The meaning of the title of Marcus Bernstein’s book disgusting I fear it will be lost on many readers born and raised in North America. Other English speakers – as we in Israel indiscriminately call all English-speaking people – will get it. “Bum” in American English is quite a different thing than “bum” in British, and Dr. Bernstein is a Canadian surgeon at the University of Toronto specializing in disease management and surgery of the colon, rectum, and anus.
Let me say this disgusting is an unusual book, which means nothing more than the truth, but it is also extremely readable, very interesting and, above all, extremely informative. It lives up to its subtitle: “What you need to know about anal health.” Bernstein is generous with his professional experience as he covers in simple and understandable terms the issues he deals with on a daily basis. “Anal problems are very common,” he notes. “Many of these are preventable and all are manageable, if not curable.”
Every human being goes through the potty training process and then lives with the problems that arise from time to time in the nether region. People are often reluctant or embarrassed to discuss, even with a doctor, common problems such as constipation, hemorrhoids, diarrhea or gas and prefer to live with them. Bernstein addresses these and a host of other questions in clear, conversational terms that remove inhibitions, clarify issues, and indicate when action is needed in this most personal and intimate part of the body.
Facts about anal health
The first sentences in disgusting set the tone for what follows – a clear, no-holds-barred statement of the facts. “The colon is a 20-foot subway line that runs from the mouth to the anus. Food goes in at one end. Poop comes out to the other one… We’re here to talk about the last part.” He emphasizes that the first part of the process can be what he calls a “spectacular sensory experience” shared with others and documented through selfies, while the last phase is a solitary mission. “There aren’t many selfies,” he commented.
To ensure that what he is saying is easily understood, Bernstein is generous with diagrams when it is necessary to explain something he is doing. The text is also far from being a gingerbread series of printed pages. He breaks it up with key points inserted into his exposition in a font different from the main text, with case studies presented on shaded backgrounds.
Indeed, Bernstein treats his 11 major themes as case studies, presumably drawn from his own extensive recordings. He begins each with an account of how his patient first presented to him, goes on to explain how he diagnosed and then treated him, and concludes with a section describing the outcome. At all times he pays as much attention to his patients and their reactions as to his own.
These 11 topics include problems such as itching, incontinence, and constipation, as well as problems such as “I see blood” or “I have diarrhea.” Along the way, he also gives us his experience dealing with Something Stuck in There.
He follows this with a chapter entitled “Odds and Ends,” which includes a brief discussion of the comparative merits of washing or wiping. In general, he prefers bidets, which are apparently extremely common in Japan and Italy. He takes a lively, hands-on approach to the topic of anal intercourse and follows that with a chapter debunking some common myths, such as whether once a day is the desirable way to move your bowels and whether colonic flushing gets rid of toxins (the answer to both is no).
His final chapter is a personal account of his professional life and experiences, some of the odd problems that arise, and some of the jokes that circulate among his colleagues. Finally, in Why I Do What I Do, he confides in his reader why he considers himself so fortunate to be doing a job he loves so much. He concludes his volume with an appendix offering ten tips for anal health and finally a 17-page glossary explaining the technical terms he used.
disgusting has been aptly described as “an outstanding contribution to both the medical literature and patient education.” With his clear, no-nonsense approach to a subject bristling with potential distractions, the author effortlessly bridges the gap that often separates the patient from the physician. However complex the subject matter, the medical content, say fellow professionals, is impeccable. Yet Bernstein presents it to his readers in a style that makes it easy to understand.
Most people will find disgusting both very informative and very entertaining. Full marks, Dr. Bernstein!■
- Nasty: What you need to know about anal health
- Marcus Bernstein, Ph.D
- Toronto, 2023
- 204 pages; $21.99 (paperback)
