10 years ago, I met a local news health reporter at my cousin’s house. By then, I had been a general surgery attending for almost a decade and was shocked by the lack of public health education about anal health care issues. I had also amassed a particularly busy proctology clinic over the years, seeing patient after patient who had suffered for extended periods, afraid to see a doctor and ultimately experiencing delayed diagnoses. Even worse were those who had seen physicians or other clinicians who skipped the exam of the anus and diagnosed “hemorrhoids.” It was a ubiquitous issue, but why?

I realized that there was a paucity of anal health education for both physicians and the public. Much of the available information was outdated, incorrect, and certainly not evidence-based. I explained this knowledge gap to the health reporter, who agreed to help educate the public with a news segment.

A week later, she came to my clinic and recorded two stories: hernias (my other area of special interest) and, more importantly, anal health education. The hernia piece aired right away, but the anal health segment was shelved before it aired. Why? Because it focused on a taboo part of the body. Apparently, we can talk about stomach issues, the pancreas, and intestinal health, but not about the last part of the digestive tract. What was most offensive to the news executives was the word anus. An anatomical term, no different from arm, hip, retina, or colon, yet somehow considered offensive.

The taboo of anal health in mainstream media

If “anus” was offensive, I asked, what word should I use? The answer: “You should use the word rectum.” I went to medical school, I practically slept with my Netter anatomy textbook for years, so there was no way I would claim that the rectum and the anus are the same body part. Anus and rectum are not interchangeable terms. They are distinct structures, each with unique functions and unique pathologies. The reality is that nearly 80 percent of people will experience a problem involving the anus at some point in their lives, which is not true of the rectum. The anus has a highly specialized function unlike any other part of the body, yet it receives minimal attention in medical education.

At that moment, it became clear that mainstream media was not ready, or able, to provide proper education about the anus. I also realized that people are uncomfortable with the word anus and even more uncomfortable with the word anal. Over time, “anal,” which is grammatically an adjective, has too often been used as a verb. As a result, the collective human psyche now has a difficult time using “anal” as an adjective. This was a problem. Luckily, every problem has a solution.

Creating a new vision for anal health education

From the ashes of that shelved news segment came a new vision for anal health education: BootyMD, a nonprofit organization created to tackle the taboo surrounding this topic. Its mission is to provide accessible anal health education for the public, along with education for physicians who are rarely exposed to this subject during training. I learned a great deal from this experience:

• First, public health education through mainstream media has its limits, perhaps even more so now.
• Second, no matter how common a health issue is, if it is considered taboo, addressing it becomes an uphill battle.
• Third, even though “anal” is simply the adjective form of anus, many people’s immediate association is with its non-medical usage.

After searching for a more approachable and accessible word, I chose the word “booty.” While not a medical term, it is widely understood and helps reduce the stigma surrounding this part of the body. Through educational articles, videos, and social media, BootyMD aims to inform the public about all health issues involving the “booty-hole” (also known as the anus).

Addressing the danger of misdiagnosed hemorrhoids

At the core of this effort is a critical message: Not all anal symptoms are hemorrhoids. Hemorrhoids have become the scapegoat for nearly every anal complaint, leading to delays in diagnosis and prolonged suffering. While hemorrhoids are often incorrectly blamed for other benign conditions, the most devastating cases occur when anal cancer is misdiagnosed as hemorrhoids. After witnessing this time and again, I feel compelled to shout from the rooftops: “DON’T ASSUME YOUR BOOTY PROBLEMS ARE DUE TO HEMORRHOIDS!”

If you are a physician, a health care professional, or just a person with a booty-hole, I invite you to join me in bringing attention to this much-needed area of health education. Whether you take time to read and share the educational materials or simply remind others not to dismiss their symptoms, every effort counts. I may never be able to restore the word “anal” to its proper grammatical role as an adjective, but I can work to reduce the stigma surrounding this part of the body, one anus at a time.

Talar Tejirian is a general surgeon.