, but simultaneously taught that it’s dirty, smelly, and disgusting. “A very confusing state of affairs,” they rightfully concluded.

  After the swabbing, I reluctantly asked my gyno if she would look at what kind of nightmare was brewing a bit south.

  It took her only a second to diagnose me. “Oh, you have a little hemorrhoid,” she said. Her tone made it sound like she’d just discovered a cute kitten hiding in a box.

  I must not have heard her right.

  “A what?” I said.

  “A hemorrhoid,” she said, taking off her gloves and making a few notes on a clipboard. She told me it was a tiny lump, not much bigger than a mosquito bite, and explained it as nothing more than a swelled vein in my butt.

  To her, this was no big deal, but I’d always thought that hemorrhoids happened only to obese truck drivers with ketchup-stained T-shirts and a lifetime subscription to RoadKing.

  How could I have a hemorrhoid? I had flower-patterned underwear, for God’s sakes. Wearing those dainty things with hemorrhoids would totally clash.

  “Just wait until you’re pregnant,” my gyno said, with a sinister wink.

  Hemorrhoids are extremely common, but I didn’t know that for years. So for the time being, I kept the ’rhoid to myself. While most of my friends were reading love stories, I mined literature for hemorrhoid references.

  I found solace in fictional characters who also suffered from the affliction, like Marx Marvelous from Another Roadside Attraction. “You women think you have it bad, having babies,” he said in the Tom Robbins novel. “Well, a woman can only give birth once every nine months, but a hemorrhoid sufferer goes through labor every time he goes to the crapper.”

  Yes, I thought, Marx gets me.

  I took baths to soothe the pain, bought supplies with “anti-hemorrhoidal” on the label, and complained to my mom. That’s when she tried to get me to do an AMA (Ask Me Anything) with my grandpa about his own ailing rear. Obviously, that didn’t go well.

  My hemorrhoids, since then, have come and gone like migrating birds. One month they are here, the next they take off. Even though I’ve studied up on the ’rhoids, I’ve never fully understood them. The whole thing—how a body part could suddenly malfunction—has continually pissed me off. Plus, with an anus this sensitive, I’m not sure how I’ll ever get to try butt sex.

  I could draw only one conclusion: Our anuses weren’t constructed correctly. The little muscles in our behinds have been finicky since we stepped out of sludge eons ago. Since ancient Egypt, scholars have been lodging formal complaints about anuses—a remedy for hemorrhoids was found written on papyrus from 1700 BC. Clearly, the anus should have been made out of a sturdier material—titanium perhaps, maybe concrete, even some nice hardy plastic would be cool.

  I contacted Peter Lunniss, a colorectal surgeon, to present him with my findings. I discovered him because of his copious writings—more than ninety publications—about defecation.

  “I feel like our assholes weren’t made right,” I explained to him. “There are so many issues.”

  “No, it’s just that we abuse them,” he said.

  “It’s not them, it’s us?”

  “Yes, it’s us,” he said, “definitely us.” He reiterated that our problems most certainly stem from user error and then went on to praise the anus for being one of the most complex organs in the body—surgeons can transplant hearts, livers, kidneys, and even faces, but they have yet to figure out how to reuse someone’s old anus. “People just take their anus for granted until it goes wrong,” he said. “You’ve got to look after them.”

  “So then what about hemorrhoids?” I said, expecting that would be enough to sway him to my side.

  From what I’d read, 40 percent of the population has had or will have hemorrhoids at some point in their lives. Most studies ev
en suspect the number is higher given the amount of people who are too embarrassed to tell anyone in the medical field about their wonky buttholes.

  Lunniss told me that I’d been thinking about hemorrhoids all wrong. We are all actually born with them—everyone from a day-old baby to Beyoncé. They begin as anal cushions, three of them, that help our anus remain airtight. “You’d be leaking gas without them,” he said.

  He explained that they give our anus an extra seal, “like the rubber ring at the top of a jam jar.”

  Doctors seem to have no qualms about ruining the connotation of perfectly good kitchen items. I once had a gynecologist describe a speculum as being like tongs.

  Lunniss said that for a variety of reasons, like pregnancy, being overweight, and constipation—anything that adds more pressure to our bottoms—the cushions may get pushed down lower and become congested with blood, which causes them to itch, hurt, and sometimes bleed. When the cushions get displaced in this way, they become their evil alter ego: hemorrhoids.

  Hemorrhoids, then, are not some weird growths or, as I once suspected, a sign that everything you love and cherish in the world spites you. They are actually a part of our body that isn’t working 100 percent at the moment.

  You can get hemorrhoids lopped off with a scalpel, blasted with a laser, or stapled with, well, a stapler, but Lunniss said that it’s best to use surgical options only as a last resort. “If it’s not done well,” he explained of the surgery, “you can lose that seal—know what I mean?”

  “I think so.” I must not have been convincing, because he continued and became even more explicit.

  “You may no longer be able to hold wind,” he told me. The best thing to do, he said, was to learn how to shit properly.

  “I know how to shit properly,” I said.

  He wasn’t so sure. “The civilized world is obsessed—they will force themselves to poo without having an urge to evacuate their bowels,” he said. “If you’re straining all the time, you’re eventually going to end up with prolapsing hemorrhoids.” He got really ominous; he said many of the young are careless with their butts and will see the consequences down the road.

  * * *

  For the next hour, Lunniss lifted the veil, enlightening me about the magnificence and complexity of the anus (and how we screw it up). If we step forward and then take a gander inside, the anus is much more complicated and sophisticated than we give it credit for.

  I was astonished to learn that we have not one but two sphincters. The one many of us are more familiar with is the one that we can clench on command. This is the external sphincter, and we control it voluntarily.

  The internal sphincter is the behind-the-scenes sphincter—you can’t see it and can’t control it, but without this sphincter, the show wouldn’t go on. It is positioned inside the anal canal and is the size of the thickest string on a guitar. It is contracted at all times except when we have to go to the bathroom.

  “So, what if we didn’t have that internal sphincter?” I asked.

  “Then we would have to rely on our external sphincter to keep the anus closed and it would get tired after about twenty-five seconds and then you would poo your pants,” said Lunniss.

  For two weeks, I told everyone I met, “Did you know that we have two anal sphincters?”

  (The internal sphincter needs much better PR.)

  Each sphincter answers to a different boss. The external sphincter pledges allegiance to the conscious bits of our brain. In medical circles, the urge to go to the bathroom is formally referred to as “the call to stool.” Why they didn’t name it “the call of dooty” we’ll never know. When you feel “the call to stool” while you’re on a ten-hour bus ride with absolutely no toilet in sight, it is the external sphincter that you will clench and pray to. It is the more civilized of the sphincters. It cares what people think of you.

  The internal sphincter is the much more practical one. We have as little say in what it does as we do in the beating of our own hearts. It does not care if you are at your new lover’s apartment; it would happily have you wreck the toilet. If the sphincter had its way, a quiet library would have no power against the onslaught of your farts. This sphincter has absolutely no shame. Its main concern is to keep the rectum unpacked and to prevent backup.

  Despite their different motivations, these two sphincters must perform an intricate tango to remove waste from your body (and keep you looking cool while doing it). When digested food comes down the pipeline and hits the internal sphincter, it opens up automatically. The contents of your bowel don’t just barrel through and crash against the external sphincter, hoping it will open. The internal sphincter is polite—at first—and will let only a tiny “sample” pass. This sample goes into the intersphincteric zone between the two sphincters—poop purgatory, if you will—and is analyzed by specialized sensor cells. These cells exist nowhere else in the body. Within an instant, these cells tell us exactly what’s knocking at the gates—something liquid, gaseous, or solid.

  Hearing about this might have been the closest to a come-to-Jesus moment I’ve ever had. “You’re right,” I said, “we almost always know if it’s a poop or a fart!”

  “The anus is so clever,” said Lunniss.

  Once the materials are analyzed, the external sphincter waits for us to survey our environment. If you sense something gaseous and you’re at a loud and bustling farmers’ market, you might choose to take your chances and let it rip while you quickly run off to the next booth. If, on the other hand, you realize it is something more than gas and you are in the middle of giving a talk to five hundred people, you will tighten your anus like you’ve got a winning lottery ticket between your cheeks while perched on the deck of a yacht going 70 knots. If you choose to do the latter—squeeze tighter—the internal sphincter gets the message, and the sample gets sucked back up, where it will be deferred until later.

  This is why you may have experienced running toward the toilet at full speed to avoid an emergency only to find that once you’ve finally made it there, you no longer have the urge.

  The reprieve will not last for long, though. There is a plane waiting to land and your external sphincter is air traffic control. The plane might go for another lap, but it will eventually need to come down. It’s only a matter of time before the internal sphincter will give it another shot, sending another sample through. When it does, and if this time you’re prepared—near a toilet, magazine in hand—you’re golden. Both sphincters will relax. Bombs away.

  Every time we go to the bathroom, I observed, it is a compromise between our animal and civilized sides. The internal sphincter is our internal pigeon: It thinks the whole world is its toilet. The external sphincter, meanwhile, is the city mayor who doesn’t want pigeon scat all over every statue.

  Lunniss said that one reason we get hemorrhoids is that we give our mayors too much power. In that way, anuses are like most governments. Give any elected official too much authority and something bad will happen. “A natural poo is when you listen to your body,” he said. “That’s what I’d call a good poo.” He explained that far too many people strain these days—they want control of when and where they go—and it’s breaking anuses everywhere.

  “I’ve never had the patience for intestines,” I admitted.

  “Well, there you go,” he said.

  Many people, he continued, also refuse public restrooms in favor of the familiarity of their own four walls. In other words, they ignore their urge until they deem it is the “right time.” I luckily do not have that problem—I have no special allegiance as long as there is toilet paper—but I have many friends who would prefer to be filmed in HD streaking across a packed football stadium than to drop their pants in a Target stall. While this might be good for the soul and the psyche, it is not good for the sphincters.

  We can overpower the urge only so many times before we get into trouble. The internal sphincter will give up on us. I spoke with Theresa Porrett, a coloproctological nurse and cons
ultant at London’s Homerton University Hospital, and she gave me her best rendition of a dejected internal sphincter’s thoughts: “You’re not going to listen to me anyway, so what’s the point?” In that way, the two sphincters have a relationship like many of us do with our loved ones. If we feel taken for granted or unappreciated, we may begin to stray.

  A straying internal sphincter is bad. You really don’t want your internal sphincter muscle to break up with you.

  “Constipation is often the result,” said Porrett.

  “Why?” I asked. “How does that work?”

  She said that if you defer too often, you will stop getting the urge, which means that your feces will sit in the rectum for longer. While it sits there, your body begins to reabsorb all its water. “It gets smaller and smaller and harder and harder,” said Porrett. “You’ll be stuck straining to push out tiny little rabbit pellets instead of a nice solid, soft sausage.”

  Porrett was another medical professional who seemed to have no qualms about ruining things: this time the connotation of perfectly good deli meat.

  After a few moments, she said, “A soft sausage really is the best way to describe it.”

  Later I would speak to another nurse who described the resulting constipation a little differently: “You will have a brick in your bottom and good luck getting that out.”

  When people are constipated, they tend to strain, which, again, can piss off the old anal pads.

  Porrett wrote a paper on the topic, titled “Take Care of Your Bowels and Your Piles Will Look After Themselves.” (Piles being another word for hemorrhoids. It comes from the Latin pila, meaning “ball.” I didn’t think this topic could keep getting sexier, but it just did.)