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Older
rural women with urinary incontinence who had nurses visit
their homes to teach them techniques for managing the problem
succeeded in reducing the severity of their incontinence by
61 percent, according to researchers at the University of
North Carolina, Chapel Hill.
The study's
control group, which did not receive intervention, had an
increase in urinary incontinence severity of 184 percent,
according to the study published in the journal Research in
Nursing and Health.
"These
research results are good news for older women," said
Dr. Patricia A. Grady, Director of the National Institute
of Nursing Research. "They indicate that easy to use
behavioral strategies work well, and that once women know
about the techniques, many can manage their own continence.
Since urinary incontinence is a leading reason for persons
in rural areas to move to a nursing home, controlling this
disorder means better control of quality of life and the ability
to remain at home longer."
The 178
women in the study (94 in an intervention group and 84 controls;
all over age 55) received 2 to 14 visits in their home by
nursing staff who taught the women behavioral techniques in
sequence to help them manage the urine loss that resulted
from factors related to stress symptoms (coughing or sneezing),
an overpowering urge to urinate, or both.
The behavioral
techniques consisted of the women setting goals for their
continence, followed by up to three behavioral phases in sequence.
Most women
began with bladder training, which involved emptying the bladder
at regular timed intervals, gradually increasing the intervals
until they were able to exend them to every 2.5 hours or longer.
Other
women began with a self-monitoring phase, which lasted for
4 weeks. Women were selected for this group because of factors
such as drinking two or more caffeinated drinks, urinating
two or more times each night, or urinating during the day
at intervals longer than 4 hours apart.
The women
in the study kept a bladder diary that included information
such as the amount of liquids they drank and intervals between
urination. Based on their diary information, the women were
urged to reduce their drinking of caffeinated beverages, adjust
the amount of fluid they drank and the timing of their drinking
in order to increase or decrease their urination intervals.
If the
women did not attain their goals during the first two phases
of the study, they were given pelvic muscle exercises to perform
during a biofeedback phase that lasted up to 12 weeks. The
women were able to track the effectiveness of their exercises
using special sensors.
"The
dramatic rise in severity of urinary incontinence in the control
group points to the progressive nature of this condition if
not managed properly," said Molly Dougherty, PhD, RN,
principle investigator of the study. "It is also important
to know that not everyone can benefit from behavioral techniques,
and that advice should be sought from healthcare professionals
for all forms of urinary incontinence, even those amenable
to behavioral modification."
This type
of intervention is well suited for visits by community-based
nurses, and is particularly valuable to women living in isolated
settings, said Dougherty.
"A
rural study of this magnitude has never been done before,"
said Dougherty. "These older women are particularly vulnerable,
because they are often poor, and healthcare resources and
long-term care facilities are lacking in rural areas."
The three-phase
behavioral intervention has been incorporated into the best
practice guidelines of the Association of Women's Health,
Obstetric and Neonatal Nurses.
Source:
Medical Week staff,
week of April 7, 2002
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