Getting the conversation going about bladder health...

Imagine a disease more common than diabetes and Alzheimer's combined, but that's so taboo nobody even wants to discuss it. That's incontinence, and it's about time we get past the embarrassment and start feeling comfortable speaking up.

It's why November has been dedicated as National Bladder Health Awareness Month, to reduce the stigma associated with bladder issues and to help patients feel confident enough to reach out for help and find treatments that can literally change their lives.

Today's guest is Aleece Fosnight, a board-certified physician assistant specializing in incontinence conditions and a medical advisor for Aeroflow Urology, and she's dedicated her career to helping people overcome their reluctance to talk about their bladder conditions. She offers important insight and guidance so you can find your voice and develop a relationship with your provider that will allow you to get on the path towards a life without leaks. 

To visit Aeroflow Urology and learn more about all they offer, click here.
To learn more about the National Association for Continence, click here, and be sure to follow us on Facebook, Instagram, Twitter and Pinterest.

Music:
Rainbows Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0 License
http://creativecommons.org/licenses/by/3.0/

For over 30 years, Tranquility has provided real-life protection for people with incontinence. Our high-quality products help you manage loss of bladder and bowel control with comfort, confidence and dignity.

Choose from disposable briefs, pull-on underwear, booster pads and more, in a wide range of sizes from youth to 5-XL. Request free samples today, so you can experience the Tranquility difference for yourself.

Go to TranquilityProducts.com and click “Free Samples

Transcript

The following transcript was generated electronically. Please let us know if you see any transcribing errors and we'll get them corrected immediately. 

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America's leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org. 

Welcome back to another episode of Life Without Leaks. I'm your host, Bruce Kassover, and joining us, as always, is the Executive Director for the National Association for Continence, Sarah Jenkins. Welcome, Sarah. 

Sarah Jenkins: Thanks, Bruce. So glad to be here. 

Bruce Kassover: Yeah, today's going to be a good one because today we're introducing something that some people might not be familiar with. We want to be talking about Bladder Health Awareness Month. November is the month that's dedicated to raising awareness about bladder health issues. And it's really important because it's something that's so stigmatized, and people are so uncomfortable discussing it that anything we can do to sort-of get that conversation going is really going to be helpful.

And joining us today is a really good friend of the podcast. It's Aleece Fosnite, and she's a board certified physician assistant who specializes in sexual medicine, women's health, urology, and she's also a medical advisor for Aeroflow Urology, which is a trusted partner to the National Association for Continence. 

And if her name sounds familiar, it's because she's been on Life Without Leaks a number of times. She's done a two-part podcast where we talked about men's health and prostate and BPH, she's talked about mental health, anxiety, and the challenges that people have when they're trying to get their issues addressed, absorbance. She's been a big advocate for the Diaper Gap, which is a project that is trying to raise awareness of how many people can't afford their absorbent products and trying to get people to give donations and participate so that those who need them can get them. So Aleece, thank you for joining us again. We really appreciate you being here with us. 

Aleece Fosnight: Oh my goodness, Bruce. It was absolutely my pleasure. I'm so excited to be here again and talking about something that is near and dear to my heart. 

Bruce Kassover: Yes. Now, I really can't think of anybody who's better to talk about trying to de stigmatize something that's difficult for a lot of people to have conversations about than you because you're a specialist, as we just talked about, in bladder health and issues related to the pelvic floor and all sorts of things like that, which anybody who's listening now knows is a challenge. But you know what? You're more than just that. You're a specialist, really, in talking about all the things that people are uncomfortable talking about.

You're, for example, you're a specialist in sexual health too, and that, and particularly about topics that people are not always even comfortable talking about with their partners. Is that a fair characterization, by the way? 

Aleece Fosnight: It is. And I think one of the things that I really treasure the most about the relationship that I have with my patients is really helping them to put them at ease and to normalize these conversations. 

These are things that, we normally have functions, bodily functions on a daily basis, whether that has anything to relate with our pelvic health in terms of urination, defecation, sexual function, it all ends up in that area. And so being able to allow a safe space for patients to come and to have those conversations is such a pleasure and honor and a privilege of mine that I get to do that.

Every single day and help people to understand that you don't have to be embarrassed by this, that you're not alone in a lot of these. And there's, there's things that we can do. And I think we'll talk about that too, during this podcast as well as most of the time people think that there's just nothing to do when it comes to concerns with urinary incontinence or even fecal incontinence.

So they don't bring it up with their providers. They just kind of push it to the side and just try to deal with it as much as they can. And we know that that is not, it's going to help that patient to become successful and to have the best mental health that they can have as well. 

Bruce Kassover: You know, you said an important term and I think that's something that that's used very commonly today, you talk about a safe space. But I think that in some cases it's used sort of reflexively and people don't really know what that means. So when you say that, what does that mean to you? What does that mean to patients?  

Aleece Fosnight: It's allowing the patient to be themselves in the exam room. It is asking open-ended questions to give them time to answer those questions, too.

We know that providers are quick to jump in and not leave enough silence because it feels awkward, but I don't mind leaving some room in the exam room for, for patients to sit and, you know, for me to ask an open-ended question and for them to really reflect and to think about it for themselves and to see how they want to answer it.

And then I think it also is important on how you respond to that answer, that the patient, you're going, “Exactly, that's what a lot of my other patients are complaining about,” or “I've heard that before.” So many times patients are like, “I'm sure you've never heard this before,” or, you know, “I'm so embarrassed or ashamed to say this to you because I've never said it out loud before.”

And when I talk to my patients, I think also because it comes across, comes across honest. I really love what I do. And I love having that relationship with my patients. And that alone, I think it's going to create a safe space. I sit down at their level, I don't have the computer in front of me. We talk real about some stuff, you know, and it, and to say, you know, sometimes, “Yeah, this sucks that we're having to have this conversation, but I'm so glad that you brought that up.”

Like I acknowledge that it's a hard thing to bring up, that they need to be proud of themselves for bringing up that conversation and advocating for themselves and that we're going to work together as a team to figure out what are your best options and what's going to work for you to, again, be the most successful at improving your pelvic function.

Bruce Kassover: Bet you get a lot of patients crying. 

Aleece Fosnight: Yeah. Every day we cry. I cry. They cry. We, I mean, it's just, it's such a vulnerable space, and when somebody recognizes that they're being heard and they're being validated, one of the notes that I made, you know, for our conversation today, Bruce, was the word “gaslit,” and so many of my patients have been gaslit by their other providers or dismissed, especially my female patients.

“Oh, you're in your sixties. Like that's just going to be a normal part of aging,” or, “Oh, you've had three babies. Yeah. Of course that's going to happen.” There's this like dismissal. And so when I have patients that are in the office that, I'm their like third or fourth provider and I'm going, “Yeah, this sucks and we need to do something about it. I don't care if you're leaking two drops of urine every day, or if you're having to go through two protective briefs every day, if it's bothering you, let's figure out how to make it better.” 

Bruce Kassover: So here's my question then: If I go to you, it sounds like I'm going to get the sort of response that I'd be hoping for, you know, I'm going to be welcomed and I'm not going to be shamed, but you can only see so many people, right? You're one person.

Aleece Fosnight: Yeah, which is why I've hired another provider so that I can pass along this information because I don't want to do it alone. I think the biggest thing is, is getting that information and training other providers to have that same approach that I do. 

Bruce Kassover: Now, the vast majority of people out there, though, are going to other physicians. So how do you have, what can you do as a patient to increase your chances that you're going to have that same sort of really rewarding interaction with whoever you happen to go with? 

Aleece Fosnight: I think making sure that you're writing your questions down ahead of time, that, I think, is one of them. The most challenging thing is, you walk in there and you're like, all right, I've got my list in my brain and I’ve Googled, I'm going to actually say it this time, right?

This is something to you that I've heard over and over again from patients as they've been wanting to talk to their provider about their concerns with urinary incontinence for the past six months, for the past year. And so I always tell patients, write it down. Write it down and say to your provider, “I have some specifics that I want to talk to you about today,” and have it in front of you.

Write it out how you want to say it. You can role play with a trusted friend or your partner to be able to get up the courage. Sometimes when you say it a couple of times in front of somebody else too, and it's not just the first time that you've had that with your provider, that that can be a little bit more of an ease to go in there.

I sometimes also think that you may not always get that right fit with that right provider the first go-around. So talking to friends, bringing it up seeing who on their website is not also afraid to talk about that too, or what their approach is. So you may have to do a little digging a little bit of vetting with that provider, but most of the time, you're going to be able to find that person. It may take a little while, but you can get there. 

Bruce Kassover: So, what happens then if you go to your doctor, you manage to get the courage to have the conversation, or at least start the conversation, and you don't feel like you're being heard? What would you do at that point? I mean, do you, do you try and sort of probe a little more? Do you sort of say, “Okay, I'm going to go out and try and find somebody new?” What do you recommend for somebody who feels like they're not being seen when they're in the, in, in the appointment? 

Aleece Fosnight: Well, I realize that we have a big shortage of healthcare providers in general in our country, but we have a huge shortage of people that are taking care of pelvic health needs and especially in urology or urogynecology.

So I recognize that some people may have been waiting for three or four months for this appointment. So to go shop around for another person can be a little bit difficult. Don't be afraid to stand up for yourself and say, “I don't know if you're hearing everything that I'm saying, I'd like to try this again,” and, and put it out to that, that it might be a little bit of a communication concern between you and that medical provider and just say, “Hey, can we try this again? Let me see if I can ask it a different way or say it a different way. I'm concerned that you're not actually hearing what I'm trying to get across to you.”

So it's okay to, to do that. I know, again, that can seem, sometimes a little abrasive or a little, I wouldn't even call it confrontational, because you're standing up for yourself, and unfortunately, that's where we are in this world when it comes to patient advocacy is that you, you are your own best advocate. So, if you can do that, or if, again, you feel brave enough to do that and just say, “Let's try this again. I don't think you're hearing what I'm saying or understanding how much this is impacting me on a daily basis or impacting my mental health.”

Bruce Kassover: I like the way you said it because, I know how you're saying it might feel a little confrontational, but it seems like it's minimally confrontational because you're really just saying, “Let's talk a little more.” I mean, especially in an environment that for so many of us can really be intimidating, I mean, there is very little that's more intimidating and sort of a regular basis than going to your doctor's office, isn't there?

Aleece Fosnight: Exactly. You know, even for me, when I'm sitting in that hot seat and the other way around, and I'm talking to my health care providers, I get nervous, right? So I, I totally understand the level of anxiety that can, that can provoke when you're getting ready for your appointment. 

Sarah Jenkins: I think these are so important because we know from our research, and I'm sure you see it firsthand how hard it is for patients to bring these issues up even to their doctors. So these are great tips. 

Aleece Fosnight: Well, I think I've said it before. There's a research, gosh, paper that came out many years ago that talked about like 72 percent of patients want their provider to bring up the topic of conversation. The majority of people want that because they feel like that if their provider is going to bring it up, that means it's an important thing.

So that also means that if there's any providers that are out there listening to this podcast, too, it's also on you, right? You've got to be a team in this with your patients. 

Sarah Jenkins: Do you have any tips for providers who maybe, you know, this isn't their area of focus, and they're seeing a patient who they're treating for a lot of different conditions, and, you know, this is always kind of the last thing that they ask about on the way out the door? What can they do to make it easier for their patients, and what can they do to kind of broach that topic so that it's not so intimidating? 

Aleece Fosnight: Yeah, I, this is funny because all of the types of conditions that I see, right, sexual health, pelvic health, urinary health, these are all taboo topics that nobody wants to talk about. And the biggest thing is because nobody knows what to do with it when somebody brings it up. And so I always tell my providers, “Who are your resources? Refer out. You don't have to treat that condition just because your patient brought it up.” So find those resources in the area that you can refer to. Who are those trusted people?

Like you should also be looking even for me being in a sexual medicine, urology practice. I know my GI people. I know my cardiologists who I can refer to, I know my mental health therapist, my pelvic floor therapist, like I've got a posse in my pocket of people I know that are going to be safe and validating providers to do that, too.

And so, when you are having that conversation, and, you know, it comes up, most of the time for my family providers or my internal medicine healthcare providers, this is when you're going through your review of systems, I always think about, you're going, you know, head to toe asking this question. So when you get to the pelvic health part of it, saying a lot of my patients that are in their fifties or even, throw it, in their thirties. I think that's the other thing, too – we think that this is a condition of somebody who's getting older when really, we know that it does impact a lot of people in their twenties, thirties and forties as well. So we have to throw it out there also and say, “You know, a lot of my other patients have been talking about concerns with urinary health, such as urinary leakage or leakage when you cough and sneeze. Is that something that's happening for you?” And you know, if they say, “No,” like, “Okay, cool. So no leaking?” I always listen. I always am like, “Are you sure? No, like no leaking whatsoever?” And they're like, “Yeah, I stay dry, like I'm not.” 

So, you know, like, “Are you ever worried about being out in public and you can't get to a restroom?” It doesn't have to take long. If you find those like little key questions to ask those patients, you'll be able to catch, you know, catch onto that and go, “Oh, okay. This is a concern that you have. I have a really amazing provider that I would be happy to refer you over. That's their expertise. That's their specialty.” You know, and just, you know, kind of verbalize that to them and obviously get their permission to say, “Is it okay if I send that referral over? They take your insurance…” And that, that's another big thing that a lot of patients are concerned about is that it's cool that we have this resource, but, “Can I afford it, that accessibility that goes along with it?”

“So that's, that's great. But how am I going to be able to, like, transportation? Is it across town? I can't get there. Is my insurance going to cover it? And am I going to be able to take off time from work to be able to go there also?” So we have to be thinking about that, too. You know, the big umbrella term is the ‘social determinants of health’ that come into play, especially when it comes with pelvic health and being able for patients to get the resources that they need. 

Sarah Jenkins: Those are great tips. Thank you. 

Bruce Kassover: Now, we've been talking a lot about bladder health awareness and how to help people feel comfortable talking to their doctors. But there's a whole other aspect to this that I think is equally important, and that's, you know, if you have a leakage problem, there's no way you're not aware, you know, you are aware that you're, you know, that's not avoidable. That's, that's a problem. And I know it. The bigger issue in awareness is getting that broader conversation going so it's not so embarrassing for people to talk about. 

Now, I think that what we've seen over the past, you know, 10 years or so, maybe a lot of it's because there's a lot more commercials on TV and more products and things is that women seem to find it a little easier to talk about among friends and family and peers, you know, they sort of say, “Oh, you know, I sneezed. Oops, I just leaked a little,” you know, and then they can sort of joke about it. And it's, but I think that among men, it's still extraordinarily taboo. And one of the things I really love about your perspective is, is how good you are talking about men's concerns and fears and things like that. So I'm wondering if you have any thoughts on what we might be able to do to more normalize the conversation from a man's perspective also.

Aleece Fosnight: Yeah, absolutely. I think from a perspective of going, you know, this is, these are normal activities of daily living that this could be a sign of something larger going on. So not that I ever want to give, put fear into somebody or concern, but it's good to guess. It's good to get it checked out. There are lots of reasons why you could have some incontinence, whether it's an enlarged prostate, whether it's an overactive bladder, whether it's bladder irritants, maybe it's performance anxiety. Maybe it's the fact that you're sitting for such a long period of time, too. We have so many more remote positions and jobs that are out there. I was talking to a patient just the other day and we were talking about his erectile dysfunction. And he was in his forties and he said, and I asked him, I said, “You know, well, what about any, how's your urinary function? Have you noticed that you've been going to the bathroom a little bit more often? Do you feel like you're not emptying?” Cause I was hinting at the fact that he sits a lot and it’s his pelvic floor, which can also contribute to erectile difficulties. And he was like, “Yeah, actually, you know, I'm really noticing that even I'm here at home, I'm struggling to make it to the restroom, you know, in time.”

And so we were able to put some of those pieces together. So I think understanding that it may not be an isolated incident. And even if it is having that conversation early and often and checking in with yourself, I think it's going to be really, really important.

In medicine, gosh, we talk about all sorts of things. I know that that's not always the case for my, for my patients. And I remind them of that. I'm like, “I get it. This is super easy for me to talk about, because I’ve talked about this 24/7 for the past 13 years of my career. And I know it's really difficult for you, but you, we've got this, we can do this.”

This is an important, important thing that we want to want to work together from again, the male perspective, it's understanding, too, that they're not alone, I think, because I don't have a lot of conversations about it. I think if we could pitch more marketing and advertising out there to bring awareness, like these podcasts, or even commercials, especially in sports line, TV stations, you know gosh, football's really big right now.

Or even in baseball, NASCAR, you know, just thinking about where a lot of, where men watching a lot of this and being able to put that on there, you know, have you experienced urinary incontinence? Here's some resources, right? We know that patients will go to the internet first and do a whole bunch of research on what actually their concern is about.

And so if we can give them those tools, lead them to safe spaces and trusted resources and trusted providers, then that's going to help get them there. And when they recognize too, that they are, they're not alone. I think that's, I hear that so often people feel so isolated that this is the only person that's dealing with us or struggling with us, or there's just not as many people as they think.

Bruce Kassover: When you talk about, you know, not being alone, it also brings up another whole category of people who are also dealing with these issues indirectly, and that's caregivers. I'm wondering also from, well, from your perspective as a practitioner, you know, I'm sure you probably have your share of people who come in with caregivers. 

I'm wondering if you have any thoughts about how people can, who are, who are taking care of people – parents, relatives, et cetera – how they can sort of help have the productive conversation themselves with their loved ones and then get them into the doctor's office also. 

Aleece Fosnight: Yeah. One of the first things that I'll tell a caregiver is, blame me for bringing up the conversation.

Yeah. I think if you can derail the conversation that you are concerned and to say, “Hey, I was talking to Aleece and she brought up this concern about urinary health and what's going on with you and your body. And you know, I just wanted to check in too, to see how things are going. And yeah. How either I could support you or find other resources to support you. I know that this is difficult and can be difficult to talk about, but I'm here. I am here to, to help and assist in any way that I can.” 

And that there's, especially from a spouse who's a caregiver, right? It takes a lot of the intimacy and kind of the sexiness that goes along with that when you're taking care of the person that you love.

And then I think if you can, and you have the resources and the means to do that, is have some reprieve. Continue to help your partner have as much independence as possible and as much privacy, right? I think that that's the other thing, too, is when somebody is going to the to the restroom or they need assistance with it, we stand there, right, watching them urinate or watching them do whatever they need to do with their pelvic floor and whatever else rather than leaving the room, closing the door, making sure they're safe, right, and that they are stable in their situation. But I think giving them some privacy can be really helpful and helping to create barriers for you as a caregiver and you as the partner, the lover, the spouse in that relationship. And even if you are a parent and a child to give some privacy, I think that that is so important and so essential.

So many of my patients that I've talked to, that as they've gotten older and they've lost some of that independence, that's one of the things that they bring up all the time is, “I wish I could just have two seconds to myself to do the things that I used to be able to do.” And so it's leaving the room, walking away, even if you walk out and you're like, got your ear to the door, right? Cause you're still listening. That's still, though, important that you're giving them that space and that you're not in their bubble. 

Bruce Kassover: Yeah, well, first of all, the first thing that I thought of when you said it is “Yes, I don't want you, anybody standing over my shoulder either.” I mean, nobody does. 

Aleece Fosnight: Right? No!

Bruce Kassover: But also I think that you're speaking to a larger issue. I mean, I think that you, you especially, you know, look, look, I'm a guy, so you, you can tell me if I'm wrong, but I do think that you hear in particular something that a lot of women in particular say, is that they don't feel like they ever have a moment themselves because they're always taking care of everything else around them. They're taking care of at work and then home. They have, you know, spouses and children and the house and they never have a moment. And it sounds like, you know, this is just another opportunity to take that away from them. You know, even the most intimate things can vanish when you have a problem like this.

Aleece Fosnight: Exactly. Yeah. You hit the nail on the head.  

Bruce Kassover: So at least there is one other thing I wanted to ask you about. And that also is Aeroflow because you are the medical advisor and you've been the medical advisor for a while. And I want to talk about how Aeroflow you, you feel can help with raising awareness. I know, for example, you've been involved as we've spoken about before with the diaper gap issue and trying to raise awareness specifically for the need for people to help get absorbent products to people who need them, who can't necessarily afford them. So I'm wondering maybe not just the diaper gap, but any of Aeroflow's efforts to try and raise awareness for bladder issues. 

Aleece Fosnight: Absolutely. So Aeroflow is an amazing medical supply company that not only provides products, incontinence products, so pads, briefs, wipes, if somebody has to intermittent cath, so catheters and all of the supplies that are used for that, they also have an amazing team that is there to support you as the provider, as the patient, as the caregiver to help connect with concerns around insurance coverage, support groups, having conversations of like, “I don't know what to do. Do you know any resources in my area?” So also that liaison that can help connect you with individuals or even medical providers. I know with Aeroflow, I, as a provider, will do prescriptions for Aeroflow or I reach out or I will help to fill out the forms for my for my patients.

But the other really, again, cool thing too, is on the flip side that if you are a patient trying to find a provider that Aeroflow can definitely help guide you in that direction as well. So they have numerous amount of resources. They have blogs, they have other resources that are out there, all linked on their website so that patients can have kind of a central place where they can get the majority of their information, too.

So, and then the amount of free products that they give out also, and just really helping, not just from that side, but supporting, you know, podcasts like this and raising awareness about something that is so common amongst the people here living in the United States. It's just it's an amazing company, and again, I'm so honored to be a part of the amazing efforts that they're doing. 

Bruce Kassover: Yeah, I definitely want to second that. I mean, you know, Aeroflow Urology has been, for a while, a Trusted Partner with the NAFC and, you know, to become a Trusted Partner, it's not just, you know, “Here's a check and we're going to be a sponsor.” There is a vetting process where we make sure that the company shares the same values and the same vision, the same sort of approach to bladder health and awareness that NAFC does and is really committed to good products and customer service and, and the whole shebang. So, you know, it's, it's really a partnership that we value also, and we definitely recommend if people do want to learn more, it is, correct me if I'm wrong, it's AeroflowUrology. com. That's A-E-R-O-F-L-O-W-U-R-O-L-O-G-Y.com. Is that, did I get that right? 

Aleece Fosnight: You got it right. Yep. 

Bruce Kassover: Excellent. And now one other thing before we go is that, you know, you certainly know as well as anybody because you've done this a number of times, is we always like to end with one little hint or tip or a bit of advice to help people live a life without leaks, and I'm wondering if you might have something to share with us today. 

Aleece Fosnight: Absolutely. And I knew you were going to ask me this because I've been on here and I thought, gosh, what are the tips that I've given before? Because I wanted something new and unique for this. And I don't think that we've talked about it before, but moving your body, movement, I'm not talking about like running a marathon or whatever else, but getting up and just moving your body.

I tell my patients all the time, a five-minute dance party in your living room. It makes so much of a difference when it comes to engaging those pelvic floor muscles. Anything that you can do that are moving your hips, that you're getting out and walking, stretching can be really good: yoga, you know, golf, Frisbee, any, just anything that's getting your body moving is going to be really helpful to engaging your core and your pelvic floor muscles also, which are key in keeping those muscles strong, happy, and healthy so that it can support your bladder and your bowels so that you can function in a pelvic floor, urinary valve optimization, as much as, as such as you can. So get out there and move your body on a daily basis, if you can. 

Bruce Kassover: I love it. And who doesn't want to have a five-minute dance party, even, whether or not it does anything for your pelvic floor.

Aleece Fosnight: Yeah. Well, you know, we talked a little bit about mental health and we know how much moving your body and those endorphins actually help to stimulate all of those receptors in your brain, those happy hormones that are in there are getting released also, so, and I'm sure that everybody that just listened to this chuckled or smiled when they thought about a dance party in the living room. I don't care if you can't dance or whatever else, or if you wanted to do the tango or the cha cha, or you wanted to bust a move, like it doesn't, it doesn't matter what kind of dance party you want to have. 

Bruce Kassover: Excellent. Well, we appreciate it. And thank you again for joining us, Aleece. It really means a lot. and we look forward to having you on again in the near future. 

Aleece Fosnight: It was my pleasure, Bruce. Thank you so much for having me again. I really, truly enjoy this. 

Bruce Kassover: Life without leaks has been brought to you by the National Association for Continence. Our music is “Rainbows” by Kevin MacLeod. More information about NAFC is available online at NAFC.org.