Written by Cara Schacter
To maintain continence, the puborectalis muscle chokes the anal canal. The sling of tissue is supposed to release during defecation. Mine has not been doing that.
In mid-March 2021, at a bowling alley, I watch balls thunder down lanes and wonder if I’ve had a bowel movement since Presidents’ Day. I try: Miralax, Restoralax, magnesium citrate (liquid and powder), senna (tea and pills), psyllium (powder and pills), Benefiber, Citrucel, digestive enzymes, Swedish bitters, probiotics, prebiotics, flax seeds (milled and whole), chia seeds, prunes, figs (soaked and dried), Squatty Potty, Dulcolax (pill and suppository), allicin, glycerin, berberine, neem, ginger, fleet enemas, artichoke extract, dandelion, cascara sagrada, pumpkin purée, licorice root, slippery elm, beans, colonic massage, sea moss, apple pectin, aloe vera (juice and gel), kiwi, acupuncture, perianal splinting, beta-glucans, alfalfa, red clover, going off Wellbutrin, going on Adderall, apple cider vinegar, prayer.
In May, I go to a gastroenterologist. He has a signet pinkie ring and gelled hair. I pull down my shorts to show the bulging in the iliac region of my lower left abdomen which, I conjecture, is from buildup in the sigmoid colon. I cry. The doctor stares.
Later, browsing the medical directory Zocdoc, I learn that he served in Afghanistan as the sole physician for 2,000 soldiers. I unfurl a tissue. I say I’m probably overemotional due to the gut-brain connection. People on podcasts say things like “gut bacteria is responsible for 95% of the body’s serotonin supply.” The doctor says to avoid cruciferous vegetables and download a low-FODMAP diet app (FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols). He prescribes Linzess — an oligopeptide agonist of guanylate cyclase-C — and refers me to Lenox Hill Radiology for an X-ray of my intestinal tract.
The main side effect of constipation medication is diarrhea. I don’t experience diarrhea so much as a prolonged leak. I cancel plans to attend a trivia party in Ridgewood, Brooklyn, so as not to risk excretion on the M train. When Linzess fails, the gastroenterologist prescribes Amitiza — a bicyclic fatty acid and prostaglandin E1 derivative. Marginal diarrhea, and then nothing at all. I track bowel behavior obsessively with a diary beside my toilet.
I watch a YouTube video by a masseuse named Monique about how to heal constipation with love. Monique holds up a piece of paper that says, “I allow life to flow freely through me.” Put one hand on your heart, she says, and ask yourself: “How true does this affirmation feel?”
Lenox Hill finds “considerable stool material in the descending colon as well as the rectosigmoid region.” My doctor diagnoses a combination of slow transit and outlet constipation. The words “peristalsis,” “lazy colon” and “dyssynergia” are used. Basically, I have reduced motility of the large intestine and a too-tight anus. The next step is an anorectal manometry to test muscular pressure in the sphincter.
You never really know how constipated you are. There is a lot of clickbait about unwittingly harboring 20 pounds of so-called toxic poop. I stop skipping the ads for seven-day gut reboots and ketogenic intermittent fasting mints. I want to — no, need to — hear about the chlorophyll lemonade by the board-certified dietitian, ayurvedic healer and mother-of-four who knew there had to be a better way.
The colorectal specialist in Turtle Bay has a benignly perverted air. “What can we do for you?” he asks. I am going to love his nurse, he tells me. She is the greatest. The woman appears wearing an Angry Birds face mask and takes me through the manometry test. The results show a reversed rectal anal gradient — I squeeze when I should push. I leave with instructions for an exercise called “anal winks.”
Bloated, I go out with a vegan writer who wants to share small plates. I wonder about the FODMAP ranking for beet carpaccio while he talks about the aesthetic disposition of brackets versus parentheses. “Round brackets are pockets of air, space to breathe away from the didacticism of the mainstream text,” he says. “Square brackets are sharp, angular. Think of when you see ‘sic.’” He goes on. I wonder if the scallop risotto is made with white or brown rice, or if it even matters at this point.
I wear the wrong outfit to pelvic floor biofeedback therapy. Had I exercised forethought about spending an hour pants-less with a cord up my rectum, I would have worn an oversize top, maybe a dress. Instead, I’m half-naked on a table at the Gastrointestinal Motility Disorder Center in a flimsy white blouse with a milkmaid neckline. It’s pastoral, coquettish and untrue to the moment.
Between anorectal pulses from the electrical stimulation probe, the physiotherapist makes conversation by asking how I’d describe my personal style. I say something irrelevant about the Olsen twins. The therapist instructs me to synchronize Kegel contractions with the rise and fall of an animated dolphin as it undulates across a monitor that is connected to the wire in my anus. The more I contract, the higher the dolphin leaps. To future appointments, I wear a skirt and thigh-highs so that I can Kegel with my outfit intact.
After my gastroenterologist demonizes seltzer and refuses to test for small intestinal bacterial overgrowth, I switch to one whose administrative assistant says he “gets a thrill” out of finding creative solutions to problems other doctors cannot solve. By my second appointment, I learn that many of my new gastroenterologist’s creative solutions involve muscle relaxants; that Valium can be compounded into suppository form by a specialty pharmacy in Park Slope; and that I am a good candidate for anal Botox.
Insurance won’t cover the $1,200 anesthesia for anal Botox sedation, so I am awake. The proctologist wears pointed toe logo-jacquard Gucci stilettos. Reviewing my folder, she says I could crack a walnut with my sphincter. If you overdo anal Botox, you risk incontinence, she continues, assuring me that her approach is conservative. She laughs. I laugh. She uses an aerosol skin refrigerant spray with a skinny straw nozzle to send a blast of freezing air inside me.
In Central Park, post-injection, a faint stinging in my butt, I sit on a bench dedicated to the loving memory of the Cohens and think about the intestinal meta-narrative. Ingest, digest, hope to produce something substantive; move through a deceptively long winding tract; consume requisite roughage; adopt a passable consistency; strive for a sense of completion. “The paradox of human life,” said Simone de Beauvoir in a Paris Review interview in 1965, “is precisely that one tries to be and, in the long run, merely exists. It’s because of this discrepancy that when you turn around and look back on your life, you see that you’ve simply existed. In other words, life isn’t behind you like a solid thing.”
My second magnetic resonance defecography is in the subbasement of Mount Sinai. The technician points to a set of built-in speakers in the MRI machine and asks if I’d like music. Whatever I want, he says. Panicked, I request “the hits.” The doctor administers three syringes of blue gel into my rectum that will simulate the passage of stool for the ultrasound. I wait for instruction to simulate defecation. “Cold Heart” by Dua Lipa and Elton John starts to play.
It’s a human sign when things go wrong
When the scent of her lingers and temptation’s strong
Cold, cold heart hardened by you (oh)
Some things looking better, baby
Just passing through (no, no, no, no, no)
This article originally appeared in The New York Times.