Aleece Fosnight, MSPAS, PA-C, on stigma as a major barrier to incontinence care

In an interview, Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, founder of the Fosnight Center for Sexual Health and medical advisor for Aeroflow Urology, highlighted the profound psychological and social dimensions that make urinary incontinence especially stigmatizing compared with other chronic health conditions. She explained that incontinence is tied to cultural taboos around bodily fluids, urination, defecation, and sexual function—topics most people avoid discussing. Unlike conditions that can remain invisible, incontinence often produces visible or sensory cues, such as wetness or odor, that trigger feelings of disgust and rejection from others. This reaction intensifies shame and secrecy for patients.

Fosnight emphasized that losing bladder control represents a violation of a core adult norm, reinforcing internalized beliefs of personal failure rather than recognition of a medical condition. Research shows incontinence is strongly associated with anxiety and depression, driven by fear of public accidents, social withdrawal, and avoidance of intimate relationships. Concerns about leakage during sexual activity can create strain in partnerships, deepening isolation and stigma.

She also described how stigma itself becomes a barrier to care, even though effective diagnostic and treatment options are available. Stigma functions as a social construct, where a condition is devalued and linked to stereotypes and discrimination. In the case of incontinence, patients often delay seeking help due to shame, embarrassment, or misconceptions that leakage is untreatable or a normal part of aging, postpartum recovery, or life in general. Fosnight noted that women, in particular, experience higher levels of internalized stigma, making them less likely to pursue medical evaluation.

Ultimately, she stressed the need to dismantle these harmful perceptions by reframing incontinence as a treatable health condition rather than a personal failing. Addressing stigma, correcting misinformation, and normalizing open discussion are essential steps toward improving patient willingness to seek timely, effective care.