Editor’s note: The Development Set is devoting this week to stories of toilets and everything that happens in them. Because, as my favorite children’s book reminds us, everyone poops.

As the season’s first real cold front descended on Fort Collins, Colorado, a subset of the city’s most destitute readied to disappear for the night. Papa Doc, 44, knelt beside his bicycle, wrestling to attach the tow-behind cart that carries his belongings. His hands show the wear and grit of decades without a domicile or the basics it ensures. He had just eaten a hot meal provided by an outreach group, but the last time he’d thoroughly washed was unclear.

Papa Doc has been homeless for thirty years and serves as a father figure for youth who find themselves on the streets. Between chatting with friends and swigging his spiked energy drink, he reflected on how he completes the most basic of human functions. “The city cut toilets out, put padlocks on the port-a-johns,” he said. “I go behind dumpsters, mostly.”

His companion, Ricky, agreed emphatically. “I piss behind trees,” he said. “But I don’t know what women do.” In his 50s, Ricky has been homeless for twenty years. His face and shirt were red with fresh stains, a result of eating spaghetti without teeth. He wouldn’t have anywhere to wash his face or clothes before dark fell.

IIn recent years, efforts to sanitize cities have pushed those without reliable shelter further to the sidelines. A growing number of communities complement camping and panhandling bans with the removal of public restrooms and water sources. Central Denver has nearly 4,000 homeless people, but only 25 public toilets. The ratio is better in Fort Collins, a college town located 70 miles north, but most facilities are only open seasonally. Those with running water close during winter while some port-a-lets are only available November through March. No bathrooms in either city are accessible 24/7, sending a clear message about who is and isn’t welcome in common spaces.

According to Housing and Urban Development’s (HUD) Annual Homelessness Assessment Report, nearly 600,000 Americans lack appropriate shelter on any given night. This can mean sleeping in a car, scoring an emergency bunk, joining unofficial encampments, or hunkering down under bridges and along riverbanks.

The vast majority find themselves wanting not only for a safe place to sleep at night but also the “perks” afforded by stable housing. Left without toilets or running water, many homeless individuals must relieve themselves in the open, wear soiled clothes for days on end, and involuntarily forgo basic hygiene. These practices can be humiliating and further limit access to public resources.

“Homeless people lack the domestic sphere of the home as a site for daily private health maintenance practices,” said Ottilie Stolte, a psychology professor at the University of Waikato. “Instead, they must stitch together a daily strategy to ensure they can get these health needs met.”

Being visibly — and olfactorily — homeless prevents many people from entering a store to use the restroom, and contributes to their stigmatization. After enforcing a camping ban, trying a short-lived panhandling prohibition, and failing to pass a sit/lie ordinance, Fort Collins came out with a “disruptive behaviors” survey last August. Two of the ten named items, inadequate/unsanitary personal hygiene and public deposit of bodily waste, target behaviors that directly result from the town’s dearth of public restrooms.

The inability to use a toilet isn’t just embarrassing. According to the 2015 No Right to Rest Report, a collaborative study by scholars and homelessness advocates in Colorado, it represents a public health crisis. For example, Stolte explained, the dearth of toilets and places to wash exacerbates health problems like body lice, skin infections, gastric illnesses, prostate and bowel issues, and the spread of communicable infections.

A lack of public restrooms can also contribute to population-wide illness transmission. “From a public health perspective, the hand-washing station is a basic need that reduces disease,” said Meghan Hughes, Communications Director for Denver’s Department of Environmental Health. “[It decreases] incidence of food-born illness, reduces transmission of communicable diseases such as colds and flu.”

This isn’t to mention the legal consequences of defecating while homeless. When people relieve themselves in the open, they run the added risk of tickets, fines, and even jail time. In Fort Collins, ordinances exist against indecent exposure, depositing bodily waste, and misuse of public waters. Numerous Colorado cities and counties have similar laws that No Right to Rest claims restrict “survival in public spaces.”