It is hard to believe this is real, but it appears that Reuters really caught Bush in a silly moment.

You would not even know it was Bush, except Reuters captioned the photo as follows:
Reuters – Wed Sep 14, 4:39 PM ET
U.S. President George W. Bush writes a note to Secretary of State Condoleezza Rice during a Security Council meeting at the 2005 World Summit and 60th General Assembly of the United Nations in New York September 14, 2005. World leaders are exploring ways to revitalize the United Nations at a summit on Wednesday but their blueprint falls short of Secretary-General Kofi Annan’s vision of freedom from want, persecution and war. REUTERS/Rick Wilking
For some reason, yahoo photos provides only the photo above. But the following story gives a fuller picture, in an article confirming Reuters claims no malicious intent:

A lovely tidbit from the above article: The Irish Examiner headline? “To Pee or Not to Pee, That is the Question.”