A Study to Assess the Effect of Pelvic Floor Muscle Strengthening Exercises on Urinary Incontinence in Patients With Cervical Cancer Undergoing Radiation Therapy at a Tertiary Cancer Center

Abstract

INTRODUCTION Cervical cancer is one of the most common and dreaded diseases of women in India, it accounts for 16 percent of total cervical cancer cases occurring globally. Some of the vital treatments for cervical cancer are radiation therapy external beam radiation and intracavitary radiation therapy. Radiation has a greater effect on the pelvic floor (PF). It causes actinic injuries and shows major symptoms of urinary incontinence (4-76%). So, to control this complication of urinary incontinence, pelvic floor muscle strengthening exercises are the most effective, economical, and feasible interventions. The rationale for the effectiveness of pelvic floor muscle strengthening exercises is they improve muscle strength increase blood flow to pelvic structure and improve the functioning of sphincter muscles. Pelvic floor muscle strengthening is an independent nursing action as it focuses on controlling urinary incontinence and improving the quality of life of patients with cervical cancer undergoing radiation therapy. It helps to gain the self-confidence and self-esteem of participants. The objective was to analyze the effect of pelvic floor muscle strengthening exercises on urinary incontinence in patients with cervical cancer undergoing radiation therapy at a tertiary cancer center. METHODS This study included 45 cervical cancer patients undergoing radiation therapy by using a non- probability-convenience sampling technique and a quasi-experimental one-group pre-post design. Intervention- consists of four pelvic floor muscle strengthening exercises including a) Kegel exercise b) Squeeze and release c) Pelvic floor/inner thigh ball Squeezed) Lower trunk rotation / Lying hip rotation was given with the help of a demonstration, and model pamphlet. These exercises were performed four times every day. The total duration of four items was 18-20 minutes for 12 weeks. Daily follow-up was done and a logbook was maintained for compliance. The patient was assessed for urinary incontinence using the ICIQ UI-SF tool and perineometer on the 8th and 12th weeks. The statistical evaluation plan was the demographic and clinical data summarized with descriptive statistics and primary objectives evaluated with the Wilcoxon sign rank test, Confidence Interval and Paired t test. Secondary objectives were evaluated with frequency distribution and chi-square t-test. RESULTS OF THE STUDIES In this study, 45 women received the intervention however 43 women completed the intervention and follow-up. The result showed the frequency, and quantity of urinary incontinence significantly reduced from the patient’s baseline parameters. Participant's ICIQ UI SF total score was observed that on pre-test mean of 12.56 (±3.74),8thweeks of intervention mean of 11.33 (±3.48), and 12thweeks of intervention mean of 8.86 (±2.97) and 95% Confidence interval 11.41-13.71, Wilcoxon sign rank test result of pre-test and 12th weeks observed that 4.022. P-value was statistically significant (p <0.001). There was a significant (P <0.001) improvement in the quality of life of participants. The research hypothesis was accepted. There was significant (p <0.001) alleviation in urinary incontinence after pelvic floor muscle strengthening exercises in a patient with cervical cancer undergoing radiation therapy. The pelvic floor muscle contractility on perineometer on pre-intervention mean was 21.63 (±2.71), on post-intervention 8 weeks’ mean was 22.33(±2.65), and 12 weeks’ mean was 23.49 (±2.16). 95% confidence interval 22.82 -24.15 (P<0.001).The pelvic floor muscle strengthening exercises were statistically significant (p <0.001) proving the improvement in pelvic floor muscle strength. CONCLUSION The result of this study suggests that pelvic floor muscle strengthening exercises were effective for alleviating urinary incontinence. Pelvic floor muscle strengthening muscle strengthening exercise might be a protective factor for preserving pelvic floor muscle strength and preventing urinary incontinence. This study also suggests that simple nursing intervention improved the quality of life and comfort of patients with cervical cancer undergoing radiation therapy. It is a feasible and cost-effective intervention.