We record all toilet breaks on the online behaviour management system.
It's reviewed by form tutors weekly, & if it's excessive, tutors raise with parents as a concern.
My dd2 (dc attend my school) is revealed on this as a right chancer
.
I have HAD WORDS. She knows she's been taking the proverbial.
Really, this is why we have designated breaks. Asking in a lesson should be a rarity. I allow on basis that it's recorded & queried by pastoral staff, but my expectations are that students wait until the independent work bit of lesson.
I've been teaching for nearly 20 years. No one has ever wet themselves through being asked to wait.
I've had no shortage of medical emergencies occur in lessons - fainting, seizures, once sadly a stroke - but no child has ever suffered as a result of being asked to wait 5 minutes for a wee. Being a bit uncomfortable because you should have used the bathroom at break because, duh, that's what break is intended for, is a lesson learned.