The Influence Of Behavior Intervention On Quality Of Life Of Adult Females With Stress Urinary Incontinence

1BackgroundUrinary incontinence (U I) is the common disease in women, especially in older women’s. the U I incidence rate is22%～46%in global women’s, and the rate is increasing with age which seriously affecting the Quality of Life of women. Stress Urinary Incontinence (SUI) is the most common one in urinary incontinence, the proportion accounted for about86%, to SUI is defined by International anti-incontinence association is:when the abdominal pressure is greater than the maximum urethral pressure, in the absence of detrusor contraction state, involuntary discharge of urine, It is almost occur in abdominal pressure increases as coughing or exercise. Stress Urinary Incontinence occurs in middle-aged and older women, younger women may also occur, It is common disease in women but the hardest to tell orther. On the epidemic survey found in patients with urinary incontinence, found that only26%patients to see doctor, the Stress Urinary Incontinence in patients with active treatmented rate is lower.The Quality of Life (Quality of Life, QOL) is defined by WHO is:the personal survival state of experience of their target expectations, standards and concerns about under the different culture and value system. Survey found that about15-30%of patients with Urinary Incontinence in physiological and psychological problems: physiological aspects, women often enuresis and urinary leakage which may cause same diease as eczema, bedsore, skin infection and inflammation of the urinary system; psychological aspects, the patient will have a strong psychological conflicts, such as anxiety, guilt, irritable, shy or hostility; social aspects, it is make the patients far away from social life for uncomfortable and shy,it is have more impact in the interpersonal relationship. The patients with UI isolated from society for a series of reasons, due to the lack of external stimulation which accelerated mental decline, the vicious spiral eventually make QOL decreased significantly in patients with urinary incontinence.For SUI brought very big negative effect to Quality of Life of adult women, A large of research and discussion was done to the treatment of the disease by many the domestic and abroad scholars in recent years. In1996, Ulmsten started the operation which named tension-free vaginal tape (TVT), in2002, Petros P reported transobturator urethral sling in the treatment of SUI. But the operation method may have some side effects or complications,and more costly, difficult to accept by the patients. So some scholars try to use the non operation method to treat the patients with SUI, and achieved certain effect. For example,some scholars try to intervene the patient’s lifestyle, Include the method such as weight control, treatment of constipation, develop a regular voiding habits or increase the frequency of urination, but the effect of this methods is not so satisfied to patients.At present, urinary incontinence has not caused enough attention in our country, with less correlation research, limited to the epidemiological survey and improvement of the operation approach.in the unoperation mode,most clinical take the single interventions,such as the pelvic floor muscle exercises or lifestyle modification,but the effect is not very satisfactory for SUI.At present,we can not see the report about the intervention approaches wich organical sequential up lot of approach on stress urinary incontinence patients and to observe its efficacy and impact on quality of life.2Objective Making multiple behavior intervention methods that wich combine lots of comprehensive behavior intervention methods, and twich take the behavior intervention on the adult female stress urinary incontinence patients, and observe its efficacy and effect on quality of life.3Subjects and Methods3.1Objects:select40cases whom diagnosised by doctor in gynecology outpatient of Shenzhen People’s Hospital from from March2010to September2010. Among it there are18cases have the primary school education,15cases of secondary school,7cases of college or above. All information will told before intervention, language expression ability of causes is normal, and the ability in communicate with others without barriers. Patients aged from24to75years old, average51.5years old.3.2Behavioral intervention methods:a survey of the quality of life with40cases of adult female SUI patients. at the same time, the behavioral interventions were done to them,the behavioral methods include:3.2.1Pelvic floor muscle exercises:guide patients and pelvic floor muscle exercises according to the Kegel:consciously contraction anus and perineum and urethral muscle, pelvic floor muscle contraction in10seconds, relax for10seconds, repeat10times for1cycle, do5cycles every day, while avoiding the gluteus maximus muscle and muscle contraction or suspension of breathing.do pelvic floor muscle exercises before a cough or heavy lifting. 3.2.2Pubis muscle exercise:active interrupt voiding during micturition,then continue to repeat exercise.3.2.3Re-establish voiding habits:patients with complete voiding diaries and referring to last week’s diary preset alarm time interval, bell decided by voiding time. If patients with voiding time do not want to urinate, should also be timely and to exhaust, if not to the micturition time was needed to urinate, contractions of the sphincter will urine to live, as far as possible to the predetermined time to urinate.3.2.4Regularly to the patient tracking guidance:in the intervention and after1weeks, the subsequent3months every2weeks, fourth months to start a monthly phone call understanding patients exercise, voiding habits and conditions of urinary incontinence, urge patients to adhere to exercise, and sole some questions in the exercise,encounted in guidance, enhance patient confidence.3.3Evaluation methods:The nursing staff by formal professional training in the time as before the intervention,3months and6months using the following3questions in patients quality of life.3.3.1International standard International Consultation on Incontinence Questionaire Female Lower Urinary TractSymptoms Module(ICIQ-FLUTS), the questionnaire includ19questions, from the number of nocturia, urinary incontinence, voiding interval number and urinary incontinence on sexual life and the impact on daily life and other different aspects of assessment in patients with urinary incontinence severity and urinary incontinence in distress.Each question has4～5options,0～3respectively assigned (or4), a total of70points, with higher values, expressed by the degree of distress more deep, the lower quality of life.3.3.2The Urogenital Distress Inventory(UDI-7) Separately from the activities,travel, social and emotional aspects of the7projects on4patients with urinary incontinence quality of life evaluation. Each project has4options:no effect, mild, moderate and severe, respectively, is divided into Oto3, a total of21points, score bigger, said stress urinary incontinence on the quality of life is, the lower.3.3.3Incontinence clinical therapeutic effect. The effect of cure was defined that clinical symptoms of patients is disappeared and abdominal pressure increases without urine exudation; The effect of effective was defined that patients clinical symptoms is decrease,and the degree of urinary incontinence severity from moderate tomild; The effect of ineffective means without clinical symptoms improved.3.4Statistical:Using statistical software SPSS13for data analysis, use the applicate the repeated measurement of variance analysis for ICIQ-FLUTS at different time points of comparison, multiple comparisons between different time using the LSD method (measurement data). Different time points in the UDI-7score as hierarchical data, use the nonparametric tests (Friedman Test) for different time points of comparison between the dependent samples. The clinical cure rate and recovery rate, using the chi-square test. P<0.05with statistical significance.4Results4.1questionnaire score of Incontinence Questionaire Female Lower Urinary TractSymptoms Module (ICIQ-FLUTS)The date of ICIQ-FLUTS were statistics in point of time as follows:before the intervention,3months after the intervention and6months after the intervention: before the intervention score was30.28±1.679, in the time of3months after the intervention,the score was28.70±1.506, in the time of6months after the intervention,the score was22.60±1.892. Through the repeated measures analysis of variance, the results showed the difference was statistically significant (F=313.560, P=0), Comparison of two two had significant differences (P<0.001), The score of ICIQ-FLUTS have declined with the passage of time.lt was indicated that the Quality of Life of patients was improved.4.2Questionnaire score of Urogenital Distress Inventory (UDI-7)The date of UDI-7were statistics in point of time as follows:before the intervention,3months after the intervention and6months after the intervention. The influence of housework (before intervention the score is2.54, the score is2.01in3months after the intervention, the score is1.45in6months after the intervention,the date of X2is43.517); The influence of activity (before intervention the score is2.56, the score is1.86in3months after the intervention, the score is1.58in6months after the intervention, the date of X2is41.797); The influence of entertainment (before intervention the score is2.61, the score is2.01in3months after the intervention, the score is1.38in6months after the intervention, the date of X2is49.515); The influence of going out (before intervention the score is2.66, the score is2.05in3months after the intervention, the score is1.29in6months after the intervention, the date of X2is55.218); The influence of social activity (before intervention the score is2.54, the score is1.88in3months after the intervention, the score is1.59in6months after the intervention, the date of X2is38.456); The influence of mood (before intervention the score is2.49, the score is1.96in3months after the intervention, the score is1.55in6months after the intervention, the date of X2is37.680); The influence of loss confidence (before intervention the score is2.59, the score is1.85in3months after the intervention, the score is1.56in6months after the intervention, the date of X2is40.659). through the dependent samples nonparametric tests (Friedman Test) analysis, results showed that the differences were statistically significant (P<0.001), The score of UDI-7have declined with the passage of time.It was indicated that the Quality of Life of patients was improved.4.3Clinical treatment effect of StatisticsIn point of time as3months after the intervention, patients with clinical cure in9 cases, effective in15cases,16cases are invalid,the total efficiency of60%. And in point of time as6months after the intervention, patients with clinical cure in19cases, effective in13cases,8cases are invalid, the total efficiency of80%. χ2is6.38, by test and analysis, the results show two time points in patients with clinical cure rate between the difference has statistical significance, with intervention time increases, patients with clinical cure rate tended to increase.5ConclusionsMost scholar think that Stress Urinary Incontinence occurs due to pelvic floor relaxation, in recent years many scholars at home and abroad has done the massive research and the discussion for its treatment. The pelvic floor muscle exercise and the coccygeal muscle exercise in this group of behavioral intervention is a kind of active pelvic floor rehabilitation method. Through independent and repeated contraction and relaxation of pelvic floor muscles, It would make muscle passive movement,increased pelvic blood circulation, enhance the support of the urethra, bladder, uterus and rectum pelvic floor muscle tension, enhance the urethral resistance, relaxation the pelvic floor muscles to restore, strengthen the levator ani muscle and distal urethral sphincter contraction, all of the favorable factors can strengthen the ability of control urine to patients. From the date in our research,we can see that after do behavior intervention in patients with stress urinary incontinence for3-6months, patients with stress urinary incontinence The symptoms caused by Stress Urinary Incontinence and interference from Stress Urinary Incontinence is reduced, the difference was statistically significant (P<0.001). Reconstructe the habits of urination in the behavioral intervention which make the patiens go to the bathroom in the regulated time, which avoid some patients to go to the bathroom immediately when they fell urine intention, which can strengthen the pelvic floor muscles exercise in a certain extent inadvertently, all of the favorable factors can reducing impact on Quality of Life of patients with stress urinary incontinence.Ttracking guidanced to the patient regularly which can establish the confidence to against stress urinary, encourage patients to actively participate in various social activities in the communication of constantly, to get rid of disease impact, and make its unremittingly, to allow patients to receive a continuity of treatment and effect feedback, which can play good role in each aspect of patient’s life, all of the favorable factors can advantageous to improve their Quality of Life.Accord to our comprehensive behavior intervention and the related clinical data, we can draw the following conclusions:adult female patients with urinary incontinence can obviously reduce degree of the stress urinary incontinence in through the behavior intervention, reducing the time of incontinence episodes, reduce eczema, pressure sores, skin infections and other physical discomfort and body odors which caused by urinary incontinence, relieve the sense of inferiority of patients, dare to communicated with orthers, the Quality of Life can be improved a lager degree. Behavior intervention also has the advantages of simple operation, no pain, no hospitalization, low cost and other advantages, is easy to be accepted by patientsand has practial value.