Urinary Incontinence among Northern Upper Egyptian Menopausal Elderly Women

AUCTORES J. General medicine and Clinical Practice Journal of General Medicine and Copy Clinical Practice rights@ Hanan Elzeblawy Hassan. Globalize your Research Open Access Hanan Elzeblawy Hassan * Research Article Urinary Incontinence among Northern Upper Egyptian Menopausal Elderly Women Hanan Elzeblawy Hassan2*, Elham Abozied Ramadan1, Amel Ahmed Hassan Omran1, Samar shaban Abdelazim Mohamed2 1 Obstetrics Gynecological Nursing, Faculty of Nursing Benha University 2 Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt *Corresponding Author: Hanan Elzeblawy Hassan, Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt. Received date: March 28, 2024; Accepted date: April 09, 2024; Published date: April 16, 2024 Citation: Hanan E. Hassan, Elham A. Ramadan, Hassan Omran AA, Abdelazim Mohamed SS, (2024), Urinary Incontinence among Northern Upper Egyptian Menopausal Elderly Women, J. General Medicine and Clinical Practice, 7(8); DOI:10.31579/2639-4162/166 Copyright: © 2024, Hanan Elzeblawy Hassan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Urinary incontinence occurs when there is dysfunction in either the storage function or occasionally, in the emptying function of the lower urinary tract. Types of urinary incontinence, based on etiology and pathophysiology, urinary incontinence is classified into three types: Stress Urinary Incontinence, Urge Urinary Incontinence, and Mixed Urinary Incontinence. Aim of the study: The study was conducted to assess urinary incontinence related factors among elderly women. Design: A descriptive study design was utilized in this study. Sample: A purposive sample was selected and this study was performed on 100 Menopausal women diagnosed with stress urinary incontinence. Setting: gynecological and urological outpatient clinics Beni-Suef university hospital. Tools: Data was collected using a structure interviewing questionnaire schedule. Results: It reveals that 72% of the study sample was obese, 70% got pregnant and delivered more than three times while 56% of them aborted from 1-3 times, about 66% of them delivered spontaneous vaginally, while about 29% delivered by cesarean section. It indicates that 56% of the study sample has no regular frequency of urination; 53% of them experienced stress urinary incontinence during day and night, 38% lost splashes amount of urine, while 27% lost large amount of urine per once. Conclusion: Statistically significant association between BMI, number of gravid, and number of parity and frequency of urinary incontinence among the studied sample were found. Recommendations: Application of health education program for measurement of management of urinary incontinence among elderly women Kew Words: urinary incontinence; menopausal elderly women; obesity Introduction Urinary incontinence occurs when there is dysfunction in either the storage function or occasionally, in the emptying function of the lower urinary tract. Urethral sphincter dysfunction and bladder dysfunction can co-exist and various components of the continence mechanism may compensate one another. For example, women may experience anatomical or neuromuscular injury during childbirth but remain asymptomatic until there is a loss of urethral sphincter function due to aging. [1-5]. Urinary incontinence is a significant health problem with serious physical, psychological, and social consequence, particularly among elderly women. Approximately 13 million people in United State suffer from urinary incontinence, with prevalence of stress urinary incontinence (SUI) varying between 10% and 30% in women between the age 15 and 64 years, as well as the prevalence of urinary incontinence in Egypt was 54.8% for all cases, and 14.8% of them suffer from stress urinary incontinence (SUI) [6-11]. The international Continence Society (ICS) has classified nomenclature types of urinary incontinence (UI), Based on etiology and pathophysiology, urinary incontinence is classified into three types: Stress Urinary Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 Incontinence (SUI), Urge Urinary Incontinence (UUI), and Mixed Urinary Incontinence (MUI) [1,12-16]. Stress Urinary Incontinence: According to the International Continence Society, Stress Urinary Incontinence is defined as the involuntary leakage of urine with exertion such as coughing, sneezing, and laughing. An increase in abdominal pressure due to physical exertion places stress on the bladder, causing urine to leak. The basic mechanisms of failure of the urethra to maintain a water-tight seal are poor urethral support by the pelvic floor muscles and intrinsic sphincter deficiency, accounts for about 50–70% of all types of UI [12]. Urge Urinary Incontinence may be triggered by simple everyday occurrences such as the sound of running water, exposure to cold temperatures, or drinking cold beverages. A classic example of a trigger is the notorious “Key in the lock” syndrome. Women are able to hold their urine until they get home, but when they insert the key in their door the urine just pours out beyond their control, occurs in about 14% of all cases [17]. Page 1 of 9 J. General medicine and Clinical Practice Copy rights@ Hanan Elzeblawy Hassan. Mixed Urinary Incontinence is the involuntary leakage of urine associated with exertion and urgency. It is a mixture of Stress and Urge Urinary Incontinence. Basically, the bladder is overactive and the urethra and urethral sphincter muscles are underactive or deficient. In some cases, the Stress symptoms are more defined than the Urge symptoms, and the patients are categorized as Stress Predominant-Mixed Urinary Incontinence sufferers. If it is the other way around and Urge symptoms are the primary complaint, then they are categorized as Urge Predominant-Mixed Urinary Incontinence sufferers [18-20]. Aim of the study The study was conducted to assess urinary incontinence related factors among elderly women through: 1. 2. 3. Assess level of obesity among elderly women with urinary incontinence Assess relationship between body mass index and frequency of urinary incontinence among elderly menopausal women. Assess relation between number of gravid and frequency of urinary incontinence among elderly women Research questions 1. 2. 3. What about the level of obesity among elderly women suffering from urinary incontinence? Is there relationship between body mass index and frequency of urinary incontinence among elderly menopausal women? Are menopausal women's gravida and parity can affect frequency of urinary incontinence? Subject and methods Study design: The study followed a descriptive study design. Study Setting and Sampling: The study was conducted at gynecological and urological outpatient clinics at Beni-Suef University Hospital. A Purposive sample was used from the above-mentioned setting. Total sample was 100 women who attended to the previous mentioned setting. Tools of data collection: Tool that was used for data collection is a structured interviewing questionnaire sheet was developed by the researcher in the Arabic language based on a review of recent literatures, under guidance of supervisors. It was consisting of three parts: Personal Characteristics No The first part: included personal characteristics data of the study women such as (age, height, weight, body mass index "BMI" education level, occupation, residence, marital status). Second part: Obstetrics history such as (number of gravidities, parity, and abortion, mode of deliveries, any complications during pregnancy, labor and post-partum, mode of delivery, weight of baby at birth and duration between pregnancy). Third part: urinary incontinence history included duration of illness, frequency, amount of leakage of urine, timing (day and night), and predisposing factors as coughing, sneezing, laughing, using sanitary towels for urine leakage, frequency of change the towels. Validity of the tools: Tools of data collection were investigated for their content validity by three experts in the field of Obstetric and Gynecological Nursing from Faculty of Nursing and Benha University. Administrative Design: An official written approval letter for data collection to conduct this study clarifying the purpose of the study was obtained from dean of faculty of nursing, Benha University to the director of Beni-Suef university hospital. Pilot study: A pilot study was conducted on 10% (10 women) to evaluate the applicability, efficiency, clarity of tools, assessment of feasibility of field work and identification of suitable place for interviewing women, beside to detect any possible obstacles that might face the researcher and interfere with data collection. Necessary modifications were done based on the pilot study findings such as (omission of some questions from tool, editing on paraphrasing of some questions, adding some questions) in order to strengthen their contents or for more simplicity and clarity. The pilot sample was excluded from the main study sample. Statistical Design: The collected data was revised, coded, tabulated and introduced to a computer using statistical package for social sciences (IBM SPSS .25.0). Data was presented and suitable analysis was done according to the type of data obtained for each parameter. Descriptive Statistics used Mean and Standard deviation (X2±SD) and range for parametric numerical data, and Frequency and percentage of non-numerical data Results % Age (in years) 50-55 years 49 49.0 > 55-60 years 38 38.0 >60 years 13 13.0 Residence Rural 71 71. 0 Urban 29 29.0 Illiterate 49 49.0 Primary education 30 30.0 Secondary education University education 18 3 18.0 3.0 Education Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 Page 2 of 9 J. General medicine and Clinical Practice Copy rights@ Hanan Elzeblawy Hassan. Marital status Married 87 87.0 widower 13 13.0 48 52 48.0 52.0 Occupation House wife Working Table 1: Distribution of studied sample according to personal characteristics (n=100). Women's Obesity Level 4% 24% 72% Normal Overweight Obese Figure 1: Distribution of studied sample according to their obesity level (n=100 Figure (1): Portrays the distribution of studied sample according to their obesity level. It reveals that most of the studied sample (72%) was obese. Table (2): Illustrates that 70% of the studied sample got pregnant and delivered more than three times while 56% of them aborted from 1-3 times. Regarding type of delivery, about 66% of them delivered spontaneous vaginally, while about 29% delivered by cesarean section. Regarding complications during pregnancy; 30% of the studied sample complained Obstetrics history No from untreated urinary tract, 19% gestational diabetes, 15% ante partum hemorrhage, 7% anemia and 7% pregnancy induced hypertension during their previous pregnancies. While complications during labor revealed that about 46% of the studied sample delivered without any complications; while 34% experienced prolonged labor. Also, complications during postpartum period showed (32%, 18%, and 14%) of them complained from chronic constipation and post-partum hemorrhage and Puerperal sepsis, respectively. % Number of gravidity 1-3 pregnancies 30 30.0 More than 3pregnancies Number of parity 70 70.0 1-3 deliveries More than 3 deliveries 30 70 30.0 70.0 Spontaneous vaginal deliveries 66 66.0 Vaginal deliveries with episiotomy Caesarean section 25 29 25.0 29.0 1 1.0 Usually between 1 - 2 year 4 4.0 Usually between 2- 3 years 51 51.0 More than 3 years 16 16.0 Not regular intervals 29 29.0 40 40.0 *Type of delivery Instrumental deliveries Duration between pregnancy *Complication during pregnancy No complications Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 Page 3 of 9 J. General medicine and Clinical Practice Copy rights@ Hanan Elzeblawy Hassan. Antepartum hemorrhage Gestational Diabetes 15 19 15.0 19.0 Pregnancy Induced Hypertension 7 7.0 Untreated urinary tract infection 30 30.0 Anemia *Complication during labor 7 7.0 No complications Antenatal hemorrhage 46 9 46.0 9.0 Prolonged Labor 36 36.0 Obstructed labor 14 14.0 *Complication during postpartum No complications 51 51.0 Postpartum hemorrhage Chronic constipation 18 32 18.0 32.0 Puerperal sepsis 14 14.0 *Results not mutually exclusive Figure (2): Present the distribution of studied sample according to urinary incontinence history. It indicates that 56% of the study sample has no regular frequency of urination. Moreover, 60% of them began to suffer from stress urinary incontinence from 5 years and more; 53% of them experienced stress urinary incontinence during day and night. Regarding the amount of urine leakage per once, (38%) lost splashes amount of urine, while (27%) lost large amount of urine per once. 27 Large quantities 38 Splashes 35 Drops Losing urine during sleep without noticing it The amount of urine leakage per once Menopausal Elderly Urinary Women Urinary Incontinence History 97 No 3 Yes 53 The common time of inco ntin ence Both 2 Night 45 Freq uency of stress urinary incontinence Freq uently The 1st occurrence of stress urinary incontinence 5 years and more Freq uency of urination per day Day Not regular but when excited 15 52 Daily 33 Rare 60 32 3-4 years 8 1-2 years 56 42 Every 3-6 hours 2 Every 1-2 hours 0 20 40 60 80 100 Figure 2: Distribution of studied sample according to urinary incontinence history (n=100) Table (3): Demonstrates the relationship between body mass index and frequency of urinary incontinence among studied sample. It demonstrates that there was statistically significant association between BMI and frequency of urinary incontinence among the studied sample (p≤0.05). Frequency of urinary incontinence About once a week or less often Two or three times a week Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 Body mass index Normal Overweight No % No % 4 100.0 6 25.0 0 0.0 8 33.3 Obese No % 10 13.8 22 30.6 X2 p-value 19.75 0.003* Page 4 of 9 J. General medicine and Clinical Practice Copy rights@ Hanan Elzeblawy Hassan. About once a day Several times a day 0 0 *Significant at p≤ 0.05 0.0 0.0 2 8 8.4 33.3 3 37 4.2 51.4 **highly significant at p≤0.01 Table 3: Relationship between body mass index and frequency of urinary incontinence (n=100) Figure (3): Present the distribution of studied sample according to using sanitary towel for urine leakage. It reveals from both figures that 63% of the studied sample used sanitary towel for urine leakage. Using Sanitary Towel for Urine Leakage 37% Yes 63% No Figure 3: Distribution of studied sample according to using sanitary towel for urine leakage (n=100) 68 Disturbs me a lot 27 Bothers me occasionally 6 After pelvic surgery 94 Times of change sanitary towel or under wear After frequent child birth Several times each day Very wet times for using sanitary towels or pads 5 Is a real handicap Wetness of the towel when changing it Stress urinary incontinence began The loss of urine is Using Sanitary Towel for Urine Leakage 7.9 41.3 2 times per day 50.8 Once per day 7.9 47.6 Wet 44.4 Damp 38 Also at home 1.6 Also when sleeping 93.7 When going out 0 Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 20 40 60 80 100 Page 5 of 9 J. General medicine and Clinical Practice Copy rights@ Hanan Elzeblawy Hassan. Table (4): Illustrates the statistical relation between number of gravid and frequency of urinary incontinence; it reveals that there were statistical differences in the frequency of urinary incontinence in relation to number of gravidities among the studied sample (p≤0.05). Number of gravidity Frequency of Urinary Incontinence 1-3 pregnancies (n=30) About once a week or less often Two or three times a week About once a day Several times a day No 10 13 2 5 *Significant at p≤ 0.05 More than three pregnancies (n=70) No % 10 14.3 17 24.3 3 4.3 40 57.1 % 33.3 43.3 6.7 16.7 X2 p-value 14.233 0.003* **highly significant at p≤0.01 Table 4: Statistical relation between number of gravid and frequency of urinary incontinence (N=100) Figure (4): Present the distribution of studied sample according to using sanitary towel for urine leakage. It reveals from figure 94% of the studied sample began to suffer from stress urinary incontinence after frequent child birth and 68% of the studied sample stress urinary incontinence disturbed them a lot. 68 Disturbs me a lot 27 Bothers me occasionally 6 After pelvic surgery 94 Times of change sanitary towel or under wear After frequent child birth Several times each day Very wet times for using sanitary towels or pads 5 Is a real handicap Wetness of the towel when changing it Stress urinary incontinence began The loss of urine is Using Sanitary Towel for Urine Leakage 7.9 41.3 2 times per day 50.8 Once per day 7.9 47.6 Wet 44.4 Damp 38 Also at home 1.6 Also when sleeping 93.7 When going out 0 20 40 60 80 100 Figure 4: Distribution of studied sample according to using sanitary towel for urine leakage (n=63) *Results not mutually exclusive Table (5) shows the statistical relation between number of parity and frequency of urinary incontinence. It reveals that there were highly statistical differences in the frequency of urinary incontinence in relation to number of parities among the studied sample (p≤0.05). Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 Page 6 of 9 J. General medicine and Clinical Practice Frequency Incontinence Copy rights@ Hanan Elzeblawy Hassan. of Urinary About once a week or less often Two or three times a week About once a day Several times a day *Significant at p≤ 0.05 number of parity 1 2 No % No 1 50.0 9 0 0.0 13 1 50.0 1 0 0.0 6 % 31.0 44.8 3.4 20.7 3 No 10 17 3 39 % 14.5 24.6 4.3 56.5 X2 p-value 22.141 0.001* **highly significant at p≤0.01 Table 5: Statistical relation between number of parity and frequency of urinary incontinence (N=100) Discussion Stress urinary incontinence results from failure of the sphincter mechanis m to maintain outlet closure during bladder filling and increased intraabdominal pressure during sneezing, coughing, running, laughing or exertion of greater physical effort [21]. The current study aimed to assess urinary incontinence related factors among elderly women. As regard to age of the studied women as a part of socio demographic characteristics of the studied women, the present study indicated that slightly less than half of the studied women were in the menopausal stage (50-55yrs) and slightly more than half were in the postmenopausal stage (>55yrs), the same results reported by El-Sayied H.A (2020), who studied Self-care model management of urinary incontinence for elderly women attending Ain Shams hospital and mentioned that near half of the studied sample their age was 50yrs and above [22]. From the researcher pint of view the aging process is associated with many changes in the body include the urinary tract system especially in women due to pregnancy and delivery that weakens the pelvic floor muscles this is the physiological explanation of increasing incidence of urinary incontinence among elderly women. In relation to Body Mass index, the present study showed that slightly less than three quarters of the studied women were obese, while one quarter was overweight. This result similar to Deshmane, S & Memchoubi, K (2018) who studied an experimental study to assess the effectiveness of pelvic floor exercise for the management of urinary incontinence among women in selected areas of Pune city and mentioned that the most dominant group was obese followed by overweight then normal weight [23]. Political, A (2019) who studied Pelvic muscle training may relieve SUI long term: study reports some patients experience extended relief after 8 weeks' training both of them documented that women suffer from urinary incontinence four times more than men due to multiple traumata from child birth that affects urethral sphincter function [27]. on the other hand, Wyman et al (2018) & Sharaf A-Y et al (2020) who studied The Impact of Nursing Interventions on the Control of Urinary Incontinence among Women and mentioned that there was no significant relationship between gravidity and frequency of urinary incontinence [2829]. Conclusion: Statistical significant association between BMI, number of gravid, and number of parity and frequency of urinary incontinence among the studied sample were found. Recommendations: 1. 2. References: 1. 2. These results were not consistent with Khalifa, M., et al (2019) who assessed the urinary Incontinence in Healthy Saudi Women and reported that the most dominant group was the obsess group followed by normal weight females and finally overweight females [24]. Concerning correlation between number of parity and frequency of urinary incontinence, the current study revealed that there was positive correlation between number of parity and frequency of urinary incontinence pre and post intervention with highly statistically significant difference (p value=0.000), this was similar to Khalifa, M et al (2019) who studied the Urinary Incontinence in Healthy Saudi Women and revealed that multi-parity was related to the urinary incontinence prevalence [24]. Also, Rizk DE et al (2019) who studied the Urinary Incontinence in The United States Women and reported that urinary incontinence prevalence was more common in females who had three or more births [25]. Regarding correlation between number of gravidity and frequency of urinary incontinence, the present study reported that there was positive correlation with statistically significant (p value = 0.003), this result was in accordance with Cotillo (2019) who studied Hospital extra: urinary incontinence and depression [26]. Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 Replication of the present study under different circumstances (sampling, setting, measurement, is recommended to validate its results. Application of health education program for measurement of management of urinary incontinence among elderly women 3. 4. 5. 6. 7. Sabzwari S, Amin F (2020): Urinary Incontinence in the Elderly: An Overlooked and Under-Treated Problem. Fam Med Med Sci Res 9: 249. Hassan H. (2019): The Impact of Evidence-Based Nursing as The Foundation for Professional Maternity Nursing Practices. Open Access Journal of Reproductive System and Sexual Disorder, 2(2): 195-197. Hassan H., Mohamed S., Ramadan E., Omran A. (2023): Urinary Incontinence among Menopausal Northern Upper Egyptian Women Impact of Deep Kegel and Breathing Exercises. New Medical Innovations and Research, 4(9): 1-12. Hassan H. (2020): Evidence-Based Practice in Midwifery and Maternity Nursing for Excellent Quality of Care Outcomes. American Journal of Nursing Research, 8(6): 606-607. Ghanim S., Mohamed S., Mohamed A., Hassan H. (2024): Nurses’ Knowledge and Practice for Reducing Falls among Older Adult Women. Nile journal for geriatric and gerontology, 7(1): 104-126. El Badawy, R. E. S., Ali, S. A., Abo El-Seoud, A. R., & Abd Allah, E. S. (2019): Health Education Intervention for Controlling of Stress Urinary Incontinence among Elderly Women at Zagazig City. Zagazig Nursing Journal, 9(2): 49-65. Mohamed S., Hassan H, Omran A., Ramadan E. (2024): Effect of Urinary Incontinence on Women's Physical Condition. Page 7 of 9 J. General medicine and Clinical Practice 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Journal of Community Medicine and Public Health Reports, 5(2): 1-5. Ahmed M., Hassan H., Mohamed A., Saleh A. (2024): Knowledge and Practice of Nurses toward Preventive Measures of Elderly Patients with Viral Hepatitis B and C in the Dialysis Unit. Nile journal for geriatric and gerontology, 7(1): 70-92. 9Hassan H., Mohammed S., Mohammed A., Ghanem S. (2024): Study Nurses' Knowledge about Fall Prevention among Elderly Women. Journal of Orthopaedic Science and Research, 5(1): 113. Ghanem S., Mohammed A., Mohammed S., Hassan H. (2024): Relationship between Nurses' Practices Regarding Fall Prevention among Elderly Women and their personal Characteristics. Journal of Orthopaedic Science and Research, 5(1):1-7. Omran A., Hassan H., Ramadan E., Mohamed S. (2024): Effect of Practicing Deep Breathing and Kegel Exercises on Menopausal Urinary Incontinence at Beni-Suef. Public Health Open Access, 8(1): 1-10. Nadir I. Osman A, Vincenzo Li Marzi b, Jean N. Cornu c, Marcus J. Drake (2018): Evaluation and Classification of Stress Urinary Incontinence: Current Concepts and Future Directions. E u r o p e a n U r o l o g y f o c u s 2 (2 0 1 6 ): 2 3 8 – 2 4 4. Hassan H., Ghanem S., Mohammed A., Mohammed S. (2024): Nurses' Knowledge and Practices about Fall Prevention among Elderly Women: Impact of Socio-demographic Characteristics . Journal of Women Health Care and Issues, 7(1):1-7. Mohamed S., Hassan H., Omran A., Ramadan E. (2024): Elderly Women Urinary Incontinence: Impact of Nurse-Based Kegel and Deep Breathing Exercise Intervention. ESP International Journal of Advancements in Science & Technology, 2(1):45-51. Hassan H., Ghanem S., Mohammed S., Mohammed A. (2024): Study Nurses' Practices Regarding Fall Prevention among Elderly Women. Clinics in Nursing, 3(1): 1-11. Mohamed S., Omran A., Ramadan E., Hassan H. (2024): Effect of Kegal and Breathing Exercise adherence on Obstetrical History of Elderly Women with Urinary Incontinence. Journal of Women Health Care and Issues, 7(2): 1-8. Cardoso AMB, Lima C and Ferreira CWS (2018): Prevalence of urinary incontinence in high impact sports athletes and their association with knowledge, attitude and practice about this dysfunction. Eur J Sport Sci; 18: 1405–1412. Casey EK and Temme K. (2017): Pelvic floor muscle function and urinary incontinence in the female athlete. Phys Sportsmed; 45: 399–407. Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 Copy rights@ Hanan Elzeblawy Hassan. 19. Hassan H. Kegels Exercises: A crucial issue during woman’s lifespan. American Research Journal of Public Health, 2020; 3(1):1-5. 20. Mohamed S., Omran A., Hassan H., Abo zied E. Effect of Deep Breathing and Kegel Exercises on Stress Urinary Incontinence among Elderly Women. Benha Journal of Applied Sciences, 2023; 8 (4): 81-89. 21. Wang SP, Zhang YJ, Zhang HL and Lu S (2019): Investigate of prevalence rate and influencing factors of stress urinary incontinence among menopausal women in Wuhan [Original in Chinese]. Chinese Journal of Family Plan Gynecotokol; 8 (4):32–35. 22. El-Sayied H.A. (2020): Self-care model management of urinary incontinence for elderly women attending Ain Shams hospital. Thesis submitted for partial fulfillment of doctorate degree in department of community health, postgraduate. Faculty of health nursing Ain Shams University Cairo.2001; P. 46. 23. Deshmane, S & Memchoubi, K. (2018): An experimental study to assess the effectiveness of pelvic floor exercise for the management of urinary incontinence among women in selected areas of Pune city. International Journal of Applied Research; 4(6): 128-13. 24. Khalifa M, Farag M, Abd El Aziz A, Ali S. Ahmed N (2019): Assessment of Psychological Symptoms and Quality of Life among Women with Urinary Incontinence. J Gynecol Res Obstet; 3(2): 064-069. 25. Rizk DE, Shaheen H, Thomas L, Dunn E and Hassan MY. (2019): The prevalence and determinants of health care-seeking behavior for urinary incontinence in United Arab Emirates women. Int. Urogynecol. J. Pelvic Floor Dysfunct., 10(3):160– 165. 26. Contillo C., (2019): Hospital extra: urinary incontinence and depression. American Journal of Nursing, 107 (1): 72C – 72 H 27. Palkhivala A. (2019): Pelvic muscle training may relieve SUI long term: study reports some patients experience extended relief after 8 weeks' training. Urology Times 2005 28. Wyman J, Fanti A, McClish D, Bump R., (2018): Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Journal of obstetrics and Gynecology, 179(4):999-1004. 29. Sharaf, A-Y, El Sebai N-A, EwiedaS-M, Shokry, M & SalemMA. (2020): The Impact of Nursing Interventions on the Control of Urinary Incontinence among Women. Journal of American Science. 6(10): 1256:1274. Page 8 of 9 J. General medicine and Clinical Practice Copy rights@ Hanan Elzeblawy Hassan. Ready to submit your research? Choose Auctores and benefit from: This work is licensed under Creative Commons Attribution 4.0 License To Submit Your Article Click Here : Submit Manuscript ➢ ➢ ➢ ➢ ➢ ➢ fast, convenient online submission rigorous peer review by experienced research in your field rapid publication on acceptance authors retain copyrights unique DOI for all articles immediate, unrestricted online access DOI:10.31579/2639-4162/166 At Auctores, research is always in progress. Learn more https://www.auctoresonline.org/journals/general-medicine-andclinical-practice Auctores Publishing LLC – Volume 7(4)-166 www.auctoresonline.org ISSN: 2639-4162 Page 9 of 9