A Study to Evaluate The Effectiveness of Pelvic Floor Strengthening Exercises on Urinary Incontinence and Quality of life among women residing in selected area at Dharapuram

Nivetha¹, Christy mekala², Jasmin sharmila³, Sheela Rani⁴

¹RN, RM, M.Sc., (N), Community Health Nursing, Bishop’s College of Nursing, Dharapuram.

²Principal, Head of the Department, Community Health Nursing, Bishop’s College of Nursing, Dharapuram.

³Associate.Professor, Community Health Nursing, Bishop’s College of Nursing, Dharapuram.

⁴Professor, Community Health Nursing, Bishop’s College of Nursing, Dharapuram.

*Corresponding Author E-mail: nivethanivis008@gmail.com

ABSTRACT:

Urinary incontinence is the loss of bladder control. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong, when you don’t get a toilet in time. The risk factors that increase the risk of developing urinary incontinence include gender, age, being overweight, smoking, family history, some disease like neurological disease or diabetes. This Study was aimed to evaluate the effectiveness of pelvic floor strengthening exercises on urinary incontinence and quality of life among women residing in Tirupur road and Jinna Maithanam at Dharapuram. The conceptual framework of the study was based on the modified King’s goal attainment theory (1981) the research design used for the present study was quasi- experimental non- equivalent control group pre- test post- test only design. Sample size was 60, out of which 30 were in experimental group and 30 were in control group. The sample were selected by non-probability purposive sampling technique and the level of urinary incontinence was assessed by adopted self- reported urinary incontinence questionnaire and quality of life was assessed by king’s health questionnaire by structured interview schedule. The pelvic floor strengthening exercises was given twice a day for 15 minutes during morning and evening. The collected data were analysed by using descriptive and inferential statistics. The mean post-test level of urinary incontinence 34.2(SD±7.7) was lower than the pre-test mean score 77.4 (SD± 8.4) in experimental group. The calculated paired ‘t’ test value was 28.6 which was significant at p<0.05 level. The post-test mean score of quality of life 312.3(SD±161.7) was higher than the pre-test mean score 743.2 (SD± 53.17). The calculated paired ‘t’ value was 12.07 which was significant at p<0.05 level. The mean post-test level of urinary incontinence in experimental group 34.2(SD±7.7) was significantly lower than the mean post-test level of urinary incontinence in control group 86.2(SD±4.7) and mean difference was 52. The calculated independent ‘t’ value was 40 which was significant at p<0.05 level. The mean post-test level of quality of life in experimental group 312.3(SD±161.7) was significantly lower than the mean post-test level of control group 696.5(SD±57.6) and the mean difference was 384.2. The calculated independent ‘t’ value was 3.7 which was significant at p<0.05 level. The findings revealed that the pelvic floor strengthening exercises can be helpful in reducing the level of urinary incontinence and improve the quality of life among women.

KEYWORDS: Effectiveness, Urinary Incontinence, Pelvic Floor Strengthening Exercises, Quality of Life

INTRODUCTION:

The urinary system, also known as the renal system, produces, stores, and eliminates urine, the fluid waste excreted by the kidneys. The kidneys make urine by filtering waste and extra water from the blood. Urinary incontinence means there is a loss of bladder control which leads to unintentional passing of urine.

During a woman’s lifetime, various health conditions can challenge bladder function. All subtypes of urinary incontinence are highly bothersome, and management should begin by assessing the patient’s willingness to engage in treatment, determining the level of treatment, determining the level of treatment desired, and discussing current evidence and recommendations for specific treatment, including benefits, alternatives, risk, and complications. Furthermore, assessment of quality of life has become an integral part of determining the effort of urinary incontinence on the individual and assessing the benefits of treatments.

Pelvic floor muscle exercise is defined as an exercise to improve pelvic floor muscle strength, power, endurance, relaxation, or a combination of these parameters.

The quality of life (QOL) concept now includes new aspects related to patient well-being because QOL has become more of a personal perception than of an objective and measurable entity.

World Continence Week is a health campaign run by the International Continence Society (ICS) every year to raise awareness of incontinence-related issues. This year World Continence Week is taking place between 20-26 June 2022.

MATERIALS AND METHODS:

Research Approach:

An Evaluative approach is used for this study.

Research Design:

A quasi-experimental non-equivalent control group pre-test and post-test only design was adopted to assess the effectiveness of pelvic floor strengthening exercises among women with urinary incontinence.

Population:

The target population selected for the study was women within the age group of 46-55 years.

The setting of the Study:

The study was conducted in selected community areas at Tirupur.

Sample:

The Sample consist of women with urinary incontinence who underwent the screening by using the questionnaire for female urinary incontinence diagnosis (QUID) scale who got a score between 11- 30.

Sample Size:

The sample size for the study consists of 60

1 30 were in the experimental group in Tirupur road.

2 30 were in the control group in Jinna Maithanam.

Sampling Technique:

Non-probability purposive sampling technique was used to select the samples.

Instrument and Scoring Procedure:

Instrument:

The tool consists of three parts

PART-I:

It consists of demographic variables such as Age, Marital status, educational status, Occupational status, Religion, Monthly income, Type of family, Duration of illness, Number of children, and Mode of delivery.

PART- II (A):

It consists of a screening procedure to assess the degree of urinary incontinence the screening tool was the Questionnaire for female urinary incontinence diagnosis (QUID) scale. It comprises 6 questions and the total score is 30.

PART-II (B):

Self-reported urinary incontinence questionnaire was used to assess the level of urinary incontinence. The UIQ consists of 21 items, 17 related to urinary leakage problems, 2 related to frequency problems, and 2 related to retention problems. Each item 26 has its own Likert rating scale structure and operational definition. The total score was 94.1-33 is mild, 34-66 is moderate, and 67-94 is severe.

PART-III:

The King’s Health questionnaire was used to assess the quality of life for urinary incontinence the KHQ comprises 21 questions divided into 9 domains the KHQ has scores for each domain ranging from 1 to 100.

Reliability:

· Reliability of the self-report urinary incontinence tool was assessed by Cronbach alpha method formula r = 0.81 and found to be reliable.

· The reliability of King’s Health Questionnaire was assessed by testing internal consistency using Cronbach’s Internal consistency formula r = 0.91 and found to be reliable.

Validity:

The content validity of the tool was validated by three experts from the field of Community Health Nursing and one block medical officer.

Protection of Human Rights:

The research proposal was approved by the dissertation committee before the study. Permission from the municipal office was obtained in written consent. The researcher-maintained confidentiality throughout the study.

Data Collection Procedure:

Data collection was done in Tirupur road and Jinna Maithanam at Dharapuram. The investigator obtained permission from municipal office prior to the study. The purpose of the study was explained to the subjects. The samples who fulfilled the inclusion criteria were selected by using purposive sampling technique. 30 samples were selected from Tirupur road for experimental group and followed by 30 samples from Jinna Maithanam for control group. 30 In control group, screening and demographic variables were conducted on the first day by using the questionnaire for female urinary incontinence diagnosis (QUID) scale to the women under 46-55 years and the screening process was stopped when 30 samples were selected. Pre- test was conducted by using self- reported urinary incontinence questionnaire and king’s health questionnaire to assess the quality of life by using structured interview method. The post-test was conducted for the control group. In experimental group data were collected from 30 women under 46-55 years. Screening was conducted by using the questionnaire for female urinary incontinence (QUID) scale to the women and 30 samples were selected. Demographic variables and pre- test were conducted by using self- reported urinary incontinence questionnaire to assess the level of urinary incontinence and king’s health questionnaire to assess the quality of life by structured interview method. The pelvic floor strengthening exercises was given for the experimental group for 30 minutes twice a day (15 minutes in the morning and 15 minutes in the evening). The exercises including bridge, squats, split table top. The exercises were demonstrated and assisted for 30 samples. The interventions were given for 21 days. The post-test was conducted to experimental group after intervention. The collected data were analysed by using descriptive and inferential statistics.

Table 1 showed that mean pre- test and post-test scores of urinary incontinence among women with in experimental group were 77.4(SD±8.4) and 34.2 (SD±7.7) respectively. The mean difference was 43.2. The ‘t’ value was 28.6which was significant at P<0.05 level which showed that pelvic floor strengthening exercises was effective in reducing the urinary incontinence among women. Hence, the research hypothesis H1 that is the mean post –test level of urinary incontinence is significantly lower than the mean pre- test level of urinary incontinence in experimental group was accepted.

Table 2 showed that mean pre- test and post-test score of quality of life among women with urinary incontinence in experimental group were 743.2(SD±53.17) and 312.3 (SD±161.7) respectively. The mean difference was 430.9. The ‘t’ value was12.07 which was significant at P<0.05 level. Hence, the research hypothesis H2 that is the mean post- test level of quality-of-life score is highly satisfied significantly lower than the mean pre -test level of quality-of-life scores in experimental group was accepted.

Table 3 showed that mean post-test scores of urinary incontinence among women experimental and control group were 34.2(SD±7.7) and 86.2(SD±4.7) respectively and the mean difference was 52. The Independent ‘t’ value was 40, which was significant at P<0.05 level which showed that pelvic floor strengthening exercises was effective in reducing urinary incontinence among women. Hence, the research hypothesis H3 that the mean post-test level of urinary incontinence in the experimental group is significantly lower than the mean post-test level of urinary incontinence in the control group was accepted.

Table 1: Comparison of mean score, standard deviation, mean difference and paired ‘t’ value of pre- test and post- test level of urinary incontinence among women with urinary in experimental group…...n= 30

S. No

Urinary Incontinence

Mean

Standard Deviation

Mean Difference

Paire ‘t’ value

Table Value

Inference

Pre-test

Post - test

77.4

34.2

±8.4

±7.7

43.2

28.6

2.05

S^*

df=29 p<0.05

Table 2: Comparison of mean score, standard deviation, mean difference and paired ‘t’ value of pre- test and post -test level of quality of life among women with urinary incontinence experimental group. n=30

S. No

Level of quality of life

Mean

Standard Deviation

Mean Difference

Paired ‘t’ value

Table Value

Inference

Pre-test

Post -test

743.2

312.3

±53.17

±161.7

430.9

12.07

2.05

S^*

df=29 p<0.05

Table-3: Comparison of mean score, standard deviation, mean difference, and independent ‘t’ value of post- test level of urinary incontinence among women in experimental and control group. n1=30, n2=30

S.No

Urinary

incontinence

Mean

Standard Deviation

MeanDifference

Independent ‘t’value

TableValue

Inference

Experimental group

Controlgroup

34.2

86.2

±7.7

±4.7

2.00

S^*

Table 4 showed that mean post-test scores of quality of life among women experimental and control group were 312.3(SD±161.7) and 696.5(SD±57.6) respectively and the mean difference was 384.2. The Independent ‘t’ value was 3.7, which was significant at P<0.05 level which showed that pelvic floor strengthening exercises was effective in reducing the urinary incontinence among women. Hence, the research hypothesis H4that the mean post-test level of quality of life in experimental group is significantly lower than the mean post-test level of quality of life in control group was accepted.

RESULTS AND DISCUSSION:

Regarding age, in experimental group, majority 22(73%) belonged to 46-50 years and least in 8(27%) belonged in 51-55 years. In control group, majority 25(83%) belonged in 46- 50 years and least in 5(17%) belonged in 51-55 years. Regarding marriage, in experimental group, majority 20(67%) belonged in married and least in 5(17%) belonged to divorced and widower, in control group majority 25(83%) belonged in married and 3(10%) belonged in widower and least 2(7%) belonged in divorced. Regarding education, in experimental group, majority 15(50%) belonged in primary education and 8(23%) belonged to higher education and least in 7(23%) belonged in no formal education, in control group majority 15(50%) belonged in primary education and 10(33%) belonged in no formal education and least 5(17%) belonged in higher education Regarding occupation, in experimental group, majority 21(70%) belonged to coolie and 5(17%) belonged to private employee and least in 4(13%) belonged to house wife, in control group majority 20(67%) belonged in house wife and least10(33%) belonged to coolie. Regarding religion, in experimental group, majority 28(93%) belonged in Hindu and 2(7%) least in Christian, in control group majority 30(100%) belonged in Muslim. Regarding income, in experimental group, majority 23(77%) belonged in Rs.5000- 10000 and least 7(23%) belonged in Rs.10001-20000, in control group majority 15(50%) belonged in Rs.10001- 20000 and 13(43%) belonged in Rs.5000 - 10000 and least 2(7%) is belonged in above 20001. Regarding family, in experimental group, majority 26(87%) belonged in nuclear family and 4(13%) least belonged in joint family and, in control group majority 25(83%) belonged to joint family and least 5(17%) belonged to nuclear family. Regarding duration of illness, in experimental group, majority 16(53%) belonged to last one year and 8(27%) belonged to last 3 months and least in 6(20%) belonged to house one year above, in control group majority 25(83%) belonged in widower, 3(10%) belonged to last one year and least 2(7%) belonged to last 3 months. Regarding mode of delivery, in experimental group, majority 17(57%) belonged to normal and 12(40%) belonged to instrumental and least in 1(3%) belonged to LSCS, in control group majority 20(67%) belonged to normal, and least 5(17%) belonged to instrumental and LSCS. Regarding number of children, in experimental group, majority 19(63%) belonged to two children and 9(30%) belonged to three children and least in 1(3%) belonged to one child and four and above, in control group majority 15(50%) belonged to three children, 10(33%) belonged to two children and 3(10%) belonged to four and above and least 2(7%) belonged to one child.

NURSING IMPLICATIONS:

The findings of the study have certain important implication for nursing service, nursing education, nursing administration and nursing research.

Nursing Service:

· Pelvic floor strengthening exercises is an effective measure to reduce the level of urinary incontinence and improving the quality of life among women.

· Student nurses be like an agent, can introduce the various measures (pelvic floor strengthening exercises) to reduce the urinary incontinence among women.

· Nursing services department must arrange the awareness program like health education to the women regarding pelvic floor strengthening exercises to strengthen the pelvic floor muscles.

Nursing Education:

· The nurse educator can orient the students with alternative therapies in reducing the level of urinary incontinence and improving the quality of life among women with urinary incontinence.

· Nurse educator can train and encourage the student nurse to utilize Pelvic floor strengthening exercises to reduce the level of urinary incontinence and improve the quality of life among women.

· Nurse educators must conduct workshops/ seminars/ in-service education to update the knowledge of students and to promote practicing alternative therapies among women with urinary incontinence.

Nursing Administrtion:

· Nurse administrator can arrange continuous education programs regarding promoting optimal wellbeing of women living with urinary incontinence.

· Nurse administrator can organize conferences and enhance the knowledge and practices of alternative therapies among women with urinary incontinence in reducing urinary incontinence and improving quality of life.

· Nurse administrator can recognize pelvic floor strengthening exercises as a cheap, cost-effective method in the executive of reducing level of urinary incontinence and improving quality of life among women.

Nursing Research:

· Large scale study can be conducted on urinary incontinence among women.

· Teachers can direct and motivate the nursing researchers. So that they can conduct research in the same and different specialties and thereby professional independence can be achieved.

RECOMMENDATIONS:

· Similar study can be conducted as comparative between male client and female client in different settings.

· A study can be conducted with the large sample size to generalize the results of the study.

· The study can be carried out for a longer time.

LIMITATIONS:

It was time consuming to explain the women with urinary incontinence because of difference in their understanding.

CONCLUSION:

The study was done to evaluate the effectiveness of pelvic floor strengthening exercises on urinary incontinence and quality of life among women residing in Tirupur road and Jinna Maithanam at Dharapuram. The calculated independent ‘t’ value was t=40 for urinary incontinence and calculated independent ‘t’ value were t= 3.7 for quality of life which was significant at p<0.05 level, where the result revealed that pelvic floor strengthening exercises was effective in reducing the level of urinary incontinence and improve the quality of life.

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