From stigma to solutions: Navigating incontinence treatment options

In this video, 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, emphasizes that clinicians play a crucial role in helping patients understand that urinary incontinence is a medical condition—not an inevitable part of aging.

Fosnight explains that reframing the condition in this way reduces shame and empowers patients to pursue care. Normalizing its prevalence—affecting 30% to 50% of older adults—while clarifying that it is common but not “normal” fosters relief and openness to treatment.

Once patients are ready to explore treatment, Fosnight stresses the importance of shared decision-making. This collaborative model blends clinical evidence with provider expertise and the patient’s personal values, goals, and readiness. She highlights the need to use plain language, validate all choices (including waiting), and consider the patient’s broader biopsychosocial context. Timing, stress levels, and life circumstances may affect which options feel feasible.

Fosnight recommends a scaffolded approach, beginning with low-risk, first-line therapies such as behavioral strategies and pelvic floor physical therapy (PFPT). Because PFPT can significantly improve or even resolve symptoms for many patients, she considers it foundational, but urges clinicians to address access barriers—including availability, virtual alternatives, cost, and insurance coverage—to ensure recommendations are realistic.

Clinicians can also guide patients in using continence products without shame, framing them as temporary supports rather than failures. Assistance with insurance navigation and product coverage can further reduce burdens.

Second-line options include medications, devices, and pessaries—tools she notes are under-discussed despite offering valuable support for certain patients. Advanced, third-line therapies range from onabotulinumtoxinA (Botox) injections and nerve stimulation to surgical interventions such as slings, bulking agents, and artificial urinary sphincters.

Throughout all stages, Fosnight underscores the importance of communication, flexibility, and prioritizing what matters most to the patient—whether that is avoiding surgery, reducing pad use, improving intimacy, or returning to meaningful activities.