Urinary assume that UI is a normal consequence

Urinary incontinence (UI) is
a common clinical condition that affects women of all ages and across different
cultures and races all over the world often increasing as a woman ages. Apart from causing
physical discomfort it can also cause psychological, social and economic
problems. It also impairs quality of life of the patients. A study conducted in
2008 revealed that approximately 348 million individuals worldwide are
suffering from UI. It is projected that the numbers
will increase from 386 million in 2013 to 423 million by 2018.

Most of
the studies on this topic have been carried out in developed countries and
affluent study populations. There is very little data on its prevalence in
India, particularly for women residing in rural area, in minority women or in
those with lower socio-economic status. (SRUTI ATUL, 2013, Maharashtra
Prevalence)

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The
prevalence of this problem is significantly high but is underestimated because
physicians rarely ask the patients about the problem and patients seldom
initiate discussion about incontinence with physician.

 Older patients may assume that UI is a normal
consequence of aging. Many women are too embarrassed to talk about it and even
in western countries some believe it to be untreatable. This problem is more
pronounced in India, where women usually do not seek treatment for their reproductive health problems and do
not vocalize their symptoms. There is a “culture of silence” and low
consultation rate among Indian women regarding such problems

Considering
this information in holistic way, we believe that there is a clear and urgent
need to know the magnitude of this problem and improve the awareness,
prevention, diagnosis and management of this condition  International and national programmes that
increase public awareness, educate clinicians and at-risk or affected
populations, and implement public campaigns designed to diminish or eliminate
social stigma will be a significant step toward reaching this objective. Such
public-health programmes will need to be adapted by region because countries
often differ in their healthcare resources, treatment guidelines and social
perceptions.

Despite
taking all precautions to obtain correct information, there is a possibility
that due to the shy nature of women in our community, illiteracy, and ignorance
of the fact that UI is a health problem, there could have been underreporting
by the females. UI is a dynamic condition and patients move back
and forth from continence to incontinence

Age had
strong co relation (p=0.01) with highest prevalence between 41 -50 years of age.
This could be due to the fact that with increase in age there is reduction in
oestrogen levels, reduced muscle tone, and also a reduced level of activity. The prevalence is seen to be more after the age of
40. The elderly people fall in selective survival and so whosoever is living
may be living a healthy life.

Unlike
other studies where Stress incontinence is most
commonly reported subtype , Mixed type of
incontinence was highest in our study (67.4%), followed by urge (22.4%) and
stress (10.2%)
as measured by RUIS. The stress
incontinence resulted due to weakness of pelvic floor muscle with risk factors
like pelvic floor muscle, nerve and connective tissue damages that occur during
pregnancy due to labour and reduced level of oestrogen hormone in menopause
phase.

Urinary incontinence has high prevalence
worldwide but the magnitude is underestimated because of lack of proper
education. Education with regards to structure and function is essential to
effectively promote continence in broadest possible population. This would be
long term investment for both quality of care and cost.  One of the important strategies in present
time is health promotion and diseases prevention. This will help in reducing
the incidence as well as prevalence. The aim of this phase was based on the concept that
the primary prevention is the main goal in the management of human disease

Continence promotion, education and primary prevention
involves informing and educating the public and health care professionals that
urinary incontinence is not inevitable, but are treatable or at least
manageable

The pelvic
floor acts as a dynamic platform that spans the outlet of the pelvis to support
the abdominal and pelvic organs. It is composed of muscle, fascia and
ligaments. Zacharin (1980) used the term the ‘pelvic trampoline’ to suggest the
characteristics of the pelvic floor. The chief function of the pelvic floor
muscle is not only to provide support for the abdominal and pelvic viscera, but
also contribute to the maintenance of continence of urine and faeces, thereby
allowing control of voiding and defecation (pelvic floor book). PFM
training is defined as a program of repeated voluntary PFM contractions taught
and supervised by a health care professional. It is the most commonly used
physiotherapy treatment for women with SUI and is effective for all types of
female incontinence, and is therefore recommended as a first-line therapy.
(HELENA 2015 PFM training)  In
incontinent women, the PFM function with regard to power (rate of force
development) is impaired as compared to continent women 4, 6.(HELENA 2015 PFM
training). It requires strong, rapid, and reflexive PFM contractions to
maintain continence 3–6 PFM training is indicated to strengthen the support of pelvic
organs and to improve the closing mechanism of the urethral sphincter.Fast and
strong PFM contractions result in the generation of an adequate squeeze
pressure in the proximal urethra, which maintains a pressure higher than that
in the bladder, thus preventing leakage 7. HELENA) The pelvic
floor  muscle exercises in SUI aim to
improve the support muscle function during stress and teaches women to contract
the muscle before and during stress, when the intra-abdominal pressure
increases, including coughing. In UUI, the training aims to inhibit the
detrusor contraction reflex.15

Results
of our study shows that pelvic floor muscle exercise is effective in reducing
symptoms due to urinary incontinence and there by improves the quality of life.
PFMT exercises help the patient strengthen the muscles of the pelvic floor.
Since Arnold Kegel, MD, first described these exercises almost 50 years ago,
fifteen numerous studies have evaluated the efficacy and durability of PFMT,
with conflicting results.  According to a
Cochrane Review of PFME, greater improvements occur when women receive a
supervised PFME program for at least three months (pfm in SUV). Patient
compliance and motivation are essential to a successful program (Treatment
option in UI) which was lacking in our subjects due to various cultural and
social factors that prevailed on minds of women which prevented them from
seeking advice and take treatment for the same.

 Majority of the
female didn’t come forward and ignored the intervention aspect. This shows
their negative approach towards heath care seeking attitude. Several factors that
have been known to determine health care seeking behaviours include lack of
awareness, cultural and belief system,

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