Men’s Incontinence Challenges: Absorbent Products And Anxiety

Bruce Kassover: Welcome back to the second half of our conversation about men’s incontinence issues. We’re talking with Aleece Fosnight, board-certified physician assistant specializing in sexual medicine, women’s health and urology, and she’s also a medical advisor for Aeroflow Urology.

So Aleece, one thing we haven’t touched on yet is products that men might choose to control their symptoms – I know that products are a first line of defense for a lot of men, so I’m wondering if you could tell us a little more about them and what they mean for people trying to manage their symptoms.

Aleece Fosnight: Yeah, absolutely. I, I think it’s really important to know what’s out there and most of the time I think men think that they have to just reserve to, to pads and that thinking about, well, what pads should I use or not use, right? It is the biggest thing we tell this for, you know, a lot of times with women, as you know, menstrual pads are not the same as incontinence pads. The absorption rate is different. And so for men because of the positioning of genitals, you want something that’s going to have almost like a triangular shape versus an actual pad that’s going to sit in your underwear.

And I want a lot of my men to feel comfortable. So I like to start with an incontinence pad first, that can be really helpful. They get to wear their own underwear. It still feels like them. It’s, you know, something that just happens to be in their underwear that’s catching, catching the urine.

If we’re having spillover or that pad is just not able to catch all of that at once. The other thing too, that that is happening also for some folks with. Like for the prostatectomy piece of it, they, if they had a little bit of BPH right? You can have prostate cancer and BPH also. So if they had some BPH that was also going on with this prostate cancer and their bladder muscle was trying to squeeze more to get past this blockage with that prostate, that bladder remembers. It doesn’t like waking up from anesthesia and go, “oh, prostate’s gone. I can calm down now.” No, it’s been trained over and over and over again for months or even sometimes for years. So you have to untrain that bladder to go, Hey, I don’t have this blockage anymore. So it’s a series of holding the bladder a little bit longer. Again, doing this pelvic floor muscle squeezes, being conscious of when you are going to the bathroom. But what can happen is some of my guys will say, “you know, it’s not, it’s not just like a constant drip, right, like the faucet that just wants to turn off.” It’s not just this constant drip, which happens a lot, but for some guys it’s this automatic like, gush and flooding that happens. You need a reservoir to catch a lot of that, a lot quicker for some of these individuals. So more of incontinence underwear may be the thing that you would want to have for those individuals.

So everybody’s, you know, just a little bit different and some folks, too, or just like, you know, I just, I feel safer with having just a complete incontinence underwear. Or again, maybe I just, I want, I want to just a pad. I tend to tell people don’t stack ’em, don’t put a, don’t put the pad in the incontinence underwear because it will overflow. Things aren’t going to catch like they, like they need to.

The other thing that a lot of my guys have no idea is, is penile clamps. And it sounds a little bit more barbaric than what, what it actually is, but they’re really soft and they’re a clamp that you can place over the end of the penis.

They’re really soft. They’re usually made out of foam, but right, it collapses that urethra and so that they, it’s trapping that urine kind of behind there. And then what they can do is they can go to the restroom and unclamp that device, and then they’re bladder will empty out the urine that’s in there. So again, another really good kind of device, too.

There are also, it’s not just this clamp, but there are these little sticky pads too that you can place over the urethra, also. So some people may not find that those clamps are comfortable, so there’s this, these sticky devices that you can use also. There are condom catheters that some folks can use, too.

I tend to, the less that you can have in the genitals, the better when it comes to equipment and devices. And the reason for that being is just infection. Right? And we have to remember, I want this to be a bridge, a stepping stone. We don’t necessarily want to use these products forever. So I have that clear expectations with my patients to begin with, right? We don’t want to just rely on pads and then not have to do this. Obviously. I want to talk to my patients about what their goals are. That’s so important to you in terms of, I, Aleece, I don’t ever want to wear pads. Ever. I’m like, okay, cool. How, how can we negotiate and get there together and figure, and figure this out?

So again, because we don’t, I don’t want to train the bladder to just continue to squeeze or not be able to hold urine like it’s designed, like it’s designed to. So we have a lot of those conversations on, again, what expectations are. What are our goals for this and that we want this to be as short as possible and, recognizing, too, if we get to a point where, say they’re only 50% continent, you know, at this, at this point, when is that incontinence happening? Why is that happening and do we need to again, throw in some more interventions or something else that’s happening again, whether we utilize a pelvic or physical therapist, maybe this is an overactive bladder situation now, right? That potentially could happen two separate processes. So that might be another type of intervention that we would want to use, whether it’s medications, water management, drinking more water, avoiding certain things that can irritate the irritate the bladder.

Bruce Kassover: So one other area of management that I wanted to ask you about is less a matter of products or medications and things of that nature, but more about mindset and sort of your approach towards the condition from, from like an anxiety perspective also, and how much of that plays into people’s symptoms and how managing that and sort of controlling, trying to get some sort of a control over things like anxiety and worry and stress might be something that makes a difference for people as well.

Aleece Fosnight: Yeah. Oh goodness. Yes, absolutely. And I tend to find that a lot of my guys are anxious and anxious over a multitude of things. But then you start throwing on urinary staff or urinary incontinence, or not being able to find a bathroom when they’re out in public just levels up this whole process.

So with that, with that being said, too, is when somebody starts to worry about when they’re going to urinate or what’s going to happen, they tend to become socially withdrawn. They’re not going out. So a lot of places, we are social creatures, right? We love being around other people. It feeds us, it does calm us, although it can cause them anxiety too. But being socially withdrawn can increase the mental health concerns we have. We have lots of research that shows that, too. And incontinence definitely has a lot of barriers to that. Anxiety makes you hyper-focused. So there is this hyper awareness of, “Where’s the bathroom? I better go now. I’m going to try to go before I have an incontinence episode.” And so what happens is then we start training the bladder to have a different set point of when it fills in the bladder of, “Okay, so my bladder typically would want to go to the bathroom and empty it out when there’s 300 milliliters that are in there.”

So about 10 ounces. Right. So, but if we start leaking at that amount we’re going to try to stop and go to the bathroom when our bladder is 250 mLs. So when that happens our bladder then thinks, “Oh, 250 is now my capacity. I’m going to give cues and signals earlier to go to the bathroom. And then it’s just this vicious cycle of you’re constantly holding less and less in your bladder and going more and more and more, which is causing more and more anxiety.

So again, just this kind of vicious anxiety cycle that’s provoking you to go to the bathroom more frequently. Now the other thing too, anxiety causes high tone pelvic floor. We have a lot of research now that directly correlates folks who have TMJ, who have anxiety, who have other stress disorders, that a lot of the stress intention is now being held in those pelvic floor muscles, right?

So those muscles clamp up, they clench, and when you go to the bathroom, you can’t relax those muscles enough for the bladder to squeeze. The chooser muscle, empty out the bladder and be able to then fully evacuate that area, too. And then it’s just more urgency, more urinary symptoms compiled on one another over and over and over again.

And so that anxiety can continue to get worse and worse and worse. So it’s not necessarily putting somebody on an anxiety medication. It’s recognizing first, and, and acknowledging it as well as validating it for that patient and saying, “I see this pattern happening. Is this what you’re, is this what you’re feeling? Is this what’s happening?”

And so again, for, for patients that are listening, you know, recognizing that too is, “Am I starting to make this a habit? Am I starting to see that my bladder is controlling my life and controlling where I go and what I do or what I’m avoiding?” Because that’s never, never what we want to do.

And being able to open up those, those questions, it’s mind over matter. You know, a lot of times too, mindfulness has been shown to really, greatly decrease anxiety. And if you throw intentionality behind, kind it where you’re saying, “Okay, I’m practicing mindfulness to have better control over my bladder.”

Right? I usually tell people, I want you to have a focus, a focus of when you’re doing your mindfulness practice, what are, what’s that intention that you’re setting for that? And if it is to have better control over your bladder, let’s name it, let’s, let’s do it. And that way we can continue to control it as well.

Bruce Kassover: I love that. That sounds great. And we also need to just get everybody “Keep Calm and Carry Onto the Bathroom” posters. That might help as well, right?

Aleece Fosnight: Yeah, absolutely. And it’s, you know, the way that I have, have heard it from a lot of my patients is it’s just this sudden right urgency and they just know if they can’t get there right then and there, it’s this panic, right, of, “Where’s the bathroom? Am I going to embarrass myself? Am I going to, you know, have an accident? Do I have a change of clothes with me?” That’s, you know, a lot of the frustration too with a lot of the patients that I talk with is, “I, I didn’t bring a, a change of clothes or what happens,” or “I’ve just, I am going to miss work or I’m going to miss this event because of, because of my incontinence?”

Bruce Kassover: And I guess that’s where being prepared with the product also can be particularly helpful.

Aleece Fosnight: Yeah, absolutely.

Bruce Kassover: And you know, that actually brings us to, to, to one last thing I wanted to ask you about is Aeroflow. You’re the medical advisor to Aeroflow urology. Maybe you could tell us a little bit about who Aeroflow is and what they do and, and how they might be of benefit to some of the listeners out there.

Aleece Fosnight: Yeah, absolutely. So Aeroflow is a company really geared towards healthcare. So it’s not just so you’re… to back up a little bit, Aeroflow is a bigger company and they do a lot of other things besides just urology. So they also help with breast pumps and that sort of thing. But in terms of Aeroflow, urology, and what it actually does is they do a lot with catheter supplies, incontinence products, which are pads. They have a lot of support for kiddos too, right? It’s not just older adults or adults that have concerns with their, with their bladder. It’s really everybody.

In terms of intermittent cathing, they have that, those products, they have longer term catheterization products. They also have protective pads that can be really helpful for somebody during the night time during sleeping. So that can be really helpful.

I love that they have products too that help to support the skin and break down. This is really important, too. When I talk to patients about wearing pads and protective underwear or whatever that looks like, that’s a warm, moist area. And now if we don’t change it enough, then we start talking about there can be skin breakdown that happens, urinary tract infections.

So we want to make sure that we at least keep that area as dry as possible. And for some folks, right, they have been maybe kind of governed by their pads all day long. They’re just like, “I just want to, I want to sleep with no underwear, but I don’t want to get my, I don’t want to have to change my sheets all the time.”

So having these kind of under pads or kind of check pads for bed can be really helpful. And Aeroflow has those, they have the skin barrier protectiveness. They have special wipes to help clean as well. And the other really thing that I love about Aeroflow is their generosity. So they’re going to try to work with patients as much as possible to get them the products that they need in a reasonable budget.

I think that that’s, you know, what we’re looking at the world right now and things have gotten so expensive. You know, that’s why people are wearing their incontinence pads or their underwear all day long literally so soaked to the point that it’s so heavy that it’s causing chafing onto the skin, too, because of that, and just, again, so much skin breakdown. So it’s just, I love their company. I know I’m a little biased because I’ve been working with them for such a long time, about three years now, which is awesome. But I love, again, kind of just the generosity and the overall awareness.

They’re really trying hard every single day to bring awareness about urinary incontinence. Trying to normalize it in the fact that this, this isn’t something that is, should be embarrassed for, should be no shame around it as well, but we know that, we know that there is. So having conversations like this and being able to partner with you all to be able to get this information out is so key and so vital to, again, bringing awareness about it, knowing that you’re not alone and that there are things that you can do to make it better.

Bruce Kassover: So to take advantage of the products and solutions that Aeroflow makes available, do you have to be a Medicare recipient or have a prescription or anything like that, or can, or is it just for anybody can go online and order these products?

Aleece Fosnight: So not everybody can go online. A lot of times you’re going to need to have a prescription from a medical provider.

And a lot of times Aeroflow will have the form ready to go for you to fill out. What does this person need? Why do they need it? How many do they need? And so a lot of times people are then, it’s kind of governed by their insurance. They’re restricted, you know, you can only have two catheters a day, which is just ridiculous.

But anyways, they are sometimes confined to what the insurance company says to them. So Aeroflow tries to go in and talk with the patients, meet them where they’re, where they’re at, what are the things that we can potentially do? Is this, what is it, FSA or HSA eligible? Are there other ways that we can get you to pay for this? Medicare’s pretty good. But Blue Cross Blue Shield and other commercial insurances are going to be really, really good too. There’s not, from what I have found, there’s not a whole lot of pushback and as long as they have a provider’s reasoning.

So I have had a patient who was self-cathing six times a day and their insurance company would only let them have four catheters, and so guess what? They were starting to reuse them and getting urinary tract infections. So once I wrote a very lovely letter to the insurance company saying, look, this person really does need to have these supplies, and here’s the reason why… I didn’t get any pushback.

But sometimes us, as healthcare providers, have to go a little bit of that extra mile to be able to support our patients in writing those letters of support and making sure that they’re getting the supplies that they need. Now, a lot of times healthcare providers don’t always ask that.

So if you’re a healthcare provider listening to this, please ask your patients. Do you feel like you have enough supplies? And if you are a patient, I want you to think about that. Am I getting enough supplies? Do I really have everything that I need? And if I could have more supplies, how much do I need? What else do I need? And then would encourage folks to go on the Aeroflow Urology website. They do have a listing of all their supplies and products on there. And so you can kind of browse and then send your provider a message and go, “Hey, the next time that we have an appointment, can we talk about increasing my supplies? I was looking on the website and saw that they also have this. Is that something that we can, can look at, too?” I love the fact that Aeroflow has a variety of products and products for, for a lot of folks to use, and that they’re getting insurance to cover a lot of these things as well.

Bruce Kassover: Excellent. And the website is AeroflowUrology.com.

That’s AEROFLOWUROLOGY.com. And we’re going to put a link in the show notes as well, so anybody who wants to go and take a look because it really does, there really is a nice variety of products there. The website itself is super intuitive and easy to use, so anybody who may be, you know, a potential user of these products, I do encourage you to go and check it out because it’s definitely worthwhile.

Well, Aleece, I want to thank you for joining us today. This was really interesting and more, it was really important and I’m hoping that the men who are listening to this, who recognize that there really are options out there to help treat their symptoms that they are not forgotten and they are not u unappreciated when it comes to recognizing that this is a real issue that really needs to be addressed. So thank you for your expertise and your time and everything you’ve offered.

Aleece Fosnight: Oh, it has been absolutely my pleasure. And the more information and education that we can get out there and more awareness about really important topics like urinary incontinence, especially with a male focus is so, so key. So I am so happy to be here as well. And thank you so much for letting me share what I have learned over the past 12 years.

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod. More information about NAFC is available online at NAFC.org.