‘Bummer’: An entertaining guide to anal health - review

The significance of the title of Marcus Burnstein’s book Bummer will, I am afraid, be lost on many readers born and raised in North America. Other Anglos – as we in Israel indiscriminatingly dub all English-speaking people – will get it. A “bum” in American English is something quite different from a “bum“ in British vernacular, and Dr. Burnstein is a Canadian surgeon at the University of Toronto specializing in disease management and surgery of the colon, rectum, and anus. 

To say that Bummer is an unusual book is to say no more than the truth, but it is also immensely readable, very interesting and, above all, extremely informative. It lives up to its subtitle: “What You Need to Know About Anal Health.” Burnstein is generous with his professional expertise, as he covers in simple, understandable terms, the issues he deals with on a daily basis. “Anal problems are very common,” he observes. “Many of them are preventable and all are manageable, if not curable.”

Every human being goes through the process of “potty training,” and thereafter lives with the problems that arise from time to time in the lower region. People are often reluctant or embarrassed to discuss, even with a doctor, common issues such as constipation, hemorrhoids, diarrhea, or wind, and prefer to live with them. Burnstein tackles these and a whole variety of other matters in clear, chatty terms that sweeps away inhibitions, clarifies issues, and indicates when action is called for in this most private and intimate of body areas. 

Facts about anal health

The first sentences in Bummer set the tone for what follows – a clear, uninhibited statement of facts. “The tubular gut is a 20-foot subway line that runs from the mouth to the anus. Food enters at one end. Poop comes out at the other…We’re here to talk about the last part.” He makes the point that the first part of the process can be what he calls “a spectacularly sensory experience,” shared with others and documented by selfies, whereas the latter phase is a solitary mission. “Not a lot of selfies,” he comments.

To ensure that what he is saying is easily understood, Burnstein is generous with diagrams when needed to explain a point he is making. The text, too, is far from a turgid succession of printed pages. He breaks it up with key points interposed into his exposition in a different typeface from the main text, with case studies presented against a shaded background. 

In fact, Burnstein treats his 11 main topics as case studies, presumably drawn from his own extensive records. He starts each with an account of how his patient first presented him/herself to him, proceeds to explain how he diagnosed and then how he treated him/her, and concludes with a section describing the result. Throughout, he takes as much account of his patients and their reactions as his own.

These 11 topics include problems such as itching, incontinence, and constipation, as well as issues like “I see blood” or “I have diarrhea.” Along the way, he gives us his experience also of dealing with “Something’s stuck up there.” 

He follows this with a chapter titled “Odds and Ends,” which includes a short discourse on the comparative merits of washing or wiping. On the whole, he rather favors bidets, which are apparently extremely common in Japan and Italy. He deals in brisk matter-of-fact fashion with the topic of anal intercourse, and follows this with a chapter devoted to debunking some common myths such as whether once a day is the desirable way to move your bowels, and whether colonic irrigation gets rid of toxins (the answer to both is no).

His last chapter is a personal account of his professional life and experience, some of the odd issues that arise, and some of the jokes that circulate among his peers. Finally, in “Why I Do What I Do,” he confides to his reader why he considers himself so fortunate to be doing a job he loves so much. He rounds off his volume with an appendix in which he offers ten tips for anal health, and finally a 17-page glossary explaining the technical terms he has used.

Bummer has been aptly described as “an exceptional contribution to both medical literature and patient education.” With his clear, no-nonsense approach to a topic bristling with potential embarrassments, the author effortlessly bridges the chasm that often divides patient from doctor. Complex though the topic is, the medical content, professional colleagues have affirmed, is impeccable. Yet Burnstein presents it to his readers in a style that makes it easily understood. 

Most people will find Bummer both highly informative and highly entertaining. Full marks, Dr. Burnstein!■

• Bummer: What You Need to Know About Anal Health
• Marcus Burnstein, MD
• Toronto, 2023
• 204 pages; $21.99 (paperback)