How to normalize conversations about urinary incontinence

In this 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, emphasizes the importance of proactive, routine screening and open communication to normalize conversations about urinary incontinence (UI) in clinical settings. She recommends that clinicians follow the American College of Physicians’ guidance for annual screening, using validated tools such as the Three Incontinence Questions (3IQ) questionnaire. This brief, evidence-based screening can be integrated into electronic health records and completed before appointments, allowing clinicians to easily identify patients with potential UI symptoms. Fosnight stresses that providers should always follow up verbally—even when patients deny leakage—because many may not perceive mild symptoms as problematic.

To make discussions more comfortable and inclusive, Fosnight advises tailoring communication to different age groups and ensuring clinic websites and materials clearly indicate that UI treatment is available. She highlights that although urinary leakage is common, it is not normal—and effective treatment options exist. The biggest barrier, she notes, is patients’ misconception that their symptoms are either too mild to address or too severe for intervention.

Fosnight also introduces the PLISSIT model—originally developed for sexual health counseling—as an effective framework for UI conversations. The acronym stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Clinicians can begin by granting “permission” for patients to discuss bladder concerns, helping reduce stigma and embarrassment. Next, they can provide concise education about UI and its treatability, followed by practical first-line recommendations such as bladder training, pelvic floor exercises, or lifestyle changes. If symptoms persist, clinicians can escalate care or refer to specialists, framing referrals as an invitation to expand the patient’s care team rather than a hand-off.

Ultimately, Fosnight underscores that empathy, routine screening, and structured communication empower patients to discuss UI openly and pursue effective management.