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!

Lots of new developments around weight-loss drugs, with the World Health Organization now stepping in to lower the dosage, and many companies like Eli Lilly actually slashing down the price for better access. Amid this what people may be forgetting are the unusual side effects of being on popular weight loss drugs.

The internet has made room for a lot of unusual confessions, but few are as chaotic, or as oddly supportive, as the Reddit threads where people taking weight-loss jabs like Ozempic and Wegovy openly discuss their most embarrassing side effects. And one theme keeps popping up: unpredictable bowel movements, including the dreaded “sleep sh*ts.”

One Reddit user started a viral thread with a painfully honest plea: “Any advice for not sh*tt*ng in the bed while sleep?” The user said they’d been dealing with this for months and called it “the most annoying side effect.” Another person, already three shots in, nervously listed “sh*tt*ng the bed” as something they were “not looking forward to.”

This mix of diarrhea, constipation, and everything in between has sparked concern, and, for many, shame. But as more people turn to GLP-1 medications for weight loss, understanding why this happens has never been more important.

Also Read: Ozempic Stomach: Why Ozempic Consumers Are Suing This Popular Weigh-loss Drug For 2 Billion Over Stomach Paralysis

Pooping Uncontrollably: It Happens More Often Than You Think

The phenomenon isn’t limited to anonymous Reddit users. A Florida nurse, interviewed by Business Insider, described weeks of constipation so bad she tried “everything from stool softeners to a megadose of Milk of Magnesia.” But by attempting to “hit it from the top and bottom,” she ended up losing control altogether, hence her reluctant membership in the self-appointed “sh*t the bed club.”

Another semaglutide user confessed online: “I quite literally sh*t myself while sleeping… tough few days of diarrhea after my first injection.” And yet, others reported the opposite: stubborn constipation, going days without relief, or passing what one Redditor bluntly called “rocks.”

These extremes highlight one thing clearly, digestive unpredictability is surprisingly common.

Why Do GLP-1 Drugs Mess With Your Gut?

Semaglutide (the active ingredient in Ozempic and Wegovy) is part of a class of medications called GLP-1 receptor agonists. These drugs work by slowing gastric emptying and nutrient absorption so users feel full for longer. But the same mechanism that makes the drugs effective can also confuse the digestive system.

Medical News Today notes that Ozempic often triggers a “stool reflex”, when food entering the gut prompts the colon to clear space. For some people, this reflex becomes unusually strong or overactive, leading to diarrhea.

On the flip side, slowing the gut too much can cause constipation. That’s why Wegovy’s own prescription info reports both diarrhea (30% of users) and constipation (24% of users) during clinical trials.

New York gastroenterologist Dr. Eric Goldstein told Insider that while digestive issues are a known side effect of GLP-1 drugs, the severity seen in social media posts is likely exaggerated because people tend to share the worst-case scenarios. Still, he emphasised that “any medication… may have changes or side effects that need to be monitored.”

How Long Does It Last — And Should You Be Worried?

Fortunately, most people don’t deal with weeks of chaos. According to 2022 research, Ozempic-related diarrhea typically lasts around three days after starting treatment. For the majority, symptoms settle within the first four weeks as the body adjusts. Only 4.3% of people stopped treatment because of GI side effects.

However, flare-ups are common after dose increases, and doctors may recommend slowing dose escalation or adjusting timing if symptoms become disruptive.

Still, experts consistently advise the same thing Reddit does, though with less sarcasm: monitor your symptoms, stay hydrated, avoid greasy or heavy foods, and reach out to your doctor if things become severe or last longer than a few weeks.

The World Health Organization (WHO) has warned that not enough weight loss jabs will be left for those who need it. While weight loss drugs offer a great potential to tackle the obesity issue that is on the rise, globally. However, the accessibility to those who actually need it is fewer than 1 in 10 people.

Worldwide, there are one billion obese people, and are the ones calling for widespread and fairer access to these GLP-1 medication. Health prediction says that by 2030, more than two billion people will be obese unless action is taken seriously.

However, the limited production of the GLP-1 medication, high costs, and supply chain constraints have become a barrier to its universal access. WHO has already added the GLP-1 medication to its 'essential' medicines list for overweight patients with diabetes that countries are advised to provide.

"Our new guidance recognises that obesity is a chronic disease that can be treated with comprehensive and lifelong care. While medication alone won't solve this global health crisis, GLP-1 therapies can help millions overcome obesity and reduce its associated harms," says WHO director-general Tedros Adhanom Ghebreyesus.

As per WHO, these drugs represent a new chapter in how society approaches obesity from a lifestyle condition to a complex, preventable, and treatable chronic disease. It says these drugs can be used long-term, for six months or more, but they should be prescribed together with guidance on diet and exercise to help people maintain their weight loss. The problem is only few people can actually access them. "Our greatest concern is equitable access," says Tedros.

Also Read: Eli Lilly's Popular Weight Loss Zepbound Price Goes Down, Now More Accessible

How Short Are We On Skinny Jabs?

As of now, WHO notes that under the present scenario of GLP-1 therapies, only 100 million people could benefit them, which is less than 10% of those who need them.

WHO's latest guidelines are now calling on countries and companies to expand access, through strategies and voluntary licensing. This means companies can grant permission for others to make affordable non-brand versions of its patented drug.

A patent on semaglutide, the main ingredient in Novo Nordisk’s Wegovy, is set to expire in many countries in 2026. Once that happens, other manufacturers will be able to produce and sell cheaper versions in markets such as India, Canada, China, Brazil and Turkey.

The WHO also says countries need to build healthier environments that support good health and help prevent obesity.

How Do GLP-1 Medications Work?

GLP-1 drugs mimic the action of the natural hormone GLP-1 to regulate blood sugar and promote weight loss. They work by increasing insulin release in a glucose-dependent manner, decreasing the liver's production of glucagon, and slowing down the emptying of the stomach, which helps lower blood sugar levels after a meal. They also act on the brain to suppress appetite and increase feelings of fullness, leading to reduced calorie intake.

In people with type 2 diabetes, notes Harvard Health, the body's cells are resistant to the effects of insulin and body does not produce enough insulin, or both. This is when GLP-1 agonists stimulate pancreas to release insulin and suppress the release of another hormone called glucagon.

These drugs also act in the brain to reduce hunger and act on the stomach to delay emptying, so you feel full for a longer time. These effects can lead to weight loss, which can be an important part of managing diabetes.

For many long-term cannabis users, the usual jokes about the munchies feel far removed from reality. Over recent years, emergency rooms have reported a steady rise in regular smokers arriving with sudden bouts of severe stomach distress that leave them curled up and unable to function. What makes it more troubling is that these episodes return several times a year, often leaving both patients and clinicians unsure of what is going on.

Scromiting: What is Cannabis Hyperemesis Syndrome (CHS)?

The source of the problem is cannabis hyperemesis syndrome (CHS), a difficult condition marked by unrelenting nausea, strong abdominal cramps and repeated vomiting that can occur four or five times an hour, according to the Cleveland Clinic.

What Is Scromiting?

Symptoms usually appear within a day of cannabis use and can linger for several days. These episodes can be so overwhelming that emergency staff have adopted the term “scromiting,” a blend of screaming and vomiting that captures how distressing it can be.

Although cases have become more common, many healthcare workers are still relatively unfamiliar with CHS because it was only identified in recent years. This makes it easy to confuse with other illnesses such as foodborne infections or stomach bugs.

“A person often will have multiple emergency visits before the condition is correctly identified, which can be very costly,” said Dr. Beatriz Carlini, a research associate professor at the University of Washington School of Medicine who studies the health risks linked to cannabis. Once a diagnosis is made, managing the condition can still be a challenge.

There are no approved treatments at present, and many standard nausea medications fail to bring relief, explained Dr. Chris Buresh, an emergency medicine physician with UW Medicine and Seattle Children’s Hospital.

This often pushes doctors to try less common options, including Haldol, a drug usually used to manage psychosis. Some people experience temporary improvement from applying capsaicin cream to the abdomen, as the warming sensation can help lessen discomfort for short periods.

Hot baths and showers are another frequent source of relief. Many patients report staying in the bathroom for long stretches to calm their symptoms.

“That is often something that helps confirm the diagnosis for me,” Buresh said. “People say a hot shower is the only thing that brings any comfort, and they end up using all the hot water in the home.”

Scromiting Recovery Challenges

Once the worst phase passes, long-term improvement is not always straightforward. Because CHS comes and goes, some cannabis users assume an episode was caused by something else and continue smoking, only to fall ill again, according to UW researchers.

Even for those who accept the diagnosis, quitting cannabis can be difficult due to dependence, which prolongs the cycle of nausea and vomiting, Carlini said. The only known cure is to stop cannabis use entirely.

Researchers still do not know the exact biological cause of CHS. The leading idea is that years of heavy cannabis use overstimulates receptors within the endocannabinoid system, which may disrupt the body’s usual control over nausea and vomiting, as outlined by the Cleveland Clinic.

Why this affects certain users and not others remains unclear. “We do not yet know if it is tied to wider access to cannabis, higher THC levels, or something else entirely,” Buresh said.

“There seems to be a point at which people become vulnerable to this condition, and that point varies from person to person,” he added. “Even small amounts of cannabis can trigger vomiting once someone crosses that threshold.”

A study released earlier this year by George Washington University researchers examined 1,052 people with CHS to learn more about potential risk patterns.

The findings showed that those who began using cannabis at younger ages were more likely to return to the ER with hyperemesis episodes. Many reported daily use and long-term consumption, with 44 percent using cannabis regularly for more than five years before symptoms began.

CHS is not limited to adults. Data shows that emergency visits among American adolescents have increased more than tenfold between 2016 and 2023. While overall rates tend to be higher in states where recreational cannabis is legal, the sharpest year-to-year rise in adolescent CHS cases has been recorded in states where recreational use is still against the law.