Aging is not merely the passage of time. It is the manifestation of biological events that occur over a span of time. It is important to recognize that people age differently. The aging body does change. Some systems slow down, while others lose their "fine tuning." As a general rule, slight, gradual changes are common, and most of these are not problems to the person who experiences them. Sudden and dramatic changes might indicate serious health problems. www.currentnursing.com
Menopause is a natural part of a woman's life cycle. While it marks the end of a woman's reproductive cycle, it can be the beginning of an exciting and rewarding time of life. Our culture has come a long way from viewing menopause with dread and associating it with a perceived decrease in a woman's value. Understanding the natural progression of age in a woman's body and becoming acquainted with the therapies available, allows women today to effectively manage their symptoms and to be proactive in maintaining their health for their later years.
Menopause is the transition period between the reproductive years of a woman's life and the cessation of ovarian function. Unless brought about by surgery or other causes, natural changes in a woman's body generally occur between the ages of 35 and 50. Menopausal symptoms are unique to each individual, both in duration and in intensity. www.nhiondemand.com
Menopausal symptoms affect about 70% of women approaching menopause. Menopause symptoms are caused by changing hormonal levels in the female reproductive system. Almost all women notice early symptoms while still having periods. This stage of gradually falling and fluctuating hormone levels is called perimenopause, which often begins in the early 40s. The symptoms of menopause usually last for the whole menopause transition (until the mid 50s), but some women may experience them for the rest of their lives. The most common symptoms are: hot flushes, vaginal dryness, mood swings, urinary incontinence, depression, anxiety etc. www.34-menopause-symptoms.com
World Health Organisation (WHO) reports that 75% of the world's postmenopausal women are living in developing countries. With the increasing life expectancy in women, the prevalence of postmenopausal problems is substantial. Studies in developing countries have found that women experience gynaecological problems throughout their reproductive years and beyond, in part due to the limited medical care they receive during labour and delivery, combined with high parity. As women move toward the years of menopause and post-menopause, they are at risk from health conditions associated "hormonal changes, health disease and stroke, gynaecological malignancies, osteoporosis, and various genitourinary conditions." www.standford.edu.com
NEED FOR THE STUDY
According to Indian menopause society (IMS) research, there are about 65 million Indian women over the age of 45. Currently men and women in India in the 60 plus age group is around 60 million i.e. about 6% of the total population. Projection for the year 2025 shows that aging population would increase to about 12% of the total and roughly half of this population will be women in the elderly age group. Average age of menopause in around 48 yrs but it strikes Indian women as young as 30-35 years. So menopausal health demands are given higher priority than even before in Indian scenario. A wide gap in the knowledge of postmenopausal symptoms (hot flushes, mood swing, urinary incontinence, anxiety, depression, dry vagina) has been documented in the women from developed and developing countries. And this gap is even wider in women from slums and urban area in developing countries.www.ispub.com
In India, there is no current health programme that caters the specific reproductive health needs of aging women. Moreover, recently launched RCH II (reproductive and child health) and NRHM (National Rural Health Mission) programmes that are means to comprehensively cover health aspects of women and children, only addresses women in the reproductive age group, ignoring those who have passed the reproductive stage. There is lack of awareness about menopause and related problems and there is a need to educate women regarding early identification of common menopausal symptoms as well for the various causes. Moreover efforts have also to be done by higher authorities for redressal of grievances of this segment of women by initiating various strategies and programmes.ww.ispub.com
Urinary incontinence is the loss of bladder control. Urinary incontinence can range from leaking a small amount of urine (such as when coughing or laughing) to having very strong urges to urinate that are difficult to control. This can be embarrassing, but it can be treated. Millions of adults in the United States have urinary incontinence. But it can also affect younger people, especially women who have just given birth. Urinary incontinence can be caused by many different medical problems, including weak pelvic muscles or diabetes. Urinary incontinence can be treated with special exercises, called Kegel exercises. Exercises of incontinence often referred to as the Kegel exercise is named after Dr Arnold Kegel, the surgeon who developed this therapy. Kegel exercise strengthens the muscle of the pelvic floor, improves sexual functioning and decrease urinary incontinence. They involve tensing and relaxing the pubococcygeal muscles around the area of the urethra, vagina and anus. They can be done anywhere, anytime. www.revirgination.net
Urinary incontinence is not a normal part of aging. The aging process merely predisposes a woman to urine loss. Weak muscles, childbirth, poor nutrition and fluid intake, gynaecological surgery, urinary tract infections, spinal cord injuries and emotions all play a role in the aetiology of incontinence. Although incontinence occurs in men, its prevalence is less than one third that of women and in most cases has a defined aetiology. Determining the cause of the women's incontinence is the key to its management. Impaired mobility, chronic constipation and prescription drugs, which can cause bladder dysfunction, should be addressed in the incontinent elderly. www.hinduonnet.com
The researcher observed that a large group of women population is in need of awareness regarding early identification and treatment of urinary incontinence. As urinary incontinence is one of the problems where women hide the process of leakage considering it as a normal part of aging, researcher felt the need to find the data on prevalence and type of the urinary incontinence among the samples. The investigator believes that a good Planned Nursing Intervention will help the postmenopausal women to improve their practice on management of urinary incontinence and thereby prevent the complications and help them to lead a stress free life. Through planned nursing intervention researcher would like to focus on the conservative treatments available other than surgical which helps to overcome their symptoms and complications. Increasing society's acceptance of menopause isn't enough. Society should honour this phase of life as a milestone during which women become free of hormonal shifts and wiser than ever. Researcher wants the woman to understand that urinary incontinence can be relieved through simple measures and thus they can reduce the level of urinary incontinence as well as improve the impact of urinary incontinence on selected domains of life(role limitation, physical /social limitation, personal relationships, emotions and sleep/energy).
STATEMENT OF PROBLEM
"A study to assess the effectiveness of Planned Nursing Intervention on management of urinary incontinence in terms of practice among postmenopausal women in selected educational institutions, Salem".
OBJECTIVES
To prepare and validate Planned Nursing Intervention on management of urinary incontinence among postmenopausal women.
To assess and compare the mean pre-test and mean post-test level of urinary incontinence among samples.
To assess and compare the mean pre-test and mean post-test level of impact of urinary incontinence on selected domains of life among samples.
To find association on pre-test level of urinary incontinence score among samples and their selected demographic variables-Age, Educational status & Parity.
HYPOTHESES: (Level of significance p < 0.05)
H1: The mean post-test level of urinary incontinence will be lower than the mean pre-test score among samples.
H2: The mean post-test level of impact of urinary incontinence on selected domains of life will be lower than the mean pre-test score among samples.
H3: There will be a significant association between the pre-test level of urinary incontinence among samples with their selected demographic variables.
H3(a): There will be significant association between the pre-test level of urinary incontinence among samples and their age.
H3(b): There will be significant association between the pre-test level of urinary incontinence among samples and their educational status.
H3(c): There will be significant association between the pre-test level of urinary incontinence among samples and their parity.
OPERATIONAL DEFINITIONS
1. Effectiveness:
It refers to the measurement of difference in mean pretest and mean post-test score. In this study it refers to the difference in the mean pre-test and mean post-test score of practice on management of urinary incontinence among samples.
a. Planned Nursing Intervention:
It is the individualized instruction given to the postmenopausal women who had urinary incontinence problems, in order to create awareness about practice and to improve the management of this problem. This programme was prepared for about 30-40mts to improve the practice of bladder sphincter control which includes techniques of pelvic floor exercises, other general measures like bladder training programme, restriction of fluid intake etc. This was taught to them in their own setting by lecture cum discussion with visual aids (pamphlets, flash cards).Followed by clarification of doubts were made.
b. Practice:
It refers to the compliance of samples (postmenopausal women present with urinary incontinence) to the prescribed measures (bladder training and kegel exercise) to manage the urinary incontinence. The effectiveness of the prescribed measures was assessed in terms of level of urinary incontinence and its impact on selected domains of life.
i) Level of urinary incontinence:
It refers to the assessment of postmenopausal women with the symptoms of urinary incontinence by a check list to know the level of urine leakage (incontinence) and the amount of urine lost each time. Individual scores were interpreted as follows: 0-dry, 1-2 slight incontinence, 3-5 moderate incontinence and 6-8 severe incontinence.
ii) Impact of UIC on selected domains of life:
It refers to the assessment of the impact of urinary incontinence on selected domains of life among samples with 0-4 point rating scale score on five domains: Role limitation, physical/social limitation, personal relationships, emotions and sleep/energy. Individual scores were interpreted as follows: 0-14 mild, 15-29 moderate and 30-45 severe.
2. Postmenopausal Women:
In this study it refers to the women who have achieved permanent cessation of menses since past consecutive 12 months with not even any spotting.
3. Urinary incontinence:
Urinary incontinence is the loss of bladder control which ranges from leaking a small amount of urine while coughing, laughing to very strong urges to urinate that are difficult to control. This will be assessed with screening tool and differentiated into stress incontinence, urge incontinence and mixed type of incontinence.
4. Demographic variables:
a) Age:
Age refers to the length of life that one has existed. In this study the age group from 40-65 years was included.
b) Educational status:
It refers to the qualification of the subjects to get knowledge through systematic methods. In this study from literate to postgraduate level women was be included.
c) Parity:
In this study it specifies the number of times a mother has delivered irrespective of outcome.
ASSUMPTIONS
Women may have varied level of practice regarding management of urinary incontinence.
Improved practice may help to adopt a healthy behavior.
Planned Nursing Intervention can be an effective tool for creating awareness on management of urinary incontinence.
Pubococcygeal muscles will be strengthened by regular bladder training and Kegel's exercise.
Practice will be influenced by their age, educational status and parity.
DELIMITATIONS
Total period of data collection is limited for 6 weeks.
The study is limited to 20 samples.
The study is delimited to postmenopausal women only.
ETHICAL CONSIDERATION
Written permission was obtained from the concerned authority in educational institutes, Salem.
Informed written consent was obtained from the individual samples who is enrolled for the study. Also assure that all information was kept confidential and used only for the present study.
SUMMARY
This chapter dealt with the contents of introduction about urinary incontinence among postmenopausal women and need for problem, objectives, hypotheses, operational definitions, assumptions, delimitations and ethical consideration.
