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Urinary incontinence is far more common than most people realize — yet it remains one of the least discussed health conditions, often leaving patients suffering quietly rather than seeking treatment. In this episode of Just Health for the People, a public health awareness initiative by Jaslok Hospital, host Jitendra Hariyan speaks with Dr. Shailesh Raina, Director of Urology, Renal Transplantation, and Robotics at Jaslok Hospital, about the types of urinary incontinence, its causes, and the treatment options available — including advanced neuromodulation therapy.
Dr. Raina brings 36 years of experience in the field, trained internationally in the UK and Belgium, and conducted India's first-ever workshop on neuropathic bladder in 2006.
Urinary incontinence refers to the loss of control over urination in men, women, or children. Dr. Raina explains that it isn't a single condition but a group of related issues, each with distinct causes and mechanisms.
Leakage that occurs when a person cannot reach the bathroom in time despite feeling an urgent need to urinate.
Leakage triggered by physical stress on the bladder — such as coughing, sneezing, or laughing.
A combination of both urge and stress incontinence.
Occurs when the bladder becomes weak (often linked to conditions like diabetes) and loses sensation, causing it to overfill and leak continuously in small amounts, similar to a bucket overflowing drop by drop.
Typically caused by a fistula — an abnormal connection between the bladder and vagina — resulting in constant, uncontrolled leakage.
Linked to situational or nervous triggers, such as anxiety before an exam causing increased urgency and frequency.
Over the last 15–20 years, medical understanding has evolved significantly. Rather than viewing the bladder as an isolated organ, doctors now recognize it as directly connected to the brain through a micturition center, which controls when the bladder is "on" (needs to empty) and "off." Disruptions to this brain-bladder connection — from spinal injuries, cauda equina syndrome, multiple sclerosis, or stroke — can cause persistent leakage or, conversely, an inability to urinate at all, a condition known as bladder detrusor dysfunction.
Frequent nighttime urination (nocturia) is technically distinct from incontinence, which specifically refers to leakage. Common causes of nocturia include:
Dr. Raina highlights an important and often-missed connection: patients with obstructive sleep apnea frequently experience nocturia — not due to any prostate or bladder issue, but as a direct effect of the sleep disorder itself. Once sleep apnea is treated (e.g., with a CPAP machine), nocturia often resolves completely. This underscores why bladder issues should always be evaluated as part of the complete clinical picture, sometimes involving a sleep specialist.
Diagnosis begins with a detailed patient history, which often reveals the type of incontinence even before physical examination — for example, a patient describing leakage during coughing points toward stress incontinence, while behavioral cues (such as sitting near a bathroom or crossing legs while talking) can offer additional clues.
Further diagnostic steps may include:
Dr. Raina describes how, for decades, incontinence has been a condition of "suffering in silence." Patients often avoid social situations, public transport, and even medical consultations due to embarrassment over odor or visible pads. This isolation can take a significant emotional toll. Dr. Raina emphasizes that with today's effective treatment options, patients should feel empowered to seek help rather than suffer silently.
The first line of treatment typically includes patient counseling and medications, particularly antimuscarinic drugs, for overactive bladder-related urge incontinence. While generally very safe, these medications aren't suitable for everyone — particularly certain elderly patients — and require careful clinical judgment.
When medications are insufficient, Botox injections into the bladder can help relax an overactive bladder.
Minimally invasive procedures are now widely available, including:
Kegel exercises — contracting the levator ani muscle, part of the pelvic floor — can help strengthen pelvic support. However, Dr. Raina cautions that Kegels are not appropriate for everyone. Patients with urgency and frequency issues (an already "tight" pelvic floor) may actually worsen their symptoms with Kegels, since the exercises can retain more urine in the bladder. Kegels should only be recommended for the right clinical indication.
A minimally invasive option for managing urgency and frequency symptoms.
When other treatments fail for overactive bladder symptoms — including urgency, frequency, and urge incontinence — sacral neuromodulation is considered a highly effective last-resort option.
The sacral bone contains nerve pathways (through the S3 foramen) that control bladder function. Rather than simply stimulating these nerves, neuromodulation modulates — meaning it regulates the signaling between the bladder and brain to reduce overactive "firing" that causes urgency and frequency.
Modern neuromodulation devices carry a battery life of approximately 10 years (up from 5 years previously). Certain patients — including pregnant women and, cautiously, diabetic patients (due to infection risk) — require special consideration before implantation. When used for the right clinical indication, success rates range from 70–75%.
Dr. Raina shares a particularly meaningful case involving a child with sacral agenesis — a congenital condition where the sacrum (and associated nerve structures) doesn't fully develop, resulting in a small, poorly functioning bladder. Through progressive bladder augmentation surgeries starting in early childhood, and later a specialized muscle transposition technique (learned during international training) to help the bladder contract effectively, the child eventually achieved independent urination by age 17 — going on to receive a full scholarship to study in Australia, supported by published clinical documentation confirming she had no ongoing medical concerns. Dr. Raina describes these long-term pediatric success stories as some of the most rewarding parts of his career.
Dr. Raina's key recommendations for maintaining healthy bladder function include:
Dr. Raina encourages anyone experiencing urgency, frequency, or any bladder-related concern to consult a urologist, gynecologist, uro-gynecologist, or pelvic floor specialist without hesitation or embarrassment. With the right diagnosis and modern treatment options — from medication to advanced neuromodulation — urinary incontinence is a highly treatable condition, and no one needs to continue suffering in silence.
This article is based on an episode of Just Health for the People, a public health awareness initiative by Jaslok Hospital, featuring Dr. Shailesh Raina, Director of Urology, Renal Transplantation, and Robotics. Watch the full video here: Urinary Incontinence Explained by Dr. Shailesh Raina
For consultation regarding urinary incontinence, bladder health, or neuromodulation therapy, please reach out to Jaslok Hospital's Department of Urology.