For many people, using the toilet is part of a daily routine they don’t give a second thought to. But for Josephine Akyaa Boateng, who lives with inflammatory bowel disease, trips to dunnies in the city are riddled with anxiety.

The way toilets are distributed in the city makes it difficult for those living with incontinence and disabilities to access them, Boateng says, recalling a time when she urgently needed but could not find one near Parliament station.

“I remember shopping where I needed to use it, and I kid you not, I was [running] around for like, a good 20 to 30 minutes, and I’m cramping,” she says. She ended up in Richmond before she found a toilet.

“That was something that has really taught me to locate some bathrooms [and] plan myself around [them], especially if I’m in a seasonal flare up.”

Mary Serry is a mother to a newborn who needs public toilets with nappy-changing facilities. She also lives with Crohn’s disease and has had many similar experiences to Boateng. When she used to frequent the city in her early twenties, she had to proactively look for the nearest public toilets to cope with her symptoms, which included vomiting, nausea, and fainting.

“In the back of your head, you’re just constantly thinking, ‘Where is the nearest toilet? Where’s the nearest rubbish bin for me to throw up in?’,” she says.

“And that is a big stressor, especially for a young adult.”

Boateng and Serry are among the 80,000 Australians living with inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. The former causes swelling along the gastrointestinal tract, commonly within the small intestine, and the latter causes ulceration along the large intestine, according to support and advocacy organisation Crohn’s and Colitis.

People with the chronic condition can experience “endure numerous attacks or ‘flares’ followed by periods of relative remission”, according to UNSW Sydney’s Microbiome Research Centre.

To meet the needs of those living with disabilities and incontinence, the Commonwealth government and local councils have implemented various public toilet strategies and initiatives – but their effectiveness may be limited by a lack of public awareness.

The National Toilet Map, launched in 2001 as part of the federal government’s $15 million National Continence Management Strategy, was designed to help the public find their nearest toilets using a person’s current geolocation or postal code. Over 23 years, it has located more than 23,000 public toilets across Australia.

Yet, Boateng and Serry say they are in the dark about the existence of the toilet map, which would have been useful when their symptoms were at their worst.

“I didn’t know that existed, that would have been so helpful… a few years ago, when I needed it,” Serry says. “I’ve seen private [health] specialists, public specialists, and not a single one of them has mentioned [it].”

“I feel like once you get diagnosed, maybe you [should] get like a little brochure [with] some resources or websites… Why is that not just standard these days?”

Currently managed by the Continence Foundation of Australia, the map outlines operating hours, gendered restrooms, wheelchair access, parking, drinking water, and more. The foundation also runs the annual Great Dunny Hunt to crowdsource updates to the map’s details with public help.

Despite this, Boateng says there needs to be more public education to increase awareness of the resources available for those living with continence challenges.

“I was having more flare ups, in my younger life, probably from 2015 to 2018, because I just didn’t have the education, I didn’t have the right support team,” she says. While the toilet map’s interactivity is useful, Boateng says it could also incorporate artificial intelligence to help those with visual disabilities who do not have access to a carer or support worker.

Public data shows there are 74 council-operated units spread across the CBD and its neighbouring metropolitan suburbs in parks, street corners, and tourist attractions. The map also lists toilets accessible to the public that are located in shopping centres, libraries, markets, and nearby universities.

However, the condensed format of the toilet map, and its reliance on local councils and private businesses to provide information voluntarily, is a stumbling block to accessing details such as the cleanliness, availability and condition of the toilet, Associate Professor at Flinders University and social scientist Dr Lisel O’Dwyer says.

“[I]t’s those details [people] really appreciate when they use a toilet.”

While social planner and public toilet researcher Katherine Webber thinks it is a good resource, “any limitations with the app also reflect the limitations that we have in public toilets across Australia,” she says.

The juxtaposition of a “private activity” in a public space such as a toilet is complicated by “layers of cultural and social norms”, Webber says, which affects elements included in public toilet development plans.

For instance, “In Australia, we’ve got lots of pedestal toilets, we’ve got a lot of urinals, and they’re all single stalls… [but] we don’t have a lot of squat toilets, we don’t have a lot of multi-occupancy toilets,” she says.

“I think there is an opportunity to expand the type of public toilets we’ve got in Australia to be more reflective of our population,” she says, such as “including more spaces for washing hands or feet for people who are preparing for prayer.”

Inequitable access to public toilets has been a longstanding issue and “considered [as] an afterthought”, social planner and public toilet researcher Katherine Webber says.

“They’re also not prioritised, because no one is given responsibilities for toilets. We don’t have the legislative requirement that says, [for example], every park must have a toilet,” she says. “Without those guidelines, it’s really easy to ignore them.”

In Victoria, councils including the City of Monash, Merri-bek City Council, and City of Boroondara have public toilet strategies.

“While that’s not required, [it] is an acknowledgement … that they are important”, Webber says.

In response to the CBD’s ageing toilet infrastructure, the City of Melbourne invested $1.25 million for the development of 18 more facilities as part of its Public Toilet Plan during 2008 to 2013.

“[It put] together a framework of work to upgrade existing toilets in the City of Melbourne and establish more where they were needed. All works in the plan have been completed,” a council spokesperson says.

Despite most public toilets not being classified as accessible, most are “wheelchair-friendly, featuring railings and no steps”, the spokesperson says.

“[The City of Melbourne] Council is considering additional upgrades in response to community demand.”