INTRODUCTION:

“Alert today, Alive tomorrow—indicator for happy contented life.

Incontinence is not a hopeless situation. It is a common problem among women and it is unnoticed. It is five times more common in women than in men. There is evidence that women do not ask for help and continue to suffer in silence. Older patients may assume that urinary incontinence is a normal consequence of ageing but it is not like so, incontinence does not lead to death but it causes substantial debility, social seclusion, psychological stress and economical burden.

It often becomes a clinical problem for the ageing women due to trauma of child birth, development of acute and chronic illness, loss of estrogenic stimulation at menopause and diminished amount of normal homeostatic reserve available to cope with stresses placed on the bladder.

In comparison with breast cancer, the common female problem of urinary incontinence receives scant attention in the media, yet it has been estimated that there may be 4, 00,000 women in the United Kingdom suffering from urinary incontinence at one time.

BACKGROUND:

The urinary incontinence is one of the problems of women above 35years. The prevalence of urinary incontinence in a community is as high as 30%. A recent study estimated that 10 million women in the UK suffer with urinary incontinence. Stress urinary incontinence (SUI) is the most common form, affecting 4million women. A prospective study of 800 women attending the outpatient department from March 2003 to December 2005 was done. Out of these 272 had different types of incontinence and were studied for various factors like age, parity, mode of delivery, menopausal status and prolapsed of genital organs. Relevant clinical examination was carried out.

A survey by Fulz et al (2003) revealed that more than 75% of women with stress incontinence reported that their symptoms were bothersome, while 29% reported that their symptoms to be moderately to extremely bothersome. Hagglund et al (2003) studied on urinary incontinence revealed that women continue to be reluctant to seek help for what they consider to be a minor problem that they believe they should be able to cope with themselves.

Haslam (2004) studied the Kegel exercise as a treatment options for urinary incontinence and reported that women experienced significant improvements in quality of life after a course of Kegel exercise. Wojno A., Terlikowski R., Knapp P (2004), reported that low percentage of women taking various preventive measures against urinary incontinence is undoubtedly due to their poor knowledge in this field. More than 70% of the respondents (217 women) did not know what Kegel exercise Urinary incontinence is a global consequence of deleterious effects of numerous factors, including past labors, assisted deliveries, obesity, smoking, constipation, hormone deficiency and others . Many women believe that urinary incontinence is the price paid for being a mother and that it is normal for aging. Due to such opinions, the ailment is considered not only embarrassing but also incurable. Therefore, patients tend to conceal their symptoms, hiding them even from their doctors. Such an attitude hinders or even precludes preventive measures, and early and thus most effective treatment and rehabilitation.Due to such opinions, the ailment is considered not only embarrassing but also incurable. Therefore, patients tend to conceal their symptoms, hiding them even from their doctors. Such an attitude hinders or even precludes preventive measures, and early and thus most effective treatment and rehabilitation.

In line of the above views, the researcherwas inspired by an enormous social significance of this pathology and its relatively high prevalence of urinary incontinence. Furthers, it was identified that urinary incontinence affects quality of life among women. Although the ailment can be treated, prevention is of the highest importance. Dissemination of the knowledge of prevention would contribute to the improvement of life quality among women at risk ofurinary incontinence.Thus, the researcher felt this study will help the women to improve the knowledge and shape proper health-promoting attitudes that may decrease its incidence and help them to follow the kegel exercise as part of their daily care in preventing urinary incontinence.

STATEMENT:

A descriptive study to assess the knowledge and attitude on urinary incontinence and demonstration of Kegel exercise as primary prevention among women at rural community in Madurai.

OBJECTIVES:

· To assess the knowledge and attitude regarding urinary incontinence among women in selected rural area.

· To correlate the knowledge and attitude regarding urinary incontinence among women in selected rural area.

· To associate demographic variables with knowledge and attitude of women in selected rural area.

CONCEPTUAL FRAMEWORK:

It was based on Nolaj Pender’s (2002) health promotion model. In this model, it comprised of Individual characteristics and experiences, Behavior specific cognition and effect, Behavior outcome, and Commitment of plan of action.

MATERIALS AND METHODS:

Research approach- Quantitative approach was adopted.

Research design- Descriptive design

Setting of the study- The selected community area was under Thiruparankundram PHC covering a population of 500 near Madurai. The investigator has conducted this study at Kaitharinagar situated approximately 8kms away from Madurai.

Sample size- Comprised of 30 women

Sample technique- Non-probability-Convenience Sampling

Sample criteria:

Inclusion criteria:

o Above the age of 35yrs.

Exclusion criteria:

o Above the age of 65 years.

o Clients with neurological problem.

Data Collection Instruments:

The tool was developed by the researcher:

Part 1: Demographic data

Part 2: Semi-Structured questionnaire for knowledge

Part 3: Rating scale for attitude

Data collection procedure:

On the day of investigation, consent was obtained orally from women. The instructions were explained to them by the investigator data were collected based on the questionnaire. On the same day, the education was given by learning module on primary level prevention of urinary incontinence with Kegel exercise demonstration to the women who were participated in this study.. They were found to be very much interested .

RESULTS:

v Among 30 samples, majority of women had 19(63.8%) inadequate knowledge,7(23%)had moderate knowledge and least 4(13%) had adequate knowledge on urinary incontinence treatment of kegel exercise. The mean for over all knowledge was 7.13(SD=2.25).

v Out of 30 subjects, attitude revealed that majority of women had 23 (76.7%) negative attitude, 4(13.3%) had neutral and least 3(10%) had positive attitude. The overall mean score was 6.86(SD=1.76).(Fig-1.)

Fig-1.Distribution of knowledge and attitude

v Among 30 samples, r =0.87 is greater than the table value of 0.63 at 0.05 level of significance which shows that there was a positive correlation between knowledge and attitude regarding urinary incontinence.

Figure-2: Correlation between knowledge and attitude

v Regarding the association between selected demographic variables of the participants with their knowledge it was found out that there was no significant association except with the education of the women ( x²=8.65 (P<0.05).Further it was found out that there was no significant association between selected demographic variables of women with their attitude regarding urinary incontinence, except with age (x2=11.33(P<0.05).

DISCUSSION:

In the current study, among 30 samples, majority of women had 19(63.8%)inadequate knowledge. This study was supported by Wojno A., Terlikowski R., Knapp P (2004), results revealedohighly insufficient knowledge on prevention and rehabilitation about urinary incontinence. Out of 30 subjects, attitude revealed that majority of women had 23 (76.7%) negative attitude.This findings was consistent with Kang (2009), indicating that respondents tended to have limited knowledge and negative attitudes toward UI.This study was supported by Hagglund et al (2003) reveals that 60% of women with urinary incontinence continue to be reluctant to seek help for they consider to be minor problem that they believe they should be able to cope with them.

It was found in the present study that there was a significant relationship between the knowledge and attitude of women regarding urinary incontinenceAcquisition of knowledge paves way for changes in an individual’s behaviour and attitude. Therefore the impact of knowledge regarding urinary incontinencewould improve the attitude of women. Thus, it inferred that specific interventions are needed to improve the women's knowledge and attitude towards urinary incontinence, nurses should take an active role in educating women about the primary prevention and treatment of urinary incontinence, thereby it helps to improve the quality of life. The primary treatment for urinary incontinence is pelvic floor muscle exercise. It is important that if these muscles are exercised correctly over an adequate period of time will regain its original muscle tone.

CONCLUSION:

This study concluded as follows:

1. Women had poor knowledge regarding urinary incontinence and its preventive measures.

2. The women had poor altitude regarding urinary incontinence.

3. There is a need to intensify health promoting actions in the field of urinary incontinence

4. The actions require more substantial involvement of nursing staff.

IMPLICATIONS:

· The findings emphasize that Nurses need to extend their service to increase in conducting regular Mass Health Education Programmein the community.

· The nursing students must be motivated to demonstrate the kegel exercise.

REFERENCES BOOKS:

1. Basavanthappa B.T, “Medical – surgical Nursing “I edition New Delhi Jaypee Brothers, Pg. No 733 - 734

2. Brunner and Siddhartha, “Text book of Medical – Surgical Nursing”, 10^th edition, Lippincott, 2004, Pg. No. 1275 – 1278.

3. Davidson’s; “Principles and practice of Medicine “, 16^th edition; Churchill Livingstone, Pg No. 476.

4. Joyce M. Black; “Medical – surgical Nursing “7th edition, W.B. Saunders, 2004, Vol 1. Pg.no 786 – 787, 895 – 903

5. Lewis, “Medical – surgical Nursing Assessment and Management of clinical problems”, 6^th edition Philadelphia: Mosby publication, 2004, Pg.No. 1195 – 1200

6. Wojno A.1, Terlikowski R.2, Knapp P. Women’s attitude towards prevention and rehabilitation of stress urinary incontinence, Prog Health Sci 2014, Vol 4, No1 Women’s attitude prevention rehabilitation stress urinary incontinence

JOURNALS:

1. Linda et al, “SIGN guidelines on managing urinary incontinence”, vol 101, No 18, Pg. No. 53 – 54, May 2005

2. Debra et al; “Discreet products of women with urinary incontinence “NSG. Times; vol 101, No 18, pg. No. 56 – 59, may 2005

3. Shankar et al, “Incontinence and balls in older people is there a link?”, Nursing Times, vol 101, No 47, pg. No 52 – 54, NOV 2005

4. Jeanette et al, urinary incontinence “: why women do not ask for help,”, Nursing Times, Vol 101, No 47, pg. No 47 – 48 NOV 2005.

5. Jeanette et al, “ Home for women” urinary incontinence, Nursing Times, vol 100, No 48, pg . No 56 – 59 NOV / DEC 2004.

NET REFERENCE:

1. Abha et al; “Incidence and epidemiology of in urinary incontinence women; “The Journal of obstetrics and Gynecology of India, vol, 57, No: 2: Mar / Apr 2007 pg. No. 155 – 157: www. Google. Com.

2. Valarie et al : kegel exercises reduces in urinary incontinence women”, www.hbns.org

3. Kang ;J Wound Ostomy Continence Nurs. 2009 Mar-Apr;36(2):194-9. doi: 10.1097/01.WON.0000347662.33088.c9

Received on 27.02.2015 Modified on 18.03.2015

Int. J. Nur. Edu. and Research 3(2): April-June, 2015; Page 149-152