I’ve had conversations about bowel movements that made people visibly uncomfortable.
“I went three times today,” I said once, half-joking. “All no-wipers.”
Some people laughed. Others told me to stop. It wasn’t workplace-appropriate. That reaction stuck with me more than I expected.
We’re scientists. We study human health and disease to hopefully help people one day. But when it comes to ourselves, or even casual conversation, there’s still this quiet line you’re not supposed to cross when talking about GI issues.
My symptoms didn’t start dramatically. It was persistent heartburn, a sense of pressure after eating, and discomfort that didn’t quite match what I thought reflux should feel like. So I did what a lot of medically literate people do. I tried to handle it myself.
I adjusted my diet. Cut things out. Added things back in. Stood in my kitchen more than once trying to decide if eating something was worth how I’d feel the next day. And when the pressure got bad enough, I found unhealthy ways to relieve it, like purging. I told myself I understood what was going on, and I didn’t really want to find out if I was wrong. Because of that, I waited over a year to see a physician, and I wish I hadn’t.
Last year, I was diagnosed with eosinophilic esophagitis (EoE). My doctor also found ectopic gastric mucosa in my upper esophagus. Two separate processes, both contributing to the same symptoms. It explained why nothing I was doing seemed to fully work. Around the same time, I started realizing how far this felt from the role I’m used to.
As an MD-PhD student, I’ve had some experience being on the other side of things. Meeting patients, asking questions, building a differential, and making a plan. Now, I was the patient.
Managing EoE alone is already an arduous process. Identifying triggers, going through repeat endoscopies, and balancing medications with long-term plans. Add in acid-producing tissue where it shouldn’t be and it starts to feel like you’re constantly negotiating with your own body.
On top of that, my attempts to manage things early on probably made everything more complicated. I started having lower GI symptoms and half a dozen new food sensitivities, and suddenly it wasn’t just one issue anymore. I’ve spent hours trying to figure it all out between doctor appointments. Looking things up late at night. Trying to narrow down what I could actually eat. At one point, I was scrolling through lists of low-sulfur foods, trying to piece together meals that wouldn’t set things off.
I started tracking everything. What I ate, when I ate it, my bowel movements, and details on color, texture, and even smell. I log it all in the notes app on my phone and color-code my entries: green for good, yellow for off, and red for diarrhea.
Sometimes patterns show up eventually, but not as quickly as you’d like. This is the kind of tracking doctors tell patients to do all the time — but actually doing it, well, that’s the hard part.
What’s unfortunate is how easy it was to normalize feeling off. Even with some medical training, I minimized it because I could still function. I kept adjusting instead of stepping back and asking if I should just get help sooner.
Over time, it started affecting more than I expected. I was getting more irritable. I would think about the next day and already feel tired of dealing with it. Eating became something I had to plan around instead of something normal. There were times I avoided eating at school or in public because I was worried about what would happen after. It’s uncomfortable and embarrassing. After a while, I just stopped wanting to go out.
GI symptoms are common, but people don’t like talking about them. Even among colleagues, certain details feel off-limits. And yet those are often the details that matter.
I’ve mentioned things in casual conversation that usually stay unspoken: colonoscopies, hemorrhoids, bowel movement consistency, and frequency. Avoiding these conversations doesn’t make the problems any less real. If anything, it just makes people wait longer to deal with them.
I’ve thought a lot about how this would have gone if I didn’t have medical training. I’ve been able to advocate for myself, ask specific questions, and understand the reasoning behind testing and treatment decisions. Even then, it’s been slow and frustrating at times. Without that background, I think it would have been overwhelming.
If I had to take one thing from this, it’s that there’s a difference between paying attention to your body and getting used to something that isn’t right. I told myself I was managing it, but I was mostly just adapting to it (and not very successfully).
We spend a lot of time telling people to listen to their bodies, but we absolutely need to take that advice more seriously ourselves.
That means seeking care earlier and letting go of the idea that we can figure everything out on our own. Be a little more honest, even when it’s uncomfortable, about things we’ve been trained to treat as clinical but still think of as private. Because sometimes the most important clinical insight starts with a question we hesitate to ask: “What are your bowel movements like?”
Or, if we’re honest with ourselves: “What are mine like?”
Jack Tiller is a rising fourth-year MD-PhD student at the University of Texas Medical Branch. Under Drs. Rakez Kayed and Mauro Montalbano, Jack studies how tau pathology impacts nuclear function in Alzheimer’s disease.
Illustration by Jennifer Bogartz
