When I was 13 years old, I was convinced I was a freak of nature, just waiting to be discovered. My case study wasn’t going to be some page-50 article in Gastroenterological Endocrinology Today, or the countless crap journals that dirty up PubMed searches. No, I was going straight to the top. My story would be one for the record books, a new classic that medical students across the country would study as the dawning of a new era of understanding within the field of human physiology. But after being interviewed for articles in JAMA and The New England Journal of Medicine, I would be chained to a table and put on display as a wondrous yet appalling monstrosity of biology. Like a two-legged elephant or a three-headed snake, I would probably end up in a circus tent, surrounded by bearded ladies and other unnatural creatures. (Personally, I never would have paid to see a bearded lady because I could see my driver’s ed teacher for free, any time I wanted.) And in this circus of freaks, I would be the main attraction. Above my cage would be a sign that said “13-Year-Old Boy With Menstrual Cycle, Look If You Dare!”
This fear was buried deep inside of me and was entirely private. As a young man who had barely hit puberty (I am actually still waiting for the growth spurt that was promised me, and for my beard to come in), the thought of menstruating was embarrassing and horrifying. I was acutely aware that my secret, if discovered by my peers, would be devastatingly and irrevocably damaging to both my reputation and my social life. Also, I was pretty sure it meant I had a vagina. I cannot say that I truly understood how the female anatomy differed from my own, but I was fairly confident that I didn’t have the requisite parts to run a good clean menstruation cycle. That being said, the evidence was clear and present, and facts are facts.
Fact one: once a month or so, I would bleed for seemingly no reason out of my anus. I was (and still am) fairly confident that menstrual blood left the body via the vagina. And as far as I could see, I didn’t have one of those. But I did have an anus, and I definitely had monthly bleeding; it couldn’t be a coincidence. Maybe this was biology’s compromise?
Fact two: I had never been a manly or even boyish kid growing up. I had beautiful flowing blonde hair down to my shoulders, and was routinely mistaken for a young girl. It happened at least once every time I left the house, from elementary school until well after my Bar Mitzvah. I’d be out to dinner with my dad and brother before Boy Scouts, and the waiter would take their orders, turn to me (mind you I am in full uniform), and say “and what can I get for the little lady?”. That kind of thing is hard to ignore. Even when I stayed home, I couldn’t escape my apparent shortage of testosterone.
Phone rings. I answer.
“Hi Lorrie this is Midge Pines from Temple Emanuel, how are you? I was wondering if you had a chance to look at the Rabbi Search Committee meeting notes because…”
“I’m sorry,” I’d interrupt, speaking as loudly and deeply as my girly little vocal cords would allow. “She’s not here right now. Can I take a message?”
“Oh I’m sorry, is this Rachel, or Rebecca? You girls sound all grown up!”
I guess I was used to being mistaken for a girl. Maybe my hair was so pretty, and my voice so high, that I had even fooled my own biology. Maybe I was less athletic and shorter than the other boys because I had some sort weird mutation. Normal boy outsides and female insides…that was a thing, right?
Fact three: Normal people don’t bleed out of their asses.
I saw two possible explanations for my condition. The first was that I was a normal (if somewhat underdeveloped) adolescent male afflicted with a fairly serious bowel disease. The second (and seemingly more rational) conclusion, was that I was menstruating out of my butt hole. I had a secret uterus that clandestinely sloughed off its lining monthly, and I had evolved a connection from this accessory female reproductive tract to my colon.
Eventually, I would decide to explore the possibility that I was indeed sick, and not a new sort of hermaphrodite after all. But first I was tempted to write off my bleeding as irritation, and started carrying my own toilet paper and M.A.W. (Moist Ass Wipes) everywhere I went. As a veteran “lactard” (my friends’ un-P.C. term for the lactose intolerant) I knew that certain foods could really do a number on my stomach. I had seen first-hand the carnage that could result from a careless rendezvous with a milkshake or a box of Krispy Kreme doughnuts, so I avoided dairy and fried foods. And most meats, because they seemed to make it worse. And gluten. And fruit juice. And raw vegetables. Still, the bleeding did not go away.
After a few more episodes of what can only be described as “heavy flow,” I was out of excuses and it was time to go to Dr. Dad. My dad is a general medicine internist in Greensboro, and has always played a big role in my family’s health care maintenance. Discussing my health with him was usually no big deal, but I was not comfortable submitting my menstruation theory, and I certainly didn’t want him to be the one to discover the anatomical abnormality that I feared hid within me. If that bomb had to drop, I wanted it to be in the safety of some anonymous doctor’s office, preferably after an unprecedented yet successful hysterectomy. When I did finally bring up the bleeding, I was amazed at the sheer number of questions my dad had about my poop.
“What color is the blood? Is it on the toilet paper or dripping in the bowl? Does it hurt? Can you feel anything weird on your anus? How often do you go? What does it feel like? Does it hurt to push it out? Are you struggling? Cramping?” He asked these questions with such genuine interest that I was compelled to answer.
“Well if you really want to know… bright red, both, always, no, a few times a day, it feels like pooping, only sometimes, as much as the next guy, and only when I eat something I shouldn’t.”
“Hmm” he said, “when was the last time this happened?”
“Recently” I replied. I did not feel it necessary to mention that, although I never kept record, it seemed to happen about once a month.
“I’d really like to get a look up there when you’re bleeding.”
The American Cancer Society suggests that men start screening for colorectal cancer once every five or ten years after age 50. This suggestion changes slightly based on family and past medical history. If a patient’s GI tract is particularly in touch with its Eastern European Jewish heritage and the bowel diseases that often accompany it, screening may start at a younger age, and/or be scheduled more frequently. My bowel, apparently, is named Moishe, corns his own beef for the corner deli, and always smells like onion bagels.
I got my first colonoscopy at age 14. Being a short Jewish guy with GI issues, I soon learned that Crohn’s Disease and Ulcerative Colitis are in fact more common causes for bloody stool than a hidden uterus and invisible ovaries. I was sick of frequent bleeding, cramping, diarrhea, and all of the other fun side effects of an angry GI tract, so I decided to get a diagnosis once and for all. If you, dear reader, take but one bit of information from this article, let it be this: prepping for a colonoscopy is one of life’s true delights. For 24 hours prior to the procedure, the patient fasts, drinks plenty of water, and swallows a large volume of an oily poison (now available in pineapple flavor!) that assists in “cleansing the colon.” This is a medical euphemism for crapping your brains out, so stock up on M.A.W.
After my exam, which was painless (that is, after a nice cocktail of Versed and Demerol), the results were a mix bag. I did not seem to have any duct connecting my colon to a secret uterus (phew), nor was there any indication of Crohn’s Disease. The doctor “couldn’t see everything” (apparently I had not finished my cleanse to 100% satisfaction), but he could see enough to rule out Crohn’s and most likely UC too.
“So, what’s wrong with me?” I asked.
“You know how some people get nose bleeds? It’s like that, but in your rectum. Let’s go with Irritable Bowel Syndrome.”
This diagnosis stuck, though it was called into question a few times here and there. The same story continued until my senior year of high school, when a three-month episode of “blanus” (my sister’s term of endearment for “bloody anus”) sent me back to the GI doctor. Surely, this wasn’t normal. After another nice colonoscopy prep (this time with close to 100% cleanliness, I am proud to say) the diagnosis came back the same: no uterus, no Crohn’s, no UC.
“You have IBS, and your colon bleeds,” my doctor explained. “There are some internal hemorrhoids, and they bleed if you don’t have enough fiber, and when you get anxious diarrhea, or constipation.”
“Ok, I get it.” I said. “You don’t have to be a dick about it.”
And I continued to “get it” for three more years until I studied abroad in Spain. Generally speaking, Spanish food and I do not get along. I love to try new foods, and I always want to like everything I try. But my pallet sophistication is limited by how picky I was as a kid. Will-power and five seasons of Top Chef can only change a man’s tongue so much, and I was having a hard time finding food I really liked in Madrid. I hadn’t eaten pork regularly in about 15 years, and was fast approaching my limit of ham-flavored things. Unable to compose a normal diet from the local fare, I ate three cups of yogurt a day. Suddenly, and much to my surprise, my bowls started moving like those of the gentiles I had admired my entire life. No blood! No pain! Just glorious, satisfying poops, day after day.
After my class ended, I went traveling for a few weeks. Arriving in Paris, I was reminded what good food tasted like. The streets smelled like piss, but I was convinced this was heaven. I didn’t find a meal that I didn’t love; every new bite of food that wasn’t jamón or patatas was my favorite. Everything was rich and flavorful and exciting, and I ate every creamy, flakey, buttery thing I saw. But I would soon learn that the gang-banging my colon was receiving had its consequences. Two days, six crepes, two steaks au poivre, three plates of boef bourguignon, and five tarte tatines later, my toilet bowl looked like a crimson Jackson Pollock painting.
As before, the bleeding continued despite my efforts to get it under control. When I got stateside I went to student health at UC Berkeley, to make sure the last two doctors hadn’t missed anything. A nice young man, who introduced himself simply as “Raj” and who wore no nametag, badge, coat, or stethoscope, took my history, blood pressure, and temperature. Then he scoped the bottom six inches of my rectum with a short anal speculum. To date, I cannot be sure that Raj was a doctor, nurse practitioner, PA, or any sort of health care worker. Still, he came to same conclusion as all the doctors I’d seen: small bleeding internal hemorrhoids, and some cracks in my rectum.
“It’s like a nose bleed,” he said.
“Yeah, I’ve heard that before.”
Somewhere buried in the poop jokes, there is a lesson. I think what sticks out in my mind is the cyclical nature of the disease. No matter how many times I am diagnosed with the same thing, I go back to the doctor when I get a flare-up. And for the most part, I think that’s a good thing. Maybe the first time I decide not to worry about a really bad flare-up will be the day I start to exhibit early signs of colon cancer. (Puh puh puh, as we would say in my house, pretending to spit on the ground to ward off bad luck.)
Even more than the cyclical nature of the disease, I think about that deep fear that I felt – that haunting feeling that something was wrong with me. It churned in the back of my consciousness for years, but I was too embarrassed to express it, or to ask the questions that could put my mind at ease. I can only guess how many ways I tried to give various doctors the opportunity to tell me that I was indeed menstruating.
“So, does everything look… alright?” I might ask.
“Yeah besides the bleeding, it looks good. No polyps, no ulcer. Looks good.”
I can’t say I wanted my GI doc to find an active cycling menses, but some kind of answer other than “eat more fiber and don’t strain when you’re on the can” would have been comforting. I hope, as a doctor, I can find ways to calm my patients’ nerves. I hope I will be aware when they’re nervous or anxious about their diagnoses (or lack thereof), so I can help them start to move past their anxieties. I hope my patients never have to feel the way I felt when I was 13. And I really hope I don’t have a uterus.