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No one tells them their bowels are going to lose strength and coordination, so it gets more and more difficult to have bowel movements. No one warns them about obstipation, much less bowel obstructions. I have a saying I repeat often in clinic: “Proper pooping prevents problems!” I say it because it makes people chuckle, because it destigmatizes needing to poop. Everyone poops. And it turns out pooping requires both a complex network of nerves to create peristalsis, and stools soft enough to move through the bowels, and I have watched more than one elderly patient die because their bowels stopped working right.

No one talks about hemorrhoids, so I have patients coming in terrified by blood in their stools–and listen, blood in your poop is definitely a good reason to see a doctor; if you’re over 50 and you haven’t had a colonoscopy, get one. It’s the best health screening we have evidence for, in my opinion. Colon cancer is a bitch. But more commonly, people have bloody stools because they have either hemorrhoids that are bleeding or because they have an anal fissure after straining on a hard bowel movement. Do you know what a hemorrhoid is? I didn’t, until I was well into medical school. Everyone has them. They’re venous columns that surround the rectum and anus. Internal ones can bleed; external ones can itch. Most people will get them eventually. Be kind about them.

Everyone is going to have trouble peeing if they live long enough. Men can’t start, women can’t stop. Because people with prostates will often have benign enlargement of the prostate–it’s not cancer, but it gets bigger–and the urethra, the tube that lets urine leave the bladder, goes through the prostate. Bigger prostate = compressed tube, less flow. Meanwhile, people with uteruses have much shorter urethras, which means that when we lose that beautiful collagen and elastic, we also lose it in the two sphincters that help us keep from leaking urine, and so we leak urine. Especially when something triggers an increase in intra-abdominal pressure, like a sneeze or a cough or a laugh.

All these things people are taught to be ashamed of and embarrassed about–they are so common. They’re normal parts of having a human body and doing the things one does with a human body. Poop trouble? Welcome to the club! People have been writing about their cures for constipation for as long as written language has existed. Listen, you are not alone. You are not alone. You are not alone. And that means that when someone else has a gross problem, you must be kind to them, because that is going to be you. There will be a day when you have diarrhea, because viral gastroenteritis spreads like wildfire every winter. There will be a day when you cough a huge glob of mucus comes out, because mucus is a natural defense mechanism and kind of miraculous but also nasty. Every gross thing a body can do, yours is likely to do, if not now then later.

But here’s the kicker: after the diagnosis, still not knowing if it had metastasised or not yet (but knowing it almost certainly had because of the size), she broke the news to her family.

And it turned out her father, grandmother and aunt had all also had it. That meant it was a genetic risk; that meant she should have been on a watchlist for it, with regular testing. But she wasn’t, because none of them ever told her.

Why?

They were embarrassed. Bowel cancer was gross and embarrassing, so they all kept it quiet. As a result, because her family was too embarrassed to even tell each other to look out for the warning signs, my sister’s friend was not put on the watchlist to save her life, and it nearly killed her.

Autumn in Yosemite Valley