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For employees at the work place, access to building toilet facilities is covered by well enforced Federal Regulations.   For customers or visitors to a business establishment, toilet access is covered mostly at the state and local level.  A few states and some municipalities have, or are considering, laws requiring 'customer' restroom access.  See Building Toilet Requirements for additional information. 

More broadly, building restroom access at non-food business establishments is typically covered by state building code.  Most States adopt the same or similar 'Model Consensus Code'.  A typical example can be found at the following location in Sect 403 of the IPC's Minimum Plumbing Facilities

Typically this code requires that all buildings have restrooms and that all occupants be allowed to use the restroom.  When a person enters a business establishment, assuming they were not immediately asked to leave,  they are an occupant. Locked restrooms are acceptable as long as all occupant requests to use the toilet facilities are honored.  

While the Code is typically adopted at the state level, building code is most often enforced at the local level. Violation is often an administrative matter (i.e. not criminal) and is typically handled by a municipal commercial building code enforcement office.  A complaint leads to an inspection of the facility.  Any code violations found may lead to warnings, fines or the closing of the business until the violation is resolved.  Unfortunately, code enforcement officers like to 'see' a code violation.  For example, if the toilet had been removed they would  issue a citation.  Unfortunately, they are less certain when enforcing a complaint from someone who was not allowed access to a restroom.   

It is also helpful if you first ask he local commercial code enforcement official to explain the code.  This forces them to read the code.   They will be less likely to say the code doesn't exist when you then tell them about the 'not allowed to use' incident. 

If they are hesitant to act, you will need to get support from an elected official.  Most elected officials are not knowledgeable about these codes.  To be successful it is important that you do as much of the ground work as possible.  Research the exact code for the area and know the Office responsible for enforcement.  Be willing to do the work on behalf of the the elected official who 'opens the doors' for you.

To better insure success you should try to interest a newspaper in what is typically a compelling human interest story.   Speaking honestly is powerful, but it is not necessary to say you lost control. It is sufficient that the 'denial' left you in a terrible situation (e.g. in crippling pain).   Reporters are almost always operating on deadline.  Let them know there is a web site that has all the support material they will need.  Also let them know there is a listing of stories published by other newspapers

Working with both a news reporter and your elected representative is mutually beneficial.  The reporter will be more confident that they have a legitimate story and the politician will know that their effort to help you will be seen by the electorate.  Besides nudging the government to act, it makes other business owners aware of local toilet code and they will begin to tow the line. Your fellow citizens are also enlightened and more willing to stand firm when told there are no public restrooms in a building. 

The Voice of Real People

As an IC patient myself, I was shopping [deleted reference] about two years ago when I had sudden bladder spasm that left me gasping in pain. I asked the manager if I could use the restroom and she haughtily proclaimed "No." I said "I have a medical condition and a medic alert card. Would that make a difference?" She said "No" and urged that I walk a block (impossible at the time) to another store to use their public restroom. Funny, I was buying more than $200 worth of merchandise... and yet that wasn't worth anything in her eyes. So, I raised my voice slightly... said something about recently having surgery. She shook her head... and other customers came to my defense. About five agonizing minutes later, she grudgingly allowed an employee to escort me to their bathroom.
Source: Email: dtd Jan 04, 2003 8:10 AM . 

I had a very upsetting situation yesterday. I was in a Waldenbooks store. It was a stand alone building, not in a mall. It was cold and rainy and I lost my car keys. My husband was on his way to get me when my 3 year old said he needed to go to the potty. The store refused to let us use their facility due to company policy. About 4 minutes later, my child urinated in his pants and on the floor. This was a large store and it is hard for me to believe that they are not legally suppose to have a public facility. This was in Raleigh NC. What is the legality of this situation?
Source: Email dtd, Feb 16, 2003 5:46 AM

I had a situation yesterday where I needed to use the restroom badly & the manager of the store wouldn't let me use it. I have ulcerative colitis. So I had to go very bad. I defecated myself. That was the most embarrassing thing to happen to me. So I want to know what steps to take next. Please contact me  a.s.a.p so I know what to do about this situation! Thank you.
Source: Email dtd  Aug 04, 2003 11:18 AM

I was x-mas shopping in a local (Carroll County Maryland) retail store with my 4 year old son recently. While shopping, he told me that he had a bellyache and needed to go (#2) to the bathroom. We walked up to the clerk at the counter and he waited patiently until she was finished assisting another customer. When he asked, she point blank said no to him and pointed to a fast food restaurant down the street. She claimed that it was the store's policy. [deleted text]   I am furious to think that a store can be so cruel and uncaring to a child. It's difficult enough for adults to have to "hold it" in a crisis such as that let along a child who is only 4 years old.
Source: Email dtd December 18, 2003 8:54 PM

I read some of the "real people voices" and found myself in the same position as some of those with young children. I too have a young child and was denied the use of their facilities because their safety door did not have a lock on it. I was unclear on what that had to do with the use of the bathroom ... [New Mexico].
Source: Web feedback dtd 07 Apr 04  01:08:25

I am pregnant and had a sudden emergency to use the bathroom. I was in a [deleted] in Lunenburg, Ma, I explained my situation and was told "no". I even went to the manager and he said that so and so would have a cow, so I couldn't. I put down my basket and left. Can they do this
Source: Web feedback dtd 14 Apr 04  08:09:10