Erik P. / Zefa / Corbis

Among the laundry list of inconveniences most of us can't abide: cold coffee, airport delays, the high price of gasoline. Our complaints about them are loud and long. But how about the dearth of clean, accessible public bathrooms in the U.S.? Surely each of us knows the desperation of being stranded without a bowl when we needed it most. And yet it's a predicament that we quietly cross our legs and accept.

"Ladies prefer to keep silent while they queue up all their lives at public toilets, missing the show after [intermission], doing kung-fu stances to pee because the seat cover is too filthy," says Jack Sim, president of the World Toilet Organization (WTO), a global body with representation from 42 member countries, which advocates for better public sanitation practices around the world. "We don't talk about [public restrooms]. And what we don't discuss, we can't improve."

If you've ever been a commuter or a tourist, a jogger or a caregiver to small children, you can attest that there's a serious lack of public toilet facilities in America. "As if the need to go to the bathroom does not exist," travel expert Arthur Frommer once quipped. In Australia, by comparison, all 14,000 of the country's public facilities are accounted for on the electronic National Public Toilet Map, a project funded by the Department of Health and Aging.

America doesn't have any comparable figures or resources. Instead, the dirty job of toilet advocacy falls entirely to volunteer groups, like the American Restroom Association (ARA), which represents the U.S. in the World Toilet Organization.

"You wonder what it says about our country and culture that we don't take responsibility, individually or collectively, for having clean facilities for people to use," says Steven Soifer, a professor of social work at the University of Maryland and a co-founder of the ARA. Soifer contends that the first step to improving our toilet deficit is to start a national potty discourse: "Ninety-eight percent of Americans don't know the laws regarding the use of public toilets and 80% of businesses do not know," he says.

For example, many of those pesky "Restrooms for Employees Only" signs that hang in most small businesses are actually in direct violation of building codes. Nearly all states have plumbing codes that require businesses to provide restroom access for customers and visitors. In New Hampshire, denying entry to a bathroom is a misdemeanor punishable by a maximum $1,200 fine.

The issue, then, is less about regulation than about education and enforcement. Restroom facilities are required by federal law in the workplace, says Robert Brubaker, who heads up the ARA's public-restroom initiative, and he thinks the government should treat the need for public facilities with the same seriousness. "We need to have the Department of Health and Human Services address this at a high level. You shouldn't have to fight [for public toilets] in every community," he says.

Indeed, in some communities the call of nature has become a call to arms. When the Ballard neighborhood council in Seattle rejected the installation of an automated self-cleaning toilet in its major intersection in 2002 on the grounds that it would be an eyesore, a community-based walking group called Feet First stepped into action. The group produced a "pit-stop" map of local, independently owned coffee shops that would happily welcome the additional pedestrian traffic a public toilet could draw. The Seattle toilet project, however, was ultimately scrapped.

Studies conducted by the Centers for Disease Control's Healthy Aging Research Network suggest that lack of readily accessible restrooms is among the factors that can shape the exercise habits of seniors. No washroom, no workout.

But getting people to hit the pavement is more than just a health concern. As urban sprawl sends development  and money  farther from downtown, municipalities are looking to combat inner-city decay by keeping the streets flush with pedestrians. In Portland, that means implementing pilot projects such as an artist-designed public restroom in Old Town Chinatown. Many people still regard such municipal facilities as germ-ridden no-go zones or the grotty province of drug dealers and criminals. Regaining confidence in public restrooms would remove one obstacle to renewing the vibrancy of urban centers.

According to Prof. Katherine Anthony, a restroom expert at the University of Illinois Urbana-Champaign, the U.S. has a history of toilet-based discrimination. She says this country's lack of potty parity  equal speed of access to public restrooms  reinforces an unspoken social hierarchy. Men spend an average 30 seconds using the toilet, and women take an average of 90 seconds; most of us are intimately familiar with the waiting lines that form outside women's restrooms.

California was the first U.S. state to confront the issue, pioneering potty parity laws in 1987, mandating, for example, that new buildings must have at least 50% more stalls available for women than for men. Other states and major cities like New York and Chicago have followed suit. "Unisex was a dirty word when they started this project in La Jolla," says Mary Coakley, who spearheaded the construction of an all-user-friendly beachfront restroom in San Diego. "But in the end everyone was really happy."

Coakley spent three years in southern California researching her project, talking to everyone from crime prevention specialists to architects. In 2005, having corralled support from 45 local businesses and 65 residents, La Jolla's Kellogg Park, which gets more than 2 million visitors a year, was finally outfitted with a state-of-the-art unisex loo. The final product was awarded a Public Works of America Award for successfully addressing a wide variety of requirements: the open-air trellis roof minimizes odors; the stalls each open to the outdoors, removing fears of crime; the amenities are vandal-proof, constructed from the same grade materials used in jail cells. "I didn't reinvent the wheel," says Coakley of the comfort station. "It was a matter of taking the best pieces of the ones I saw and putting it together."

When members of the WTO meet for the World Toilet Summit later this fall in New Delhi, India, delegates will learn about the best global toilet practices, from developments in eco-sanitation to the latest offerings from the Restroom Specialist Training Course at the World Toilet College in Singapore, the only program in the world that teaches toilet design, maintenance and hygiene. Such topics may elicit the public's distaste, but that makes WTO president Jack Sim all the more adamant that his organization is necessary. "People go [to the bathroom] six times a day, yet they can't talk about it. We are in a state of denial that we are toileting beings," says Sim. "We need to make toilets a mainstream subject."