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Community exercise based intervention for urinary incontinence in elderly village women in rural Bangladesh.

Author(s) Nasima Yasmin1, Nicola Cherry2.
Affiliation(s) 1Physiotherapy Department, Gonobishwabidalay, Dhaka, Bangladesh, 2Department of Medicine, University of Alberta, Canada, Canada.
Country - ies of focus Bangladesh
Relevant to the conference tracks Chronic Diseases
Summary A feasibility study in 5 GK villages was carried out to assess the effect of exercise on incontinence in this population. Three locally trained female physiotherapists worked with a Canadian physiotherapist experienced in exercise based management of urinary incontinence to develop a culturally appropriate exercise regime and to train 10 community paramedics. The intervention adopted included training in pelvic floor muscle exercises, followed by group exercise classes, lead by physiotherapists, and held in the village for 2 hours twice weekly for 3 months.
Background Urinary incontinence is a common feature of aging adults over 40 years of age. Exercise based interventions to manage incontinence has been practiced effectively in the Western world and Japan, but very little has been published on such interventions in developing countries. Gonoshasthaya Kendra (GK) a national charitable foundation based in Savar, Bangladesh, provides community based comprehensive primary health care among 1.2 million rural residents. In 2009-10 GK health workers interviewed 40,000 men and women over the age of 60 years in 535 villages. Overall, 28% reported troublesome urinary incontinence, with higher prevalence in older women.
Objectives To identify and resolve any problems of implementation of the proposed intervention and measures of outcome through a pilot study in 5 villages (4 intervention and one control).
Methodology This was followed by a three month maintenance period with monitoring and reinforcement by the paramedics. Frequency of micturation and of incontinence was recorded for 3 days each month for 6 months. As almost all participants were illiterate, a body belt with ribbons that were tied upon a urinary episode was used as a bladder diary.
Results More than 80% of women in the intervention villages completed the 3 month exercise program and the urinary monitoring for six months. Urinary frequency and leakage decreased significantly in the intervention group.
Conclusion This presentation will focus on the role of the community physiotherapists in developing and implementing the exercise program and on the reaction of the elderly women to the community exercise program.