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!

Irritable Bowel Syndrome (IBS) is a common but often overlooked gastrointestinal disorder; as a result, IBS is very prevalent, with less than 15% being diagnosed.

Individuals frequently experience recurrent symptoms such as bloated abdomen, abdominal pain, gas, diarrhea, or constipation, and normalize these symptoms over time or attribute them to "something they ate" or everyday stresses. Therefore, IBS remains undiagnosed for many years.

Why Diagnosis Is Often Delayed

One reason for this delay in being diagnosed is that the symptoms occur intermittently. It is also important to note that the presentation of these symptoms is inconsistent and unpredictable; there may be episodes where the IBS can last many days, and then completely resolve, thus providing a false sense of relief. Therefore, many individuals choose to delay consulting with a physician due to their belief that the symptoms they are experiencing are not serious.

Stigma Around Digestive Health

Another contributing factor is that there is still a degree of reluctance or discomfort associated with discussing problems related to the gastrointestinal tract openly; this only further complicates under-reporting statistics.

A ‘Functional’ Disorder Adds to Confusion

Finally, IBS is a functional disorder. Therefore, routine diagnostic testing will not reveal any visible abnormalities. Many patients may assume that the symptoms they are experiencing are not "real" or are not significant enough to warrant seeking medical attention, even though the discomfort they experience can be quite significant and affect their daily lives.

If you continually ignore symptoms of IBS, it will hurt your quality of life, productivity, and mental health. If you have persistent discomfort, you are likely to develop anxious feelings about eating, socializing, and travelling. Furthermore, if you don't manage your symptoms, you may experience a combination of untreated IBS with one or more other illnesses that are either gastrointestinal or metabolic; consequently, establishing the correct diagnosis for your IBS will be increasingly difficult as time goes on.

Why Early Action Matters

It is of the utmost importance to identify and respond to early warning signs of IBS as quickly as possible. A thorough evaluation can rule out other illnesses and provide a pathway for appropriate management, including dietary modifications, stress management techniques, and, if necessary, medical treatment.

Once you address your IBS, you will experience better control of your symptoms and eliminate the long-term consequences of IBS, both physically and psychologically.

India has long been considered a low-incidence country for colorectal cancer, but that picture is changing fast. Based on current trends, India could see a sharp rise in colorectal cancer cases and deaths by 2035, driven largely by rapid urbanization and the widespread adoption of westernized lifestyles. The burden is expected to hit urban populations hardest, making timely awareness and screening no longer optional, but essential.

A Younger Face On An Older Disease

Perhaps the most alarming shift is who is getting diagnosed. Over the past decade, there has been a worrying increase in colorectal cancer among younger Indians, patients in their 40s and 50s who would not traditionally have been considered high risk. Clinical observations suggest that as many as one in five colorectal cancer patients today falls into this younger age group.

What makes this particularly concerning is not just the frequency, but the severity. These younger patients are presenting with more node-positive disease and poorer tumor histology than their older counterparts. The cancer is often more aggressive and more advanced at the time of diagnosis, a direct consequence of delayed recognition and a lack of awareness among younger demographics.

Symptoms That Are Too Often Dismissed

The red flags for colorectal cancer are not subtle. Rectal bleeding, persistent abdominal discomfort, pain, and a noticeable change in bowel habits are the most common warning signs. In some cases, patients may present with bowel obstruction. And yet, these symptoms are routinely dismissed, mistaken for hemorrhoids, acidity, or irritable bowel syndrome, until the disease has progressed significantly.

The message from clinicians is unambiguous – never ignore these symptoms, regardless of age.

Who Is At Highest Risk?

While colorectal cancer can affect anyone, certain individuals carry a substantially higher risk and should be especially vigilant. These include those with a family history of colorectal or uterine cancer, patients with inflammatory bowel disease, individuals with multiple gastrointestinal polyps, and those with features suggestive of hereditary cancer syndromes.

For anyone with a relevant family history, specialists strongly advise seeking a formal genetic risk assessment. Early identification of hereditary risk can be lifesaving, and the conversation with a doctor should not be delayed.

Screening: The Most Powerful Tool Available

The most effective way to defeat cancer is to detect it early, ideally before it becomes cancer at all.

While routine population-level colorectal cancer screening is not yet standard practice in India, advanced diagnostic tools are increasingly available at quaternary care centers. These include colonoscopy, fecal occult blood testing, CT colonography, flexible sigmoidoscopy, double-contrast barium enema, and DNA stool testing. Importantly, these methods can identify precancerous polyps before malignant transformation, providing an opportunity to intervene well before a cancer develops.

In Western countries, organized screening programs have already demonstrated meaningful reductions in colorectal cancer mortality. The tools are now available in India; what is needed is the awareness and urgency to use them.

Treatment Has Never Been More Sophisticated

For those who do receive a colorectal cancer diagnosis, the landscape of treatment has transformed dramatically over the past two decades. Leading oncology centers in India now follow a personalized, multidisciplinary approach combining surgery, combination chemotherapy, radiation where indicated, and biomarker-guided targeted therapies tailored to each patient's tumor profile.

In metastatic disease, targeted therapies designed around tumor characteristics and biomarkers have revolutionized outcomes. Minimally invasive techniques, including laparoscopic surgery and advanced robotic surgical systems such as the Da Vinci Xi, have made recovery faster, less painful, and significantly shorter, improving quality of life alongside survival rates.

Even Metastatic Disease Is Not A Death Sentence

Advanced or metastatic colorectal cancer does not mean the end of hope. With modern chemotherapy and immunotherapy protocols, many patients with liver or lung metastases are being successfully downstaged, allowing surgical intervention that was previously not possible.

Specialized centres in India are now performing high volumes of parenchyma-sparing, image-guided liver resections for colorectal liver metastasis, with outcomes comparable to the best institutions globally.

The Way Forward

The priorities are clear: build awareness around symptoms, promote regular screening among high-risk individuals, and ensure that those diagnosed, at any stage, have access to specialized, multidisciplinary care.

Colorectal cancer, even when diagnosed late, is increasingly a beatable disease. The combination of early detection, advanced treatment, and the right medical expertise means that for a growing number of patients, a return to normal life is not just possible, it is the expectation.

Colorectal Cancer is not only one of the most common and deadly cancers, but is also one of the most preventable ones.

Unlike many other cancers, patients have a clear window of opportunity to stop it before it even begins. Almost always, these cancers start as small growths called polyps or precancerous lesions on the inner lining of the colon or rectum.

There is a long interval of time before polyps develop into cancer. During this time, they can be removed if they are identified. If a doctor removes a precancerous polyp during a routine screening, they would not only have nipped the cancer in the bud, but would have also prevented it from occurring.

However, there is a persistent taboo surrounding discussing bowel movements and other risk factors, and public understanding of its symptoms and crucial screening procedures frequently lags.

Dr Jeremy Clark, a consultant general surgeon specializing in colorectal diseases at Nuffield Health in Brighton, has underscored five critical warning signs the public must recognize, The Independent reported.

1. Blood in stool

“Passing blood when you go to the toilet is a worrying feature that you should flag to your GP,” Clark said, adding that the color can vary from bright red to almost black.

“If you see blood in the stools, particularly darker-colored blood or blood that’s actually mixed in with the stools, just once, and it’s significant, that should be reported to your doctor straight away. Don’t wait for that to keep on happening,” he added.

2. Changes in Bowel Habits

Dr. Clark stated that although more constipation may not be a risk factor, any sudden changes in bowel movements that last for a couple of weeks and do not go back to normal must be checked.

“If your bowels go from working once a day like clockwork, and then suddenly you’re going two or three times a day, and the bowels are a bit looser, that’s something that needs to be looked into,” the expert added.

3. Abdominal pain

Dr Clark highlighted that bowel cancers can cause abdominal pain, even in the initial days.

4. Bloatedness

The feeling of being 'quite often’ bloated may also indicate that something is going wrong in the bowel, Dr. Clark said.

5. Unexplained weight loss

Bowel cancers can impact digestion and cause weight loss

Dr Clark said that as these symptoms are common with other conditions, such as hemorrhoids or irritable bowel syndrome (IBS), people often ignore or easily dismiss these symptoms. He urged patients not to ignore and visit their doctor if they notice any of these symptoms.

Also read: US Health Secretary Robert F. Kennedy Jr. Stalls 600M Global Vaccine Aid For Poor Nations: Report

What Is Colorectal Cancer?

The American Cancer Society notes that colorectal cancer is a cancer that starts in the colon or the rectum. Colorectal cancer impacts around 1.9 million people every year, noted the World Health Organization (WHO) as per its 2022 data.

It is a disease of the large bowel and a type of cancer that originates from the rectum or colon. A person's colon, cecum, rectum, and anus make up the large intestine.

According to experts, if you are above 45 years of age or have high-risk factors, you need to take the initiative to be screened.

The FIT (Fecal Immunochemical Test) is a simple, non-invasive at-home stool test kit that can collect a small sample of your feces, which can then be tested.

“If it comes back as positive, that means there is blood in your stools which needs to be investigated,” Clark said, adding that the next step is typically the Colonoscopy – the gold standard.