Prevalence of SUI in Australian Women
Stress urinary continence (SUI) is a clinical condition in which unintentional loss of urine occurs during physical activity such as coughing, running, lifting objects or sneezing. It is the most commonly occurring problem in women under the age of 60 and certain factors such as pregnancy, childbirth, obesity, menopause, high impact sport and repeated lifting of heavy objects increased the risk of developing SUI (Lavelle & Zyczynski 2016). Female SUI is a highly prevalent issue in Australian women and this has been the reason for many psychosocial problems in women. This essay provides a brief insight into the prevalence of SUI in Australia and pathophysiology and its impact on psychological well-being in clients. In response to the challenges faced by women, the essay also discusses about possible treatment options for stress UI and the role of the community nurse in supporting clients with stress UI (Bagnola, Pearce & Broome, 2017).
SUI is highly prevalent in Australian women and it has affected about 37% of the Australian females. Pregnancy and childbirth are risk factors of SUI, however it does not mean that SUI is restricted to pregnant women or women who have had children (Bing et al., 2015). Australian Statistics has also revealed that 12% of Australian women who never had children also have incontinence and the disease prevalence has been found to increase with age (Urinary incontinence fact sheet | Women’s Health Queensland Wide, 2017). According to 2010 data, about 4.2 million Australians lived with urinary incontinence and it is estimated that by 2030, the number of people living with SUI will increase to 5.6 million (Continence Foundation of Australia, 2017). The occurrence of SUI has significantly affected the lives of women.
Apart from psychosocial challenges in females due to SUI, the financial impact of the condition is also huge. It has been associated with loss of productivity and high health care cost for the client. Females suffering from SUI incur huge costs in seeking formal care, physiotherapy, nursing care and spending money on pharmaceuticals, pathology and medical imaging (Milsom et al., 2014). Many also require aids and equipment support to manage their condition. Commonly used tools include toilets frames or continence aids such as absorbent pads (Australia’s Health, 2016). The financial impact of SUI is also understood from the 2010 data that $271 million total health system expenditure in Australia was incurred for incontinence (Continence Foundation of Australia, 2017). Due to risk of urinary leakage, many women have avoided going to work. This has been the reason for huge productivity loss due to SUI. Hence, apart from psychological and physical burden, the monetary value of the burden of SUI is also high. Awareness about the pathophysiology and risk factors for SUI is necessary to reduce the number of people living with SUI (Wu et al., 2014).
Pathophysiology of Female SUI
To gain an insight into the pathophysiology of female SUI, exploring the anatomy of the female urinary system is necessary. Urethral pressure, prolapsed condition and sphincter dysfunction also contribute to SUI pathophysiology. The urinary system of women consists of the bladder, urethra and the sphincter muscle. The bladder is responsible for storing urine and pushing it through the urethra (Brunzel, 2016). In addition, the flow of urine is controlled by the sphincter muscle. Conditions that lead to stress in the abdominal pelvic organ result in the diagnosis of SUI. The pelvic floor muscles and connective tissue support the bladder and the weakening of the pelvic floor muscles causes SUI (Wood & Anger, 2014). Sangsawang & Sangsawang (2013) also suggest that urethral support, vesical neck function and urethral muscles plays a role in continence and damage to the muscles and nerves of the pelvic floor destroys the connection between the endopelvic fascia and the muscles. Hence, such kind of muscle damage results in incontinence in females Pregnancy, child birth, menopause, impaired mobility due to stroke and constipation acts as the risk factor of urinary incontinence. Health and lifestyle issues in females such as obesity, physical inactivity and diabetes also increase the risk of UI (Nigam et al., 2017).
Due to risk of urine leakage, many women avoid leaving the house or participating in sports. Their daily life is significantly affected resulting in reduced participation is in social activities and professional work. Occupational restriction and poor work performance is seen in women due to loss of concentration, interruptions in work, frequent toilet breaks and inability to perform physical activity (Sinclair & Ramsay, 2011). All this leads to feelings of humiliation and the physiological well-being of women is seriously hampered. Women with SUI have reduced self-esteem and negative body image due to SUI. Due to fear of being incontinent in a public place, they withdraw from social and recreational activities. Their social and professional activity is disrupted and this leads to great emotional discomfort. The level of impact on daily lives of women is dependent on individual personality, severity of SUI and coping skills they have (Wan et al., 2014). Hence, unpredictability of urine leakages affects psychological well-being of women and tends to lead to a poor quality of life.
Sexual life is important for overall quality of life and emotional well-being in women. However, the diagnosis of SUI alters the sexual function of women. Evidence has revealed that women with SUI show less interest in sexual intercourse and 25-50% women also experience sexual dysfunction (Stadnicka et al., 2015). Hence, relationship of couples is affected resulting in reduced affection, physical proximity and intimacy. During intimacy, some women also become conscious of a fear of smelling bad. SUI is highly associated with interference in sexual function because female reproductive structure and urinary systems share common anatomy (Mota, 2017). On the whole, the interpersonal and mental state of women is affected. From the above challenges in lives of women affected by SUI, it can be said that women also have to incur high cost in psychosocial terms too. There is a need to teach women adaptation strategies to reduce the impact of SUI on sexual activity. Conservative treatment might also result in improving quality of life and sexuality in women (Moroni et al., 2016).
Psychosocial Impact of SUI
Brimbank Council is one of the local council and largest municipality situated in Melbourne. Clients who reside in the Brimbank Council area can be referred to Western Continence service to get help with management issues related to SUI. The service specially offers assessment and management service for urinary and fecal continence (Western Health, 2017). Other diverse services offered by Brimbank Council includes the continence assessment, bladder ultrasonography and urodynamic investigation, conservative management strategies, continence and appliance aid, surgical referral, liaison with other continence service and other service providers (Western Health, 2017). Hence, apart from assessment and management service for SUI, Brimbank Council also refers clients to specific surgical units, other continence service near the locality. It also handles appointments for nurse assessment and physiotherapy assessment either by home visit or by visiting Sunshine Hospital, Williamstown Hospital and Sunbury Day Hospital. All these service are provided by a continence service team comprising of doctors, nurses and physiotherapists (Western Health, 2017).
For women who are suffering from SUI, it is necessary to refer them to relevant health care professionals who can provide them the right treatment. Firstly, physician or doctors play a role in providing non-invasive therapeutic interventions to them before initiating treatment for SUI (Qaseem et al., 2014). Such treatments are started after identifying the contributing factors of SUI in an individual client. As obesity is a risk factor for SUI, non-pharmacological management is done by modification of diet, weight loss, increasing physical activity and providing proper nutrition to the patient (DeMaagd & Davenport, 2012). The effectiveness of weigh loss intervention has been proved and Subak et al., (2009) has revealed that weight loss intervention reduces the frequency of incontinence episodes. Clinicians are also involved in providing pharmacotherapy and other invasive treatment like surgery. Various types of surgeries depending on severity may be performed on a patient. In case of pharmacotherapy, estrogen and hormone replacement therapy are common treatment choices for SUI patients. Hence, referral to physicians is beneficial for clients as they help to modify their behavior and address the severity of symptoms (DeMaagd & Davenport, 2012).
Apart from regular physicians, physiotherapists also play a key role in providing non-invasive treatment to clients. They play a role in providing pelvic floor muscle exercise and bladder training, habit training and use of tools to manage urinary leakage in daily life. The effectiveness of such intervention is dependent on awareness of patients of the need to urinate and this results in significant improvement in day time incontinence issue. Exercise training to strengthen the bladder muscle of clients, which in turn, controls urinary function (DeMaagd & Davenport, 2012). However, exercise training interventions are more effective in younger women compared to older adults due to memory related disorders. The benefit of seeking care and support from physiotherapist is to teach the client to cope with the disease and develop skills to adapt new healthy behavior and manage incontinence episodes in daily life (Ghaderi & Oskouei, 2014).
Financial Impact of SUI
As indicated from the above discussion, both invasive and non-invasive therapeutic treatment options are available for women with SUI. Certain conditions like being over-weight and giving birth to babies put extra pressure on the pelvic floor muscles thus leading to SUI. Hence, pelvic floor muscle exercise is a common non-invasive treatment given to patients (Bø & Herbert, 2013). The benefits of pelvic floor exercise are that it activates and strengthens the pelvic floor muscles which facilitate proper functioning of the bowel, uterus and bladder. This type of exercise is provided under regular supervision of physiotherapist so that exercise routine and appropriate sitting and standing postures are maintained (Dumoulin, Hay?Smith & Mac Habée?Séguin, 2014). Healthy diet and dietary intervention is also a part of behavioral treatment because intake of quality food high in fibre reduces the problem of constipation, which increases complications in patient. Evidence has showed that chronic constipation weakens the pelvic muscle strength and increases pressure on the bladder (Perera et al., 2014). Hence, dietary interventions are necessary to manage symptoms. A continence nurse or general practitioner can recommend the right laxative and diet to patients with SUI. Other types of non-invasive treatment options for patient includes vaginal cones, biofeedback, electrical stimulation, weight loss, estrogen therapy or urethral injections (Bertotto et al., 2017).
The invasive treatment option of surgery is suggested for those patients where behavioral intervention cannot reduce the complications or severity. The main purpose of surgery is to reposition the bladder and provide them support. Two common methods of surgery include the colposuspension and the sling procedure (Schimpf et al., 2014). The first procedure involves the repositionining of the bladder neck and the second procedure involves placing a fascia under the urethra to provide support to it. Before clinicians proceed with the surgery, they conduct urodynamic assessment of client to interpret whether she has a favorable condition to proceed with the surgery or not (Urinary incontinence fact sheet | Women’s Health Queensland Wide, 2017).
Apart from doctors and physiotherapist, the community nurse also plays a critical role in supporting client with SUI. They play a major role in educating patients and helping them to live positively with SUI. Individualized nursing care plan decreases the occurrence and adverse consequence of SUI in women (Doenges, Moorhouse & Murr, 2014). Firstly, the nurse engages in assessment and management of SUI by review of past history of the patient, physical assessment, leakage observation, making an input output chart and measurement of residual volume. Secondly, he/she provides assistance to people in coping with SUI on a daily basis. The nurses provide toileting assistance and habit training to match patient’s toilet schedule with voiding habits (Wood & Anger, 2014). They also help clients to deal with emotional impact of incontinence. They provide advice to patients regarding using disposable pads and using electrical nerve stimulation (Teunissen et al., 2015). With this information, it can be said that treatment and care by a community nurse improves the quality of life of clients.
Role of Community Nurse for SUI
The essay gave an insight into issue of SUI and its prevalence in women in Australia. The severity and disease burden of SUI is understood from the prevalence rate, total health care cost for SUI, psychosocial and financial impact on patient. The evidence regarding certain risk factors of SUI also suggested that maintaining a healthy diet and health lifestyle is necessary to prevent the rate of SUI in Australia. Nurses, doctors and physiotherapist play a key role in providing treatment support and referral to clients. For residents living in the Brimbank Council area, the Western Continence Service is playing a crucial role in referring clients to appropriate services and providing relevant treatment.
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Treatment Options for SUI
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