It's a situation anyone could find themselves in - having to answer the call of nature in the middle of an important meeting.
But when you are the US president, at a gathering of more than 150 world leaders, it is even more tricky.
While talk at the UN world summit was focused on terrorism and internal reform, George W Bush appeared to have been caught short.
And, he is said to have turned to Secretary of State Condoleezza Rice for advice.
"I think I may need a bathroom break? Is this possible?" a Reuters news agency photographer caught him writing in a note to Ms Rice.
The photograph, and Mr Bush's apparent request for permission to pee, has been the subject of discussion on a number of satirical websites.
President Bush was among monarchs, presidents and prime ministers for the opening of the three-day summit, marking the 60th anniversary of the UN.
In a speech, he urged the UN to pursue meaningful reforms to allow it to meet modern challenges and said the US was committed to helping overcome poverty.
"I think I may need a bathroom break. Is this possible?" the pencil-written note reads.
