“My engagement-moon was hot!” Chloe exclaimed. “My fiancé wined me, dined me, and inserted all my suppositories.” “Where’s the romance without enemas?” Judy laughed at their restaurant table. Finally, someone who understood! “When we mention anal . . . we mean fissures.” Then they looked at the menu. “Are you doing caffeine?” Chloe asked. “Want a latte? They have great almond croissants here.”
“Caffeine: yes. Milk: not so much,” Judy replied. “Gluten: maybe. Nuts: out. Unless you want our entire conversation overtaken by my loud stomach noises.” “I don’t mind,” Chloe answered. “Because mine will be even louder.” Chloe and Judy had known each other for a while due to their respective books about World War II, but a couple of weeks earlier Judy had noticed that Chloe was featured on Today and in People articles about ulcerative colitis—a disease Judy suffered from as well. In these articles, Chloe spoke about her disease intimately, with details Judy was stunned to see in print: bloody stools, leakage, rectal irritation.
These were symptoms Judy had experienced but had never discussed outside a hospital, not even with her closest friends. What a relief to have someone put it all out there; Judy felt seen! Chloe, she thought, was truly brave. Judy immediately DMed Chloe to thank her for her unusual candor about her bowel habits, which is how they ended up in a café in the basement of 30 Rock, just below NBC. Both Chloe, in her studio-ready chic red dress and stilettos, and Judy, in her writerly three layers of athleisure, had clocked the nearest bathroom within seconds of sitting down. Now they quipped about bowel movement consistency, the sheer pain of digesting apple juice, and the art of finding clean toilets in New York City. (For instance, Chloe is a top customer at numerous coffee shops across Manhattan just to gain entry to their bathrooms, whereas constant access to a sanitary loo in Midtown East is the main reason Judy joined the Harvard Club.) What a pleasure to schmooze openly with someone who shared the intestinally challenged lifestyle! Few people talk frankly about our culture’s final taboo: the bowel.
Never mind analyzing stool habits; even an escaped digestive gurgle makes people blush in sheer shame. We think of the intestines as abject and debased, but they are as crucial and special as our other body parts, and the tissues that create our farts, burps, and gaseous cramps deserve the same TLC as any other major organ system. Welcome to our Bowel Movement Movement! But this isn’t all a joke. The meteoric rise in colon cancer cases among young people has been making national headlines. Colorectal cancer is now the top cause of cancer deaths in men and women under fifty in the United States. African Americans are 20 percent more likely to get colorectal cancer than most other groups. The incidence of all manner of bowel conditions affecting the large and small intestines is skyrocketing. Fifteen percent of Americans— mostly women—are diagnosed with irritable bowel syndrome (IBS), and this figure likely underestimates the condition’s prevalence. That’s over forty million people with abdominal pain, bloating, diarrhea, and constipation. On top of this, half of Americans develop diverticulosis—potentially dangerous pouches in the wall of the colon—by age sixty; over two million have been diagnosed with celiac disease, an autoimmune reaction to eating gluten that damages the small intestine’s lining and which is increasingly prevalent; and three million suffer from inflammatory bowel disease (IBD), chronic inflammation of the gastrointestinal tract. IBD en compasses ulcerative colitis (which both Judy and Chloe have) and Crohn’s disease, and its occurrence is steeply on the rise. According to the National Institutes of Health, from 2006 to 2021, IBD prevalence increased at a staggering rate of 46 percent. Though researchers do not yet know exactly what is causing this hike, it’s likely that environmental factors such as the Western diet and even the use of hand sanitizer (which has changed our microbial landscape), as well as increased awareness and better diagnostic tools, are contributing elements. These numbers are crazy high. On that fateful January day, deep in the bowels of Rockefeller Center, Judy and Chloe were giddy, thrilled to be able to share with each other so candidly and easily. What a joy to have someone else understand your shame, pain, and obsessive concern with excreta.
As Judy walked Chloe back to her office, both of them knew: They had to do something. They had a duty (doodie?) to bring this sense of relief and camaraderie to others. “Why not write a book?” Chloe suggested. It struck Judy that Chloe was onto something: She had never seen a book that really delved into the GI tract from a personal, candid viewpoint. In the decades that she’d had colitis and a pouch, Judy had simply never come across a book that spoke to her lived experience. Though there are excellent related medical texts out there (in fact, many of them are sources here) and several guides written by smart, thoughtful health practitioners, they often feel aseptic and/or don’t prepare you for what to wear to red carpet film festivals. A handful of fascinating cultural histories and investigative reports have delved into the alimentary canal, as have a billion re lated cookbooks and tomes that tout the promise of specific diets, but again, none of these publications address actual everyday life on the toilet. Cancer, hoarding, depression, infertility—these conditions all have their popular narratives, featured in scripted and reality TV shows and movies, but where’s the protagonist with diverticulitis? Bowel disease remains deeply taboo. But we need to talk about our bowels without shame. Not only do information and guidance improve people’s lives, but honest ac counts of disease inspire others to be honest with themselves. Just as our foremothers opened up conversations around breast health, we need to talk about bowel disorders so that people know which symptoms are abnormal, realize when something is awry, and have the shame-free confidence to call a doctor. This will help people feel less alone and may even save lives. So here we, Chloe and Judy, are! Together, we bowel babes have a combined fifty-six years of experience navigating colitis, a disease in which the large intestine becomes inflamed, leading to a variety of symptoms from gas cramps to bloody stools—sometimes over twenty times a day. We handle our conditions differently, thereby offering you, dear readers, a wider scope of experience and insight. Chloe manages her colitis with traditional medication alongside alternative therapies.
Judy opted for surgery and had her colon re moved and her small intestine converted to a pouch; she lives with the pouch’s strange consequences and complications. Both of us have children and careers, and both of us travel the world—and, as with most people who suffer from intestinal disease, both of us think about our bowels at every turn, every day. In this book, we are not offering a miracle cure or dietary panacea; we are not selling a lifestyle or theory (this is no snort-three-cups-of-cinnamon-zest before-your-daily-bone-marrow-and-turmeric-midafternoon breakfast kind of thing), but we’re schmoozing (shooting the shit?), sharing advice, information, and personal stories (very personal stories) in the hope of opening cultural conversation to provide comfort, camaraderie, and potentially lifesaving awareness. With topics ranging from the unexpected complications of medications to what to order on a first date, this book encompasses the physical, emotional, and practical experiences of living with a bowel disorder in a way that we hope is loud, witty, and—dare we say it—explosive. We want to help those facing a bowel disease or syndrome diagnosis, to demonstrate options, and to open up discussion.
Three Important Notes
1. In this book, we’ve chosen to focus on a few common disorders: IBS, IBD, celiac disease, and diverticulitis. Each of these conditions has a different origin and prognosis, but the lived experience is often similar, with overlapping symptoms, diagnostic tests, treatments, complications, and day-to-day worries ranging from what-to-wear-when-bloated to is-this a-sign-of-cancer. Both of us have ulcerative colitis, a form of IBD, which is highlighted in our personal tales, but we included information and insights about these other conditions as well.
2. We are not doctors! (Well, Judy is a doctor of art history, but unless you’re particularly concerned with postmodern conceptions of interiority, I wouldn’t take any of her advice too seriously.) We have interviewed several of the world’s top physicians in the field and included their insights, but ultimately The Girl’s Guide to Guts is not a medical guide. Please talk to your physician about any and all of this. That is, don’t try this at home, kids, before okaying it with your doctor.
3. We’ve brought to the page a bit of stigma-busting, stoma celebrating, Febreze-and-toilet-paper humor that attempts to normalize women’s bathrooming. We’ve tried to be humorous because, well, we’re hilarious, and also, humor helps us relay information, connect, and survive. But our (at tempted) humor should not detract from the fact that we are talking about serious conditions that can cause staggering degrees of physical and emotional pain. What we are: your bowel besties.
We hope to share the warmth and understanding of a trusted friend. Just as we came together thanks to a profound interest in fecal consistency, we offer our companionship. Girl, you are no longer on the toilet alone. We’re right there with you! The Girl’s Guide to Guts might focus on the abdomen, but we hope it’s full of heart.
