In discussing the psychosocial impact of urinary incontinence, 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, highlights how profoundly the condition affects identity, dignity, and social connection. She explains that continence is a powerful social norm, and losing it threatens one’s sense of self. Shame, more than the physical symptoms themselves, often drives feelings of loneliness in both men and women, regardless of age.
Drawing on the work of Brené Brown, Fosnight distinguishes between guilt and shame. Guilt, she notes, is tied to behavior—“I did something bad”—and can be adaptive, motivating people to seek solutions and make changes. For example, after an incontinence episode, guilt might prompt someone to explore treatment or coping strategies. Shame, however, is tied to identity—“I am bad”—and fosters isolation, secrecy, and unworthiness. Unlike guilt, which can inspire action, shame erodes self-esteem and discourages help-seeking.
Fosnight describes how shame surrounding urinary incontinence leads individuals to conceal symptoms, avoid social interactions, and limit disclosure even to health care professionals. This withdrawal reinforces isolation and diminishes quality of life. Embarrassment emerges as the most significant barrier to care, with patients fearing judgment and rejection more than the condition itself. In turn, they may silently endure symptoms rather than risk exposure.
Ultimately, Fosnight emphasizes that the cycle of shame, secrecy, and loneliness compounds the burden of urinary incontinence far beyond its physical effects. The stigma drives self-imposed restrictions, reduces engagement with support networks, and prevents individuals from accessing professional help that could improve their lives. Breaking this cycle, she suggests, requires recognition that urinary incontinence is not a personal failing but a medical condition—one that deserves open conversation, empathy, and appropriate care.