One afternoon during the summer of 2000, her first year as a bus driver in Oregons Portland, Hope Okazaki had a troubling episode of gastrointestinal distress while on the job. She had just finished an almost two-hour tour through the east side of town, and her bus was parked at the Gateway Transit Center, in a lot across from Fred Meyer, a local grocery store and retailer.

“I was so embarrassed,” says Okazaki, who is now 53. “I bought underwear at Fred Meyer, then walked through the store to the restroom and changed my underwear, but I still smelled bad, you know, because I couldn’t get a shower.”

Still, Okazaki got back in the bus and drove the same route in the opposite direction. “I didn’t tell nobody what happened because I was so humiliated,” she says.

Not every driver has had an incident like this. But many have. And even for those who haven’t, fear lingers.

“There are times when you’re on the bus and you’re thinking to yourself, ‘How am I going to get off this thing without having an accident?’” says Mike Burr, 64, a Seattle-area bus operator for more than 16 years. Sometimes, he drives a three-and-a-half-hour route without getting a break. “And then you pull up at the last terminal, and the last terminal has a restroom, and you’re the first one off the bus.”

Under pressure to make tight schedules and keep their customers and bosses satisfied, bus drivers across the country, especially those in urban areas, say they’re suffering from a lack of bathroom access. In recent years, drivers in the District of Columbia, Las Vegas, Yonkers, New York, the state of Connecticut and elsewhere have complained about the problem. While the complaints appear minor to some, the lack of easy restroom access can pose major health and safety risks to passengers, outside traffic and drivers themselves.

Toilet Troubles In The Emerald City

The bathroom problem has become a recurring issue in Seattle, where King County Metro Transit, the regional transportation authority, operates about 200 bus routes and maintenance crews replace about 60 urine-soiled driver seats a year.

Last November, the Washington Department of Labor and Industries slammed Metro with a $3,500 fine for not providing enough restrooms to employees and for disciplining drivers who were late after visiting bathrooms. Several months later, Metro is still attempting to address the issue with the local bus drivers’ union. It’s unresolved as the two sides head into contract arbitration this spring.

“The problem is systemwide, and it’s pretty pervasive,” says Clinton DeVoss, second vice president at Amalgamated Transit Union, or ATU, Local 587. “There’s no way to quickly and easily fix it.”

DeVoss says Metro needs to build new bathrooms and relocate existing terminals to locations closer to bathrooms. It also should give drivers longer break times, which, right now, are only five minutes long. Drivers say that’s not enough time.

“If traffic is not perfect and passenger loading and unloading is not perfect, you don’t have that time when you finally arrive at the terminal,” says Cheryl Rowe, 54, another driver in the Seattle area.

Sometimes, terminals are crowded, and not every terminal has a toilet. One of Rowe’s four routes ends at a church that isn’t open during the week. Whenever she does that trip, Rowe spends about an hour and 20 minutes without a break. If she’s ahead of schedule, sees little traffic on the road and feels like her passengers won’t make too much of a fuss, she pulls over and uses a private restroom. She did that at a roadside coffee shop last week.

Others, though, have decided comfort isn’t worth the risk of tardiness.

“I have had female drivers tell me they wear adult diapers,” Rowe says. “I’ve had female drivers tell me they carry a coffee can with them.”

The consequences can be harsh for drivers who show up late or don’t finish routes on time. In Seattle, customer complaints can lead to discipline such as mandatory training, retraining and counseling sessions, or having a watchful supervisor ride the bus. Rowe, who serves as a union steward, says she’s represented workers disciplined for using the bathroom.

Transit authorities, for their part, insist they do not discipline drivers for using restrooms.

“There may be some disagreement about the nuance of it,” says Jeff Switzer, a representation of King County Metro Transit, when asked about the accusations.

No Laughing Matter

Occasionally, drivers find themselves belittled for taking urination seriously.

Last November, local newscasters in Omaha, Nebraska, giggled their way through a story on Seattle’s soiled-seat replacements. A month later, a man in suburban Cleveland produced a video of a paratransit driver attempting to stealthily pee into a cup before dumping it outside his parked bus. A local news outlet showed the video and interviewed the person who recorded it. He called it “disgusting” and “nasty.” Two years ago, a Chicago bus driver preparing to take a bathroom break was physically assaulted by an angry passenger.

In addition to the embarrassment of having to use the bathroom in less than ideal conditions, the health risks of “holding it in” are genuine.

Okazaki, the driver from Portland, says she’s developed irritable bowel syndrome during her 20-year career. The causes of IBS aren’t fully understood, but frequent or increased stress can be a trigger, and a doctor tells Okazaki her case is work-related. Meanwhile, a few years into her roughly decadelong tenure in Seattle, Rowe began contracting urinary tract infections. Waiting too long to pass urine is a major cause of UTIs.

It’s not good for the health and safety of passengers, either. Driver advocates frequently point to a 2011 study that found “having an extreme urge to void” exerts “a large negative effect” on basic cognitive functions. The mental decline is comparable with what happens after a person spends a full day without sleep or drinks a couple of beers, according to the research.

One way to overcome that obstacle is to reduce fluid intake.

That’s what Burr, the driver with the marathonesque shifts in suburban Seattle, does. It can be a challenge because he’s a Type 2 diabetic and his medication makes him want to go more than usual. But thus far, Burr says, he’s managed to get by without incident.

Still, driving on an empty stomach presents its own risks. Dehydration can slow acuity and bring on fatigue. For those reasons, Rowe says she refuses to drink less water before her shifts. “It’s not safe for me to be operating a 60-foot bus when I’m dehydrated,” she says.

It’s not as simple as a choice between one or the other. But when it comes to the periodic trade-offs between safety and performance, Rowe knows where she stands.

“When you gotta go, you gotta go,” Rowe says. “And if I’m going to be a safe driver, I’m going to have to take care of my personal business, and sometimes that’s not convenient for everybody else.”