You're thinking city buses. I'm thinking long-haul busses (like greyhound in the US). Greyhound buses likely have facilities, what I'm actually talking about are the buses used a core parts of the transportation infrastructure all over South America. Many of these also have facilities but I've been on many where the bathroom isn't functioning or just plain isn't there. You can easily travel for 30 minutes to an hour without stopping.
We're largely (70%) talking about commuters here, they're taking this twice a day, most days out of the year. Again, I'm not sure why for 90%+ of people that this would be an issue.