Gross Anatomy

by Mara Altman

  Besides drinking lots of fluids to stave off constipation and eating breakfast in the morning to stimulate our intestines, she said another important factor in anus health is our position on the toilet. “It’s important. Really important!”

  She has it out for the Western toilet. “We design toilets to match the sink and look great with the shower,” she said, “but we don’t design them to actually help us poo better.”

  Maybe Porrett was onto something. My parents’ peach toilet matches their peach sink, their peach tub, and even the flecks of peach in their tile.

  There are two basic schools of thought: squatting and sitting. Squatting was the go-to since just about forever, while sitting became popular only with the advent of indoor plumbing in the 1800s.

  Sitting, while popular, wreaks havoc on our buttholes. Porrett explained that because we stand on two legs, there is a lot of pressure on our lower region, so several fail-safes have been put into place to ensure all our goods don’t fall out when we stand up or sit down. Our sphincters are one fail-safe, but that’s not enough to support all the pressure. Another is a muscle that encircles our gut. It looks like a cowboy went and lassoed the bottom of our large intestine and then pulled it tight. The lasso creates a kink in our bowels not so unlike a kink in a hose. When we sit on the toilet, the kink remains put, which means we have to exert more force—strain—to get the job done.

  Squatting, on the other hand, unkinks the kink, giving last night’s dinner a straight gastrointestinal path to speed through. Our anuses remain tension-free—barely bothered—like a pebble gently washed over by a passing stream.

  “I think if you lived in India,” Porrett said, “you wouldn’t have any hemorrhoids.”

  She made it sound like people in Asia and Africa, where many still practice the squat, have archetypal puckers. (I lived in India for a year, and while I was there, I definitely perfected the squat, but I think the benefits were outweighed by the relentless dysentery.)

  This is all well and good, but it poses a problem, since toilet time is sacred for many people. We go for the bowel movement but stay for the serenity. I know and respect many friends and family who would be upset at the prospect of giving up their seat for a hole in the ground—it would start to feel more like a gym class than a respite from the outside world. If my husband couldn’t sit on the pot while simultaneously playing games on his iPhone, he would probably swear off the body function altogether.

  The good news is that it’s possible to get into the ultimate position without leaving our porcelain perch. Porrett told me that after months in a physiology lab, she and her fellow researchers figured out the riddle. If we sit on the toilet but lean forward with our elbows on our knees and elevate our feet by using something as everyday as the Yellow Pages (finally, a real reason for those antiquated telephone directories), we will be just as effective as our ancestors who took up next to a tree. There is a company that makes a stool called the Squatty Potty for exactly this purpose.

  “And never push from your butt!” she said. “That’s a very unhealthy way to poo.”

  “Then where do you suggest we push from?”

  “Your abdomen,” she said.

  “Tighten it like you’re getting punched in the gut?” I asked.

  “No,” she said, “take a deep breath and kind of push down.”

  So the takeaway to exemplary bathroom habits—and conveniently also the key to avoiding hemorrhoids—came down to two words: Don’t Strain.

  * * *

  This essay should be over now, but a problem cropped up during the reporting. Back when I was talking to Peter Lunniss, I found out that hemorrhoids are not the worst thing to happen to an anus. I had asked him, “Is it true that anuses stretch out like the elastic on an old pair of underwear?” It was kind of a joke. I wanted it to be a joke.

  But then he said, “Yes.”

  And I said, “Really?”

  “Yes,” he said.

  “Dammit,” I said. “That’s bad news.”

  “Your anus becomes increasingly floppy.”

  “It becomes floppy?”

  “Much more in women than in men,” he said. “Women have a hard time compared to men with the anus.”

  I’d always imagined that men had the floppier anuses. I didn’t realize how devoutly I’d believed that until I heard otherwise. “Can’t be.”

  “It is,” he said.

  How was it possible that we are on the lower side of the wage gap and have a floppier butthole? If we are going to be the gender with the floppy buttholes, we should at least get paid more. It did not seem reasonable that life could be so unfair.

  By “floppy,” Lunniss meant that women experience more fecal incontinence, which means that the stool does not heed the sphincteric gates, but rather passes through to the other side unexpectedly.

  I didn’t believe this news—I refused to—so over the next week, I talked to quite a few rectal professionals. There was a lot of conflicting information, but while not everyone in the butthole community agreed, there seemed to be some consensus that women tend to be anally disadvantaged, especially if they’ve had babies.

  This is another reason to bow down to women: Billions of them have put their anuses on the line to ensure that we have a civilization.

  During childbirth, women may suffer stretching and tears on the anus. These tears are called obstetric anal sphincter injuries, which makes for the most incongruous acronym of all time: OASIS. Within a scholarly article, it sounds like this: “Whether cesarean delivery should be performed to protect against OASIS is controversial, especially as primary prevention.” To wit, this is the only kind of OASIS you don’t want.

  These tears on the anus, which in some cases are so tiny that they aren’t even visible, can sometimes have repercussions twenty to thirty years down the road. Danielle Maier, a nurse who helps run the Center for Functional GI & Motility Disorders at the University of North Carolina, said that 90 to 95 percent of her patients are female. A lot of women come into her clinic in their fifties and sixties with sphincter issues and pelvic dyssynergia. “That’s the Greek term for ‘My bottom don’t work right,’” she explained.

  “They’ll say, ‘But my child is thirty years old,’ and I say, ‘That’s awesome, but after you have a baby, the damage is done,’” she said. “It’s trauma plus time.”

  Many comedians have quipped, “Comedy is tragedy plus time.” This, clearly, does not hold true for anuses.

  Maier explained that the reason we don’t see problems until later is that when we are young, we are able to compensate for the damage, but as we get older and weaker, the ability to compensate wanes.

  If women suffer a severe tear during childbirth, the sphincters may even become alienated from one another and need to become reacquainted with outside help. Really odd things can happen to your sphincters. Things I couldn’t have imagined. There’s something called paradoxical contraction—the more you try to relax your sphincter, the tighter it gets. It’s some of the best evidence I’ve seen for the argument that true evil exists in the world. For these situations, in simplest terms, you have to relearn how to poop. A technique that is often recommended is called biofeedback. This therapy helps you regain muscle control by showing you how much pressure you exert in your bottom via a screen. You can think about it as couple’s therapy for your sphincters, only instead of a sofa and a therapist, there’s a wire up your butt and a gastroenterologist.

  “Women don’t talk about this stuff,” said Maier, “which is weird to me because we seem to talk about everything else.”

  If we did talk about it openly, I tried to envision how it would go: “Rita, I can’t make it to coffee today. I’ve got that two p.m. anus-control class.”

  “Oh, that’s right. I forgot. Good luck with those sphincters!”

  Until that happens, know that there is a burgeoning marketplace of products—adult diapers, mostly—that help us deal with our collective crap. What was a $1.8 billion
industry in 2015 is expected to grow to $2.7 billion by 2020, according to Euromonitor International, a market research firm. There is a bright side to those stats; if you’re experiencing anal leakage, you can know for sure that you’re not alone.

  I dug for more of a silver lining, but I couldn’t find one. The more I dug, the worse I felt. Women, it turns out, may be not just more prone to floppy buttholes, but also more prone to constipation. Medical researchers don’t know why, yet. They suspect it’s a combination of our fluctuating hormones and the fact that we are so busy taking care of other people—kids, spouses, ailing parents—that we don’t put our own need to poop first. When pooping, we should follow the same instructions that flight attendants give passengers when the oxygen masks drop: Do yours first and then help those around you.

  I needed someone to put all this information into perspective, so I called my aunt Karen. Not only is she a woman with an anus, she also practiced obstetrics for thirty-five years. I knew she’d cut through the bullshit and give it to me straight. You could go to her in tears about a new haircut and that woman will not indulge you; she will confirm that you need to buy a wig or go into hiding.

  At sixty-eight years old, she has investigated thousands of women’s crotches. When I got on the phone with her and explained all that I’d learned about sphincters, she said most of the terrible things are very rare and that I was too fixated on the extreme. “It’s not like poop comes out,” she said of fecal incontinence. “More often it’s a brown staining.”

  I pondered that for a second and came to a conclusion: “I’m still not into it.”

  She told me that we all—men and women—get weaker as we get older. “It’s a pisser,” she said. “You lose hair. You shrink down. Your muscles aren’t as strong, but what are you going to do? It’s part and parcel of getting older.”

  I tried to step back and look at the bigger picture; fecal incontinence is a new milestone. If you’re pooping your pants, you’ve made it that far—it’s a badge of honor that signifies a long life and a well-used orifice. It’s the equivalent of calluses on a construction worker’s worn and weathered hands.

  Nope! A floppy butthole still sounded awful.

  “Look, I have a looser anus than I did ten years ago,” she said. She explained that she’d had a C-section, so she definitely wouldn’t chalk it up to the type of delivery.

  “It’s not flopping in the breeze,” she said, “but sure, I notice the change and it pisses me off.”

  That said, she explained that it’s not the most horrendous of changes. “I have a floppy butt now, too,” she said of her once perky behind. She found that more disconcerting than a slightly floppy anus. “You just have to laugh at this stuff.”

  * * *

  After hearing about the possible destruction, I realized that I had to stop worrying and start enjoying my butthole while I’ve still got a (mostly) functioning one. For too long, I’d been concerned that with such a finicky anus, I would have problems turning my exit into an entrance, but it was clear to me now that I needed to stop coddling the butthole and step forth to fulfill the highest of all my orifice-inspired aspirations: butt sex.

  To see if my optimistic mental state matched my physical one, I once more approached Danielle Maier, the nurse at the rectal clinic at the University of North Carolina. “If you’re someone who’s had hemorrhoids on and off,” I asked, “would you find it inadvisable to have butt sex?”

  She told me that she would suggest waiting until they aren’t flared, but that anal sex—if it’s consensual, you use lubricant, and you are able to relax your sphincter muscles, but like really relax them—shouldn’t be the cause of any extra problem whatsoever.

  “The key is to relax,” I reiterated, mostly to myself.

  Then she said something that took a few days—and some counseling— to process and will no doubt stick with me until my last breath. “When people defecate,” she said, “they put out stools that are larger than most of the penises I’ve seen, so it really shouldn’t be an issue.”

  Yet another health professional trying to ruin things: this time the male sex organ.

  Despite her comment, I remained undeterred, but before going forth, I decided that it would be fun and informative to get some pro tips from someone who has had a lot of experience with putting objects into her anus. I contacted Natasha Starr, a twenty-eight-year-old porn star who hails from Poland and has made a living out of sodomy.

  On the About Me section of her webpage, you’ll learn that she’s tall, thin, blond, and a Libra. She has been nominated for several AVN awards—the porn industry’s answer to the Oscars—all for her anal scenes. Before talking to her, I checked out some of her films (All Things Anal, Anal Warriors, Let’s Try Anal, I Wanna Buttfuck Your Daughter 16) and was properly impressed: no orifices seemed to be harmed during the making of her movies.

  Starr had a deep, raspy voice and a thick Eastern European accent. In retrospect, talking to her was like going down a double black diamond when I should have been on a bunny hill, but I didn’t know that yet. “My first-time anal experience was when I was fifteen,” she said, introducing herself. “My boyfriend couldn’t come. I said, ‘If you can go in my ass, maybe you come faster.’ That’s how it happened the first time.”

  Natasha Starr, like Wolfgang Amadeus Mozart, was obviously one of those young prodigies.

  I began our interview by asking her how to get started. I’d heard that when dealing with the ass, it was smart to take baby steps. I thought she’d recommend some good introductory finger play or butt plugs.

  “I like it when they put it in deep,” she said, going straight to the dick, “because if you put it a little bit, it feels like you are taking a poop.”

  “I could see that,” I said. I wanted to show her that I was on board, even though I was so off board that no board was in sight.

  “On the movies they like to see the penetration,” she said. “Long strokes, you know? That feels weird.”

  “Because then you feel like you’re pooping over and over again,” I said, still trying to commiserate.

  “Yeah, they come out all the way and come back again,” she said. “So I like it put in all the way to the end and just pound it. That is how I like it.”

  This was an aspect of anal sex that I had never considered.

  We talked for at least another half hour and touched on subjects she found essential, like the foods that pair best with sodomy. A big steak. Yes! Lasagna. No! But overall, this was not a conversation for the everyday butt-sex dabbler. She may as well have been explaining quantum mechanics to a napping Ewok. What I found liberating, though, was how we ended our talk. As we wrapped up, I asked, “Do you ever have any issues with your anus?”

  “I actually do have hemorrhoid,” she said.

  I was shocked. “You do?” I said. I’d seen her asshole live on my computer screen—it looked pristine, smooth and pink; it reminded me of an angel’s halo.

  “I do have hemorrhoid,” she said again. “Maybe I push too hard? I don’t know.”

  She was saying it like it was no big deal, like thousands of people don’t depend on her to be sexy each and every day.

  “Maybe it’s a skin tag,” I told her. I’d learned about them the previous week. An external hemorrhoid, in its wake, often leaves a souvenir behind in the form of a tiny flap of skin. Hemorrhoids, it turns out, have egos and don’t want to be forgotten. The tag is nothing to worry about; it is no more than a little ’rhoid graffito communicating “I was here.”

  “I don’t know,” she said. “I think it’s a hemorrhoid.”

  It felt so empowering to hear that not only was I not the only one with a hem, but also someone superhot shared my affliction. I thanked her for her time and honesty.

  “Why?” she said. “It is not a problem. No one ever complained to me about this thing before.”

  * * *

  I may not have learned proper butt-fuck technique—all the necessary sodomy facts I ne
ed are probably up on the Cosmo website anyway—but in the meantime, Starr demonstrated something even more important. I was impressed by how she was so open. Back when I’d spoken with Porrett, she’d said that many people are so ashamed of their butt problems—not just hemorrhoids and incontinence but also more serious symptoms—that treatable issues often become fatal because of their refusal to tell a doctor. “People literally die of embarrassment,” she’d told me.

  Until we get it together and put some major funding behind the development of bionic buttholes—what an exciting day that will be!—we have to do the best we can with the sphincters we were born with.

  In the meantime, I’d like to think that if my grandpa were looking down on me right now, he’d have a giant smile plastered across his face. “You finally figured it out, kiddo,” he’d say. “Just like with the countertops in our Palm Springs place, you’ve got to treat your anus with respect.”

  11

  The Human Stain

  I always wanted my birthmark to signify something, like maybe that I am the next vampire slayer. Some old man might walk up to me and be like, “OMG, you have the marking of the slayer on your lower back!” and I’d be like, “What are you talking about? You crazy?” At which point, he’d be like, “No, I’ve been looking for you since the last millennium.” Then we’d embrace like old friends, followed by a cool montage of me learning martial arts, sweating at totally appropriate moments, and basically saving the world.

  This has yet to happen.

  The most I’ve gotten is, “What’s that weird red mark above your ass? Looks like someone got high and tried to draw Australia.”

  If I’m not in fact the next vampire slayer, which is yet to be proven, I want to know what the hell is the point of having a marking. Are birthmarks just random splotches that mean absolutely nothing? How do they get there? Do they serve any purpose, and most important, when exactly is a person officially too old to start learning to be an assassin?