A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

The common perception about varicose veins is that they are merely an aesthetic or cosmetic problem. Varicose veins are indeed enlarged, twisted blood vessels that many people believe are not life-threatening. But the reality is that the condition may be a symptom of something more serious.

The disease manifests itself through insufficient blood supply in the body caused by faulty valves. As the blood vessels cannot effectively move the blood from the veins back to the heart, the blood tends to accumulate in the veins themselves. Other symptoms may include pain, heaviness, swelling, and skin sores in severe cases.

What Are The Causes Of Varicose Veins?

Varicose veins don’t develop overnight; they are usually the result of multiple underlying factors that gradually affect vein health and blood flow:

1. Valve dysfunction and poor circulation: Healthy veins rely on tiny valves to prevent backflow. When these valves weaken, blood starts collecting in the veins, leading to increased pressure and visible swelling.

2. Prolonged standing or sitting: These days, occupations require long hours of standing, which can hinder proper blood circulation and increase the risk.

3. Hormonal changes: Hormonal fluctuations during pregnancy, menopause, or while using hormonal therapies can relax vein walls, making them more prone to dysfunction.

4. Genetics: A family history of varicose veins significantly raises the likelihood of developing them, indicating a hereditary component in vein wall strength and valve efficiency.

5. Obesity and lack of physical activity: Excess body weight puts additional pressure on veins, while a sedentary lifestyle reduces the efficiency of blood circulation, leading to vein damage over time.

6. Ageing: As people age, veins lose elasticity, and valves may wear out, making older adults more susceptible to developing varicose veins.

What Are The Tips To Take Care Of?

People can manage or reverse varicose veins by:

• Making sure blood is circulating well in the body: An inactive lifestyle or standing for long periods can lead to increased risks of vein disease. Exercise and movement, along with raising the legs, will ensure that blood continues circulating well.

• Maintaining a healthy weight: Obesity can lead to increased pressure on the veins of the legs. Maintaining a healthy body weight is important to avoid and treat varicose veins.

• Wear compression stockings: Compression stockings apply gentle pressure to the veins, which enables them to circulate blood effectively and avoid swelling and other conditions.

• See a vein specialist if necessary: In cases of persistent pain, discoloration of skin, severe itching, or sores that don't heal, it is advised to see a vein specialist, as these symptoms could signal something worse.

How Can It Be Treated?

Varicose vein treatment procedures have become much easier in the modern world. Varicose veins can now be treated with minimally invasive procedures that address the problem at its root cause. These minimally invasive treatments include EVLT (Endovenous Laser Treatment), Radiofrequency Ablation (RFA), and glue ablation. A laser fibre is inserted into the varicose vein during this operation, where it effectively closes it off.

Blood is automatically redirected through other veins after this treatment, which is relatively quick and involves local anesthesia. Patients generally recover within one day. However, EVLT is much less painful, safer, and does not involve leaving scars behind.

Varicose veins are often a symptom of vein disease and thus not just a cosmetic problem. They can be a visible sign of an underlying circulatory issue. Paying attention to early symptoms and seeking medical advice can help prevent complications and improve overall vascular health. Preventing further problems is easy when one knows what to do.

Knee problems were once considered an issue associated with old age. However, an increasing number of Indians in their 30s are experiencing knee pain, stiffness, and cartilage damage similar to arthritis. Doctors are reporting more cases of young adults seeking treatment for knee-related issues that can affect mobility and quality of life.

Sedentary Lifestyle And Lack of Physical Activity

One of the biggest reasons behind early knee damage is a sedentary lifestyle. Many young professionals spend long hours sitting at desks, working on computers, or using mobile devices. Lack of regular movement weakens the muscles around the knees, reducing the support they provide to the joint.

At the same time, some individuals suddenly engage in intense workouts without proper conditioning. This puts excessive stress on the knees, increasing the risk of injuries and long-term wear and tear. Maintaining a balanced exercise routine with strength training and stretching can help protect knee health.

Rising Obesity And Excess Weight

India has witnessed a rise in obesity among young adults. Excess body weight places additional pressure on the knee joints, which are responsible for supporting most of the body’s weight. Even a small increase in weight can significantly increase stress on the knees during activities such as walking, climbing stairs, or running.

Over time, this extra pressure can lead to cartilage deterioration, inflammation, and chronic pain. Maintaining a healthy weight through proper nutrition and regular exercise can reduce the risk of developing arthritis-like symptoms at an early age.

Poor Posture And Nutritional Deficiencies

Poor posture while sitting, standing, or exercising can also contribute to knee problems. Improper movement patterns may cause uneven stress on the joints, leading to gradual damage. Additionally, untreated sports injuries or ligament tears can accelerate knee degeneration if not managed properly.

Nutritional deficiencies, particularly low levels of vitamin D and calcium, are another concern. These nutrients play a vital role in maintaining strong bones and joint health. Deficiencies can weaken the musculoskeletal system and make individuals more susceptible to knee-related issues.

Steps to Protect Knee Health

Preventing early knee damage requires a combination of healthy habits. Individuals should engage in regular low-impact exercises such as walking, swimming, or cycling to strengthen the muscles around the knee. Maintaining a healthy body weight can significantly reduce pressure on the joints.

It is also important to follow an ergonomic posture while working, take frequent breaks from prolonged sitting, and avoid sudden high-intensity workouts without proper preparation. A balanced diet rich in calcium, vitamin D, protein, and anti-inflammatory foods can support bone and joint health. Most importantly, persistent knee pain should not be ignored, and timely consultation with a healthcare professional can prevent minor issues from becoming serious conditions.

Conclusion

The growing incidence of arthritis-like knee damage among Indians in their 30s is a result of multiple lifestyle factors, including inactivity, obesity, poor posture, injuries, and nutritional deficiencies. While the problem is becoming more common, it is largely preventable. Regular exercise, maintaining a healthy weight, following a balanced diet, and seeking timely medical attention can help preserve knee health and reduce the risk of long-term joint damage.

Prime Minister Narendra Modi proposed the idea of a dedicated yoga day during his address to the 69th session of the UN General Assembly in 2014. On December 11, 2014, all 193 UN member states unanimously agreed to observe the International Day of Yoga on June 21.

The primary objective of the International Day of Yoga is to raise awareness about yoga as a holistic practice for mental and physical well-being. Yoga originated in India, and it has a history of more than 5000 years. Some people regard it as a fashionable fitness, but it can be beneficial in various chronic diseases, including diabetes, hypertension, and chronic kidney disease.

The Challenges Faced by Dialysis Patients

Dialysis is a life-saving treatment for stage 5 CKD patients. It has to be done 2- 3 times/week. It has been seen that these patients become physically inactive, which leads to poorer outcomes. They also have a lot of comorbidities like hypertension and diabetes, besides stress. Over the last few years, scientific studies have shown that regular exercise in patients improves outcomes. These patients are a captive audience as they spend 8-12 hours in a dialysis unit every week.

Hence, many dialysis units have incorporated exercise into the dialysis sessions. Yoga has been purported to have multiple health benefits. Over the last few years, even Western science is starting to provide some concrete clues as to how yoga works to improve health, heal aches and pains, and keep sickness at bay.

Yoga: Benefits For Heart Health

Research studies have shown that Yoga lowers blood pressure and slows the heart rate. Two studies of people with hypertension, published in the leading scientific journal The Lancet, compared the effects of Savasana (Corpse Pose) with simply lying on a couch.

After three months, Savasana was associated with a 26-point drop in systolic blood pressure (the top number) and a 15-point drop in diastolic blood pressure (the bottom number), and the higher the initial blood pressure, the bigger the drop. A slower heart rate can benefit people with high blood pressure or heart disease, and people who've had a stroke. Yoga lowers LDL (“bad”) cholesterol and boosts HDL (“good”) cholesterol.

Yoga: Diabetes and Weight Management

In people with diabetes, yoga has been found to lower blood sugar in several ways: by lowering cortisol and adrenaline levels, encouraging weight loss, and improving sensitivity to the effects of insulin. If your blood sugar levels improve, there is a reduced risk of diabetic complications such as heart attack, kidney damage, and blindness.

Researchers have also found that people who practiced yoga for at least 30 minutes once a week for at least four years gained less weight during middle adulthood. People who were overweight actually lost weight. Overall, those who practiced yoga had a lower body mass index (BMI) compared with those who did not practice yoga. Researchers attributed this to mindfulness. Mindful eating can lead to a more positive relationship with food and eating.

Yoga also acts as a stress buster. It quells the fluctuations of the mind, according to it, slows down the mental loops of frustration, regret, anger, fear, and desire that can cause stress. And since stress is implicated in so many health problems—from migraines and insomnia to lupus, MS, eczema, high blood pressure, and heart attacks—if you learn to quiet your mind, you’ll be likely to live longer and healthier.

Yoga: Evidence For Dialysis Patients

There is a lack of good scientific data about the direct benefits of yoga in dialysis patients, but the absence of evidence does not mean evidence of absence. Some people regard it as a fashionable fitness, but it can be beneficial in various chronic diseases, including diabetes and hypertension. Diabetes and high blood pressure are among the commonest comorbidities in Dialysis patients. These patients are under great stress due to their kidney failure.

In another study, a 6-month yoga program was found to be a safe and effective measure as adjuvant therapy to conventional treatment modalities in reducing blood pressure, improving renal function, and improving QOL in these patients.

For the last 5 years, we have been celebrating World Yoga Day in our Dialysis unit and encouraging our Dialysis patients to regularly practice Yoga. Even after a kidney transplant, the better the blood pressure control, the longer the life of the transplanted kidney. Thus, there is enough indirect evidence that yoga is beneficial in patients with kidney diseases.

Yoga: Benefits for Kidney Disease Patients

However, it should be done under expert supervision. There are many other poses in yoga; you can choose those that are suitable for you under the guidance of a professional practitioner. In a word, practicing yoga can promote metabolism, blood circulation, and help discharge more metabolic wastes and toxins. It can improve endocrine functions and help repair damaged tissues.

It can strengthen physical fitness and enhance immunity. It can make the mind peaceful and ease pressure and chronic pains. They also assist in managing water retention in the body. This enables sound sleep schedules and hence better rest. A well-rested body is better able to perform functions such as regulating water in the body and stabilizing the heartbeat.

Precautions Before Practicing Yoga

Though yoga is safe, not every kidney failure patient can do all the poses. For example, if the patients have polycystic kidney disease, bending and other positions that can cause pressure on the abdomen and back should be avoided. If the patients have high blood pressure or lower back pain, leg lifts should be avoided. It is necessary to practice yoga under the guidance of a professional practitioner if you have kidney disease. Yoga asanas are known to increase relaxation.

There are many poses in yoga that are suitable for dialysis patients. Some of these could be done safely during dialysis sessions. However, special care should be taken to ensure that no arm movement on the side has an AV fistula where dialysis is taking place. For those patients who have a permacath (or permanent catheter), these restrictions are not that severe. Of these, I recommend the following, which can be done during the dialysis sessions, preferably before taking snacks and tea.

Yoga During Dialysis

1. Anulom vilom: A person needs to inhale through the left nostril and exhale through the right nostril, and then inhale through the right nostril and exhale through the left one. These alternate nostril breath exercises can promote blood circulation. All these are best done first thing in the morning

2. Kapaal Bhaarti: In this, the person exhales forcefully and then inhales passively. This is repeated a few times as per convenience, followed by a break and 3 – 5 sessions.

3. Bhastrika: In this, a person inhales deeply, followed by forceful exhalation. This is then reapted 3-5 times maximum.

4. Shavasana: In this one lies flat on the couch and is absolutely listless on the couch for a few minutes, with arms and legs lying loosely.

Yoga For Non-dialysis Days:

1. Vrikshaaasan: In this one stands straight and then places the right foot on the inner side of the left thigh, joins the hands, and raises them above the head. After a few minutes, the hands are brought down, and now the left foot is placed on the inner side of the left thigh, and the hands are joined and raised above the head.

2. Tada Asaan: In this, a person stands on his toes and stretches his arms above his head, and joins his hands. In this posture, he then breathes freely and holds as long as possible.

3. Cobra pose: In this, a person lies on his belly with hands flat on the floor on each side and inhales and extends the spine forward, lifts the chest and head off the floor. One needs to make sure that the legs and feet are parallel and hold this position for several breaths. This can help put mild pressure on the kidneys and revitalize the kidney functions.

4. Camel pose: In this asana, the person kneels on the floor, extends the spine, opens the chest, and reaches for the feet. One needs to make sure that the thighs are perpendicular to the floor and the toes are tucked. This posture can help improve blood circulation as well as the body’s circulatory system.

5. Paschimottanasana: In this asana, you bend forward and try to touch your toes.

6. Surya Namaskaar: It is one of the best Yogic aasanas as it involves a combination of 11 steps. You can see details on YouTube.

7. Kati chaakra aasan: in this one lies on the floor and stretches the hands on the sides and legs kept 3 feet apart. The head is turned to one side, and the knees are in the opposite direction

Thus, yoga keeps the internal organs healthy, balances the various systems in the body, and effectively controls the stress of the body and mind. Some of the yoga asanas and pranayamas facilitate internal cleansing rituals that ensure the flushing out of toxins from the body.