Many of us may have taken ibuprofen, sometimes two pills at once, especially when we are struggling with menstrual cramps. Well, as good these pills may be in treating the pain, they are not recommended for your health, especially if you are someone who consumes it on a daily basis or frequently. Gastroenterologist Trisha Pasricha, MD, writes in The Washington Post about why should you avoid taking nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen, naproxen and aspirin.

What happens when you consume pain killers?

She writes that NSAIDs are great in treating short term pain. They comprise of a group of drugs that inhibit the production of prostaglandins, which serve as a variety of purposes in the body. Some of which also includes contracting the uterus during menses and regulating blood flow in our vessels.

While one to two doses every now and then is okay, following a regular dosage routine, which could range from several times a month, or twice in an hour or so could lead to health risk. NSAIDs are well known to increase intestinal permeability. This means, these painkillers could damage the lining of your gut.

A 2018 review by Ingvar Bjarnason et. al., also writes about how NSAIDs can reduce the blood flow in the tiny vessels that feeds our guts. It can also disrupt the intestinal cells forming a barrier between the outside world and your insides.

What can be done?

While people with conditions like migraines, chronic back pain or bad period cramps can find NSAIDs to be helpful. It is always advisable to have a chat with your physicians to explore NSAID alternatives.

Pasricha suggests acetaminophen.

However, if someone is in dire need of NSAID, her tip is to take the pill right at the start of your symptoms. She says that the drug can do a far better job at stopping things at the source than chasing after all prostaglandins.

Why is it a concern?

NSAIDs are available as over the counter drug, which means people do not need a prescription for it and can make medical decision about them without the guidance of a physician.

A 2018 study published in the Official Journal of the International Society for Pharmacoepidemiology by David W Kaufman, et.al., found that 15% of adult ibuprofen users in the US have exceeded the maximum recommended daily dose. The study also mentions that more than a third of ibuprofen users were taking other NSAIDs, like aspirin and naproxen, while consuming ibuprofen at the same time. Out of these, 61% did not realise that they were using NSAIDs.

Pasricha talks about how it ruptures the gut wall, as she herself has rushed to the hospital in the middle of the night "far more times than" she can count "to perform an emergency endoscopy on someone who was bleeding profusely from an ulcer caused by NSAID".

Another 2009 study published in the American Journal of Gastroenterology states that as many as 1 in 4 chronic NSAID users will get an ulcer and about 4% will bleed or rupture through the gut wall.

An older study from 2005 titled A quantitative analysis of NSAID-induced small bowel pathology by capsule enteroscopy, found that as 75 percent of people regularly using NSAIDs develop low-grade inflammation in their small bowels. NSAIDs can also lead to development of fatty liver disease. This happens because your gut lining becomes more permeable, more toxins and bacteria from the outside world enters your liver and leads to inflammation.

A 2011 study titled Haemoglobin decreases in NSAID users over time: an analysis of two large outcome trials, states that as many as 6% of people taking NSAIDs regularly have found their blood count dropping within a few months of starting the medicines, this suggests that this is due to the small, slow amount of bleeding in the gut overtime.

Although classified as a rare disease, hemophilia in India is widespread and overlooked. According to the World Federation of Hemophilia (WFH), about 75 percent of individuals affected by hemophilia are undiagnosed across the globe, hence lack proper healthcare, which is associated with an elevated incidence of complications.

Hemophilia: The Undiagnosed Populations

In India, the gap is stark. The WFH has provided statistics that indicate that India has one of the largest hemophilia populations worldwide, with approximately 24,000 patients registered, whereas the estimated prevalence is approximately 1.2 lakhs, indicating that a large pool remains undiagnosed or outside the care pathway.

The implications of being undiagnosed or not receiving appropriate medical care are both clinical and non-clinical. Many people are losing milestones, dreams, or are otherwise negatively affected by the anxiety associated with living with an undiagnosed condition. For clinicians, this "hidden population" poses a daunting and deeply concerning challenge.

They are not missing; rather, they remain unseen due to delayed recognition, often presenting only after irreversible damage has already set in.

Hemophilia: Symptoms

Children with persistent symptoms of joint swelling, unexplained excessive bleeding after sustaining minor injuries, and other symptoms are usually diagnosed with other health conditions, like bone injuries or nutrient deficiencies.

This period of clinical ambiguity can extend for months or even years before appropriate diagnostic testing and referrals are initiated.

Joint damage is often established by the time a conclusive diagnosis is made, and may lead to reduced mobility or early deformity, chronic pain, disability, and loss of functional independence. Severe complications, including intracranial hemorrhage, continue to pose significant risks in inadequately treated patients.

Hemophilia: Importance Of Timely Diagnosis

The barriers to timely diagnosis are both clinical and systemic, ranging from limited awareness and low suspicion among primary care providers to fragmented referral pathways and frequent misdiagnosis. At the systemic level, uneven access to the diagnostic infrastructure persists.

The availability of coagulation tests and specialists is mainly limited to the tertiary settings, thus posing a problem for patients from tier 2 and tier 3 regions. It is vital to understand the costs associated with a delay in diagnosis in the context of how far hemophilia care has evolved.

Hemophilia: The Role Of Prophylaxis

Over the past decade, advances in treatment have significantly improved patient outcomes. Clinical goals are no longer limited to managing bleeds as they occur, but to preventing them altogether, making “zero bleeds” an achievable reality. This is where prophylaxis takes centre stage.

Where on-demand therapy treats hemophilia symptoms only after a bleeding episode has occurred, prophylaxis seeks to prevent bleeding completely and is considered the gold standard of care globally. It can bring about reductions in bleeds by up to 90% and maintain healthy joints, allowing children to achieve near-normal musculoskeletal development.

When initiated early, prophylaxis can prevent the onset of joint damage. However, when patients are diagnosed late, they often enter care only after irreversible complications have already occurred. This makes early identification not just important, but decisive in altering disease trajectory.

Hemophilia: Progress Is Visible

Encouragingly, progress is visible. Several Indian states have demonstrated that publicly funded hemophilia programs, including access to prophylaxis and decentralized care models, can significantly improve patient outcomes. Initiatives that integrate early patient identification, diagnostic access, and coordinated care pathways are beginning to reduce delays and expand equitable access.

These state-led efforts offer important lessons for making prophylaxis the national standard of care in India. Recognizing hemophilia early and initiating prophylaxis in time is not just a clinical goal; it is the most critical step in changing the life course of these patients.

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.