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We don't blame you, Isaac...
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The Binding of Isaac, to lightly put it, is a really gross game, filled to the brim with Body Horror, Gorn, and Toilet Humor. While the cartoonish artstyle makes most of it slightly more easier on the eyes than it should be (if you're not too easily disgusted that is), you'll still find yourself cringing over what you'll come across.


  • Really, the environments and enemies in general, from the giant turds lining the floors, the enemies that look like giant anuses firing out laser beams, grotesque monsters lined with all manner of horrific markings... ich. Rebirth adds more details, including things like tiny maggots crawling around the floor in large numbers.
    • The Repentance expansion introduces Dross, a filthy sewer in which most of the enemies and bosses are poop-based. The water in the floor is also murky and, like in Downpour, can drip from the ceiling. Most of the floor's bosses are also poop-themed, with two of them described later below.
    • The Womb, as the name implies, is a level that literally takes place in a womb, with its walls made of flesh and oftentimes green pus on the floors, and filled with rocks made of flesh, fetus or cell-like enemies. The pits one would normally find have fleshy walls, and some of them are filled with urine.
      • Utero adds spiky bones on the walls that look like jagged, sharp teeth, as well as a red, miasma-like screen shader that makes it look like blood is in the air. Repentance makes the level's flesh look much darker, as if rotting, and ditches the previous shader for a new, dark yellowish one and a slight screen-warping effect, making it appear as if the area is submerged in toxic fluid.
      • The Womb's music track in Rebirth, "Viscera", contains... indescribable fleshy sounds that might be a little unnerving to some players. The same applies to the new music track for Utero in Repentance, "Caesarian".
      • The Scarred Womb in Afterbirth further ups the ante. Seriously, it looks like what happened after Mom got a chainsaw to her insides, some of the walls are even "stitched" together with staples, and the walls inside are a fleshy white, making the copious amounts of blood stand out. Definitely not pretty. As for the urine pits, the urine is replaced with blood. Repentance even adds a red shader to further emphasize how nightmarishly gross it looks.
      • And Repentance brings us the CORPSE from Antibirth, and all that it implies - a dead, decayed version of the Womb, with zombified enemies that often have body parts missing or their guts jutting out of their bodies. There's a green miasma-like screen shader reminiscent of the stench of rot, some rooms have you ankle-deep in dark red blood, and others have such blood drip from the ceiling, Downpour-style. If the Womb/Utero/Scarred Womb were disgusting, the Corpse takes it from 0 to 60.
  • Mom herself. She looks rather normal (if rather chubby) in the opening cutscene, but if you use Mom's Bra or fight her as a final boss, she turns into a straight-up Gonk.
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    • It gets worse in Repentance, as Mom returns in the Corpse as Mother. She's essentially a zombified version of herself after Isaac killed her, sporting grey and rotten flesh over her body, and half of her skull obscured by said flesh. Her second phase involves her bursting out of the wall to attack as a massive floating flesh orb, with two other heads where her shoulders were.
  • Mom's. Pad. Also complete with a Gross-Up Close-Up. Appropiately enough, it inflicts enemies with fear!
  • There is a "Gulp!" pill, which destroys trinkets and adds their effects to you permanently - presumably by swallowing them. There are trinkets like a used diaper, a dead fish's head (or its tail), a cancer tumor, the heart of a child, a pushing pin, parasitic worms, coins, scissors, a broken syringe... Draw your own conclusions.
    • Marbles is a trinket version of "Gulp!", and true to its inspiration (kids swallowing small toys like marbles), it has a chance of swallowing a trinket to apply its effects permanently after taking damage. Bad enough that a pill makes it happen voluntarily, but with Marbles, Isaac's gonna gulp down his trinkets whether he wants it or not.
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  • In an example of Shown Their Work, there's a striking amount of enemies and items in the game that are based on real life medical terminology and phenomena. Such examples like the "Fistula" and "Teratoma" bosses, the "Proptosis" item and many more that aren't immediately obvious. This could lead to players searching it up on the internet with unintended results...
  • The game's massive amount of Body Horror, from most of the power-ups that affect Isaac in gruesome ways, to almost all the enemies. Some enemies, like Gurdy or the Stain, seem to be made completely out of flesh, body parts, and viscera.
  • Some items can dye your tears with blood, such as toothpicks, which props your eyes open.
  • The Placenta power-up. Isaac presumably uses it by eating it, and you're forced to look at his blood-smeared mouth for the rest of the run.
  • The Ipecac power-up is a rather literal example. Ipecac in real life is a powerful emetic (ie something that deliberately induces vomiting). So upon getting this power-up you get to witness Isaac green, vomit-covered, and violently ill-looking as he pukes up poisonous bombs. Ouch. Just imagine how miserable the poor kid feels.
    • The item's unlock cutscene (part of it pictured above) lampshades such, too.
  • The aftermath of any room clearing, which leaves the entire room covered in blood, guts, bones, and destroyed piles of poop. The worst is probably after any fight with Larry Jr., who poops all over the room, leaving the entire room practically smothered with blood and feces.
  • Mega Fatty, while probably not the most horrid-looking boss (although its bleeding from the mouth and eyes and grotesque obesity doesn't make it look pleasant in the slightest either), definitely has some of the most disgusting attacks, which includes projectile puking upwards which sends down a rain of vomit, and letting out a fart that either sends a wave of damaging diarrhea or produces Dips. That's right. There's a boss that attacks you by sharting.
    • The Cage is just as gross, if not grosser, which is a given since he's the rotting corpse of Mega Fatty. Not only does he vomit greyish bullets from his decapitated body, but is also stained with a greenish substance (likely vomit) and has an attack where he opens up the huge stitch on his stomach to send out Vises that fire puke-green Brimstone lasers.
    • The Fatty enemies whom Mega Fatty basically serves as a King Mook to aren’t as bad but they do have their share of gross attacks, such as farting on you. But the really disgusting ones are the Fat Sacks and Conjoined Fatties, the former who has empty eye sockets that bleed profusely, and the latter who, like Mega Fatty, also has a diarrhea-based attack, except it's vivid green slime that damages you.
  • Then there’s Peep, who true to his name, uses urine as his weapon. Damaging him also causes his eyes to pop out of his sockets. And worse, he’s one of the more mild examples...
    • The Bloat, for as hated as he is, has his eyes come out of his sockets as soon as the fight starts. And he's every bit as obese as his "alive" counterpart.
  • Mama Gurdy is another nausea-inducing boss, from her deformed appearance to having an attack where she vomits up a pale orange substance on you. Seems like most of the bosses in this game are fond of using vomiting as an attack method...
  • And of course, because the game couldn't be complete without them, the game also stars poop-themed bosses.
    • Dingle is a literal pile of crap. As soon as he speeds towards you, he has a chance to leave a pile of poop. He also spawns Dips and fires poop bullets as his form of attack. Dangle, his alternate counterpart, has a lighter and grosser color sceheme, and has corny pieces protuding from him, which he fires instead of poop. His Corny Dip summons are self-explanatory.
    • Brownie, Dangle's evolved form, is even more gross. He's a giant turd full of corn that leaves trails of poop everywhere he goes and spawns Corn Dips. What's even worse is his black champion version, where instead of smaller poop-based enemies, he spawns Chargers, which are maggot-based enemies. Yes, poop filled with maggots. Make that as you will.
    • Repentance introduces two more bosses that are found in the aforementioned Dross - while the last one on the list is unarguably the biggest offender, Clog is no slouch either. Much like Brownie, he's a giant turd, except he's a dark color. And his attacks involve Bullet Hell patterns of poop shots, spawning Drips, and farting and forming large rows of poop piles across the room.
    • But the unarguable winner to the grossest boss in the game (as well as one of the hardest of any first floor bosses) is Colostomia, which is, you guessed it, based off a colostomy bag, meaning she's essentially a liquid pile of turd suspended in a bag of water. And her attacks are just as gross, by farting explosive gas and firing Butt Bombs that cause the gas to explode. Then when she gets to low enough health, the bag will burst and the boss' real body will merge with the already murky water, splashing it and firing poop shots that match her color. And finally, when you defeat her, she melts into the water, leaving you standing in her remains after the battle.
  • The item "Harlequin Baby" is a reference to the rare and horrifying real-world disorder Harlequin Ichthyosis, which causes babies to be born with puffy red eyes, green or red crackled/scaly skin, and stretched out lips. There are some enemies that also look like harlequin babies, referred to as Freds, with Mr. Fred serving as King Mook to them. Naturally they look really off-putting, Mr. Fred moreso due to being bigger and therefore having more detail.
  • Some of the health items you get, like "Breakfast", "Lunch", "Dinner", and "Dessert", are rotten milk, old meat, and wet and dry dog food. Not only is it repulsive, they also have some depressing implications. Repentance gives us "Supper", which seems to be actual human food in a can, but then again, it could be some sort of Mystery Meat.
  • Lilith's Tainted counterpart, the Harlot, weaponizes Womb Horror by using her child Gello as a weapon. He literally bursts forth from her every time he's sent out to attack, with a gush of blood erupting from her. There's even an umbilical cord connecting him to her, while she looks grotesquely pregnant and moves slower as a result. Not only is it unsettling, it's also very nauseating. Not to mention she has an Eyeless Face with her blindfold gone.
  • Lastly, this can be invoked depending on the items you pick up. To name an example, Dr. Fetus turns your tears into bombs. Butt Bombs turn your bombs into explosive poops that temporarily confuse enemies in the room. Combine both and Isaac is reduced to literally using explosive Dung Fu.
    • The No. 2 item is also a diaper on which, each three seconds you fire, leaves an explosive poop on the floor. You're basically dooming poor Isaac to soil himself every time you fire to attack.
    • Number One lets Isaac attack with his pee! Combine it with something like Brimstone or Ipecac, and those projectiles launched out of his mouth are decidedly yellow-colored. He's peeing out of his mouth. The only upside of this is that he gains a rather silly-looking smile on his face with Number One applied, so he seemingly enjoys it.
    • The Intruder, introduced in Antibirth and added in Repentance, is a spider that... well, to put it bluntly, forces itself into Isaac's head. Its legs poke out of his eyes while his face is ripped open to reveal the spider inside. Taking damage has a chance of causing Your Head Asplode, leaving just the blood-gushing stump of Isaac's neck behind as the Intruder jumps out. How he's still alive after that is anyone's guess.
    • Playdough Cookie has a minor form of this. It's, well, a cookie made of playdough that Isaac stuffs into his mouth, which translates to random tear effects on every shot. His mouth is absolutely crammed full of the cookie's contents and hangs open so you can keep looking at it. Now remember that playdough isn't for consumption...
    • Akeldama basically makes Isaac leave behind a bloody trail of guts while in a room full of enemies, represented by a string of tears.
    • Giant Cell makes a bunch of small faces cluster on one side of Isaac's face. Taking damage makes one of those faces leap out as a small, fully formed mini-Isaac familiar. Imagine how that must feel - a little minion forcing its way out on top of the injury you just sustained.
    • Large Zit is, well, a zit on Isaac's face that gives a chance of firing a creep shot while attacking. That doesn't sound so bad on paper, but keep in mind how acne scars form after picking at pimples and the like for long enough. Now remember that Isaac's primary attack method is with his tears.
    • Leprosy, true to its name, makes Isaac's head look all misshappen and lumpy. Taking damage causes some of his flesh to fly off and then orbit his body to block projectiles and damage enemies it hits. It's a horrific disease weaponized by a small child...
    • Stem Cells gives an extra health up and some shot speed... while also planting a large, dark red lump of flesh on the side of Isaac's face. It looks disturbingly like an embryo.
    • Dead Tooth causes a rotten, grey/brown tooth to jut out of Isaac's jaw, and firing forms a green shield around him to poison enemies. That tooth is so rotted and decayed that it makes a poisonous aura of halitosis!
    • Kidney Stone gives a Charged Attack where Isaac can launch the stone as a high damage projectile after his head turns red, followed by an innacurate shotgun-like tear spray. The force of pushing that kidney stone out makes him cry particularly hard afterward! If you've had these before, you're likely to feel sympathy pains watching him do it again and again.
    • Tough Love is a set of brass knuckles. On pickup, Isaac suddenly gets a bruised face with one eye left swollen shut, and his mouth all lopside. He gains a chance to fire teeth that have more damage than his tears. Not only is it unsightly, it also is rather depressing with its implications.

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