Awarding Pelvic Floor Exercise in Elderly Patients with Urinary

Incontinence

Luci Riani Br Ginting

, Kuat Sitepu

, Isidorus Jehaman

, Miftahul Zannah

, and Arfia Ningsih

Faculty of Public Health, Institut Kesehatan Medistra Lubuk Pakam, Indonesia

Faculty of Nursing and Physiotherapy, Institut Kesehatan Medistra Lubuk Pakam, Indonesia

Keywords: Pelvic Floor Exercise, Inkontinensia Urin

Abstract: Changes and degradation in the physical, psychological, social and spiritual well-being of the elderly greatly

affects the health status of the elderly. One of the physical changes in the elderly is urinary incontinence.

The high incidence of urinary incontienence causes the need for physiotherapy with the pelvic floor

excercise method. Pelvic floor exercise method aims to determine the effect of providing pelvic floor

exercise to patients with urinary incontinence. This research is a quasi-experimental study using pre-test and

post-test one group design. Total samples of 15 people were taken by accidental sampling. Stastical analysis

using T-Test. The results obtained p value <α = (0,000 < 0.05)Which means that there is a significant

influence on pelvic floor exercise on patients with urinary incontinence in the elderly at Grandmed Hospital.

Suggestion for future researchers are expected to use a larger number of samples from this study and a

longer reasearch time from this study so that the results obtained are more optimal.

1 INTRODUCTION

According to WHO the age limit of the elderly

(elderly) population group aged 60 years is or more.

WHO data shows that life expectancy in 2000 was

66 years, increased in 2012 to 70 years, and 71 years

in 2013. And the increasing number of elderly

population in 2009 was 7.49% of the total elderly

population. world population, in 2011 became

7.69% and in 2013 increased to 8.1% of the total

population of the elderly population, according to

the WHO Age criteria is 60-74 years. (WHO, 2015).

Data in the United States is estimated that

around 10-12 million adults experience urinary

incontinence. Its severity increases with age and

parity. At the age of 15 years or more the incidence

is 10%, while at the age of 35-65 years it reaches

12%. Prevalence will increase to 16% in women

over 65 years. In multipara there is an incidence of

5%, in women with one child reaching 10% and

increasing to 20% in women with 5 children

(Collein, 2012).

Whereas in Indonesia the high life expectancy

(UHH) is an indicator of the success of achieving

national development in the health sector, since

2004-2015 life expectancy has increased from 68.6

years to 70.8 years and is projected in 2030-2035

life expectancy in Indonesia it will reach 72.2 years

which Indonesia will enter the aging period (aging),

which in 2020 will be estimated that 10% of the

population will be aged 60 years and over, according

to law No. 13 1998 criteria elderly is 60 years and

over ( KEMENKES RI, 2016 ).

Based on the results of records on the Health

Profile of the Province of West Sumatra in 2014, the

percentage of elderly in West Sumatra increased

from 5.45% to 23.9% in 2013, while an increase in

the number of elderly that continues to rise from

year to year is seen from 2007 data as many as

28,557 people, in 2010 as many as 57,625 people

and in 2011 as many as 82,784 people. In 2012-2013

the number of elderly people also increased,

reaching 91,573, in 2014 the number increased to

101,173 people, while in 2015 the number of elderly

increased to 114,305 people, or reached 9%

compared to the previous year (Padang City Health

Office, 2015 ).

Changes and decreases both physically,

psychologically, socially and spiritually which are

experienced by the elderly greatly affect the health

status of the elderly. One of the physical changes

experienced by the elderly that needs attention is the

urinary system. As a result of changes in urinary

function, the elderly experience a disruption in

Ginting, L., Sitepu, K., Jehaman, I., Zannah, M. and Ningsih, A.

Awarding Pelvic Floor Exercise in Elderly Patients with Urinary Incontinence.

DOI: 10.5220/0009471802390246

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 239-246

ISBN: 978-989-758-460-2

239

controlling urine output which is commonly referred

to as urinary incontinence (Meiner, 2015).

The results of research from several

universities coordinated by the center of aging

studies of Indonesian universities (CAS UI) showed

the emergence of geriatric syndrome which

sequentially in the form of disorders as follows,

among others Nutrition 41.6%, Cognitive 38.4% and

third urinary disorders / urinary incontinence by

27.8%, subsequent immobilization disorders 21.3%

and depression 17.3%.It is estimated that there are

more than 200 million people in the world

experiencing problems in controlling urine

(Elizabeth, 2014).

According to research (Onat, 2014) it is

estimated that 25-35% of all late adults will

experience urinary incontinence during their

lifetime. A survey conducted in various Asian

countries found that the prevalence in several Asian

countries was on average 21.6% (14.8% in women

and 6.8% in men). Compared to the age of

production, in the elderly the prevalence of urinary

incontinence is higher. The prevalence of urinary

incontinence in elderly women is 38% and in men

19%. Urinary incontinence affects individuals of all

ages, although it is most often found among the

elderly, the condition is not a normal consequence of

aging and is often not treatable.

Urinary incontinence was carried out by the

Urology Department of the FK-Airlangga University

Dr. Soetomo on 793 patients, the results of the

incidence of urinary incontinence in men were

3.02% while in women it was 6.79% (Angelita,

2012). In Gorontalo Province, based on data from

the Provincial Health Office in 2013, 2,371 elderly

had been treated at a hospital with urinary

incontinence problems.

Data from epidemiological studies from five

countries shows the incidence of urinary

incontinence in men aged <39 years by 2.4%, and

10.4% in men aged> 60 years, whereas in women

aged <39 years by 7.3% and 19.3 % In women. > 60

years old. The impact of urinary incontinence is

estimated to be 15-35% in the population aged 60

years and over who live in the community with a

female prevalence twice as large as that of men

(Jahromi, 2015).

Continentia conducted a study of the profile of

urinary incontinence in Indonesia in 2008 involving

six teaching hospitals, namely: Jakarta, Surabaya,

Bandung, Semarang, Makassar and Medan.

Obtained the results of the prevalence of urinary

incontinence as much as 13% of 2,765 respondents

with a total population of geriatric (age over 60

years) of 22.2% more than the total adult population

(aged 18-59 years) of 12.0% with the conclusion of

prevalence Urinary incontinence is found to increase

with age (PERKINA, 2012).

Urinary incontinence is a condition in which a

person unconsciously experiences urine leakage both

in small amounts and in large amounts. This can be

experienced by everyone no exception. But

generally the prevalence increases with age,

especially in women.

Another problem related to urinary

incontinence is that sufferers rarely report their

condition to health workers. With reasons of shame

and it is taboo to discuss with others. As a result, this

problem is rarely overcome properly (Potter, 2013).

In general, urinary incontinence is caused by

changes in the anatomy and function of the elderly

urinary organs, obesity (obesity), menopause, old

age, lack of activity and vaginal surgery, decreased

levels of the hormone estrogen in women at

menopause (50 years and over).

Increasing weight and pressure during

pregnancy can cause pelvic floor muscle weakness

due to pressure for nine months. The delivery

process can also make pelvic floor muscles damaged

by muscle stretches and supporting tissues and tear

of the birth canal, thereby increasing the risk of

urinary incontinence (Sankarganesh, Kumar, 2018).

Gender factors play a role in urinary incontinence,

especially in women due to decreased levels of the

hormone estrogen at menopause, there will be a

decrease in vaginal muscle tone and urinary tract

(urethral) muscle, causing urinary incontinence. The

risk of urinary incontinence increases in women with

greater body mass index values, a history of

hysterectomy, urinary infection, and perineal

trauma. Symptoms of incontinence that usually

occurs is urinating when coughing, straining,

laughing, sneezing, running and feeling a sudden

urge to urinate, repeatedly urinating and urinating at

night (Setiati, 2014).

The results of Galih Adhi Isak Setiawan's

research, About the effect of adding faradik

stimulation on pelvic floor exercise to decrease

urinary incontinence frequency on urinary

incontinence stress in Muhammadiyah Yogyakarta

hospital, obtained 0.05 (p <0.05) there was an

influence in decreasing urinary incontinence

frequency from before and after treatment.

Based on a survey conducted at Grandmed

Lubuk Pakam Hospital, the elderly population in the

inpatient room at Grandmed Lubuk Pakam Hospital

in 4 inpatient rooms were 40 elderlyand there are 18

elderly who experience urinary incontinence for 1

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

240

month so the results obtained are the prevalence of

urinary incontinence as much as 45% of 40 elderly

people.

Pelvic floor musculature is composed of several

layers with bony attachments to the pubic bone and

coccyx. The anterior-posterior fibers are oriented

almost horizontally and form the inferior support for

the trunk. Laterally, the tissues blend into a fascial

layer overlying the obturator internus. Both right and

left sides of the muscles contribute fibers to the

perineal body located between the vagina and

rectum. The Structure and action of the muscles of

each layer. That fibers run from anterior-posterior

create a superior force toward the heart while the

more superficial fibers surround the sphincters and

procedure a puckering motion (Kisner, 2016).

Urinary incontinence results from a decrease in

pelvic floor muscle strength that can be caused by

aging. Another cause by extreme stretching of the

pelvic floor tissues in inherent in the process of

labour and vaginal delivery. The pelvic floor

musculature may also be torn or incised during the

birth process. An episiotomy is an incision made in

the perineal body. It is automatically considered a

second-degree laceration according to the following

classification of perineal lacerations (Kisner, 2016).

Episotomy is common occurred in 33% to 51%

of vaginal delivers there is no strong medical

evidence suppoting its use. In fact outcomes with

episotomy are worse in some cases including pain

with intercourse and extension of the episotomy in

particular, the physiotherapy is able to provide

education and support for the patient as she explores

her options.

The physiotherapy intervention used to handle

cases of urinary incontinence is pelvic floor exercise

that aims to increase the strength of the pelvic floor

muscles. This exercise is done in series with the type

of contraction exercises to increase the strength of

the pelvic floor muscles so that it can strengthen the

function of the external sphincter in the bladder, and

make the urethra tightly closed by contracting

relaxes that are carried out continuously or

repeatedly. This exercise is also very effective for

controlling urinary without drugs or surgery (Ma,

Liu, 2019).

Visual aids are critical in teaching patients about

pelvic floor function. Emphasis should be on both

slin/ hammock fibers and orientation of the

musculature. To visualize the fibers that run

anterior-posterior as well as the circumferential

fibers (Kisner, 2016).

From the above background the researcher is

interested in conducting research on the Effect of

Giving pelvic floor exercise to patients with urinary

incontinence in the elderly at Grandmed Lubuk

Pakam Hospital in 2019.

2 RESEARCH METHODS

This research was conducted at the Grandmed

Poly Physiotherapy Hospital, located at Jl Raya

Medan, No.66, Lubuk Pakam. The research was

conducted in February - July 2018. This type of

research is quasi-experimental.

In this study observations and measurements

were made before and after treatment to see the

effect of pelvic floor exercise on urinary

incontinence that can be seen on Figure 1.

X P2

Figure 1: Implementation of research activities.

Where P1 is first observation (Pretest) to see

urinary incontinence before pelvic floor exercise in

the elderly, X is the treatment given pelvic floor

exercise and P2 is the second obsevation (posttes) to

determine urinaty incontience after pelvic floor

exercise according to Figure 2 the number of

samples in the study were 15 people who took based

on the inclusion criteria and exclusion criteria.

Inclusion criteria in the study are elderly who

experience urinary incontinence, respondents are

aware and can be actively invited to communicate,

patients use catheters and pampers. While the

Exclusion Criteria are, respondents with impaired

consciousness, respondents resign before pelvic

floor exercise and elderly with heart disease.

Figure 2: Reaserch Implemtation Flow.

Population

Sam

el: n=15

Urinary incontinence

measureament with SSI before

pelvic floor exercise

Interventionpelvic floor

Urinary incontinence measureament

with SSI after pelvic floor exercise

Data anal

sis

Awarding Pelvic Floor Exercise in Elderly Patients with Urinary Incontinence

241

Procedure for implementing the Pelvic Floor

Exercise method

Pelvic floor exercise is a method of exercise on

the pelvic floor muscles that is useful for

strengthening pelvic floor muscles, increasing tone

of pelvic floor muscles, and making the urethra

tightly closed by contracting relaxes that are carried

out continuously or repeatedly. This exercise is also

very effective for controlling urinary incontinence

without drugs or surgery (Rocha, Carvalho, Natal,

2018). Objectives 1) strengthen the muscles that

support the bladder and urethra, 2) help maintain

muscle control for urination. The therapy starts

from:

 Patient preparation, explain to the patient

the procedures and goals of Pelvic Floor

Exercise intervention, position the patient

as comfortable as possible.

 Equipment preparation place or bad must

not be too low or high, and must not be too

soft, there is a place for training (clean and

safe walls).

 Therapy management perform a bridge.

bridge (bridge). Start by lying down

 supine and bend both knees, and give a fist-

sized gap between the legs. After that,

tighten the lower abdominal muscles and

raise the pelvis from the floor. Stop when

the shoulders and knees form a straight

line. Hold for 8 seconds and slowly return

your pelvis to the floor. Try not to turn your

head when the pelvis is lifted because it can

strain your neck. 2) Practice wall squats.

Lean against the wall, and open your feet

hip-width apart. Take a deep breath and

tighten your pelvic floor muscles. Then,

lower your back to rub against the wall into

a squat position (like sitting in a chair).

Hold for 10 seconds, then stand back up, 3)

Do a "dead bug crunch" Lie on your back

on the floor, bend your knees and soles of

your feet at knee height. Extend both arms

firmly to the ceiling. Breathe deeply,

tighten muscles pelvic floor, and straighten

your left hand and left leg in the opposite

direction, return to the starting position, and

repeat with the right side of your body.

 Pelvic Duration applied: 1) Intensity:

Perform 3 repetitions, Duration 15 minutes,

Frequency 2 times a week for 1 month of

research.

Measurement Method, using structured

measurements that defines what will be

observed through a careful planning (Nursalam,

2011). Observations were made before (pre-test)

and after (post-test) pelvic floor exercise for

patients suffering from urinary incontinence.

Measurement using the Sandvix Saverity Index

(SSI) Scale. SSI consists of two questions where

the results of the study regarding urinary

incontinence are obtained by multiplying the

score of the first question answer by the score of

the second question,

 Skor 1-2 : mild incontinence

 Skor 3-5 :moderate incontinence

 Skor 6-8 :severe incontinence

 Skor 12 :very heavy

3 RESULT

Respondents in this study amounted to 15

people who suffer from urinary incontinence who

have fulfilled the requirements to become

respondents with the provisions that have been

made. Characteristics of respondents in this study

based on age and gender.

The number of respondents based on age, aged

60-65 as many as 10 people (66.7%), aged 66-70

amounted to 3 people (20.0%) while in 71-74 aged 2

people (13.3%). While based on gender, there are 7

men (46.7%), while there are 8 women (53.3%).

Based on the measurement results of urinary

incontinence with SSI Before being given Pelvic

Floor Exercise Interventions an average value of 5.8

(severe incontinence) was obtained, while the results

of measuring urinary incontinence with SSI after

being given Pelvic Floor Exercise obtained an

average value of 2.5 (incontinence) is) Statistical test

results obtained p value α < (0,000 <0.005), it can be

concluded that there is a significant influence

between urinary incontinence before and after being

treated with pelvic floor exercise for patients with

urinary incontinence in the elderly at Grandmed

Lubuk Pakam Hospital.

4 DISCUSSION

Based on the results of research conducted on 15

patients aged at most aged 60-65 years, as many as

10 people (66.7%), while at the age of 66-70 years

as many as 3 people (20.0%), and at least at the age

of 71-65 74 years as many as 2 people (13.3%). This

is consistent with the existing theory that the

problem of urinary incontinence from changes that

occur at that age, changes in the urinary system or

the urinary system potentially have a significant

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

242

level of importance. Urinary incontinence problems

are not caused directly by the aging process, triggers

urinary incontinence in the elderly is a condition that

often occurs in old age combined with age-related

changes in the urinary system (Stanley, 2010).

Patients often consume certain drugs because of

their illness. These medications can be one of the

causes of loss of bladder control in older people. If

this condition occurs, the discontinuation or

replacement of the drug if possible, a decrease in the

dose or modification of the drug administration

schedule (Setiati, 2007)

Based on the results of research conducted on 15

patients the majority of female sex characteristics

are 8 people (53.3%) and 7 people (46.7%) men.

Urinary incontinence can be caused by

complications from urinary tract infections, loss of

sphincter control or sudden changes in abdominal

pressure. Incontinence can be permanent for

example in spinal cord trauma or temporary in

pregnant women with a pelvic floor

structureweakness can result in urinary incontinence.

Although urine incontinence can occur in patients of

various ages, loss of urinary control is a problem for

the elderly (Engla, 2017).

Weight gain and pressure during pregnancy can

cause pelvic floor muscle weakness due to pressure

for nine months. The growing fetus places added

stress on postural muscles as the center of gravity

shifts forward and upward and the spine shifts to

compensate and maintain stability. In addition, after

delivery, activities involving holding and caring for

the baby stress postural muscles. Muscles that

require emphasis for strengthening and stretching

are listed. General exercise descriptions are listed in

respective. Subsequent sections describe adaptations

of exercises specific for the pregnant woman. The

delivery process can also make pelvic floor muscles

damaged due to muscle strain and supporting tissues

and tear of the birth canal so that it can increase the

risk of urinary incontinence. With a decrease in

estrogen levels in women at the age of menopause

(50 years and over), there will be a decrease in the

tone of vaginal muscles and urinary tract muscles

(urethra) (Setiati, 2007)

Urinary incontinence problems are not caused

directly by the aging process, triggers urinary

incontinence in the elderly is a condition that often

occurs in old age combined with age-related changes

in the urinary system. Flexibility and stretching

exercises are implemented with caution. Remember

that connective tissues and supporting joint

structures are at increased risk of injury from

forceful stresses during pregnancy and the

immediate postpartum period because of hormonal

changes (Stanley, 2010).

Based on the results of research conducted on

15 people on the measurement of the value of the

SSI before giving pelvic floor exercise which has a

value of = 5.53 and SD = 2.031.

Changes that occur in the urinary system are a

decrease in vaginal muscle tone and urinary tract

(urethral) muscle caused by a decrease in the

hormone estrogen, causing urinary incontinence, the

muscles become weak, the capacity decreases to 200

ml or causes the frequency of BAK to increase.

Impaired sphincter function causes the bladder to

leak when coughing or sneezing, it can also be

caused by abnormalities in the area around the

urinary tract, disturbed cerebral function and

resulting in bladder contractions, urinary discharge

occurs with dilation of the bladder, a lot of urine in

the bladder to excessive capacity (Brunner, 2010,).

As we get older, there are some changes in the

anatomy and function of the urinary organs, namely:

weakening of the pelvic floor muscles due to

multiple pregnancies, vaginal delivery (especially

long process), heavy lifting, obesity, lack of

hormone replacement at menopause, habits incorrect

straining, stroke, enlarged prostate gland, etc. (Ellen,

2017).

From research conducted by Arnold, et al

(2009) based on the type of urinary incontinence, the

incidence of Urinary Stress Incontinence was

58.82%, Urge Incontinence Urine was 11.77% and

Mixed Urinary Incontinence was 29.41%. There are

three most types of urinary incontinence in women,

namely stress urinary incontinence, urge urinary

incontinence and urinary mixed incontinence. These

three types can be evaluated through history taking

and simple clinical judgment.

Urinary incontinence can be caused by

complications from urinary tract infections, loss of

sphincter control or occurrence abdominal pressure

changes suddenly. Incontinence can be permanent,

for example in spinal cord trauma or temporary in

pregnant women with weak pelvic floor structures

can result in urinary incontinence. (Engla, 2017).

Successful strengthening is unlikely without this

educational component in fact intructing women in

pelvic floor exrecises by verbal of written instruction

alone caused increased pressure to the appropriate

superiorly directed force. Women who have never

been pregnant may also present with pelvic floor

dysfunction. Excessive straining because of chronic

constipation, smoking, chronic cough, obesity, and

hysterectomy can contribute to these impairments in

any woman. The role of estrogen in the development

of incontinence is still unclear, with some studies

citing estrogen depletion as a risk factor and others

that found a connection between incontinence and

Awarding Pelvic Floor Exercise in Elderly Patients with Urinary Incontinence

243

estrogen replacement therapy. High caffeine intake

(more than 400 mg/day) is a specific risk factor for

urge incontinence (Kisner, 2016).

The use of exercise and biofeedback, including

surface musculosceletal for treatment of pelvic floor

dysfunction in a female population is well

supported. Musculo can show by electromyography

allows for immediate visual and/or auditory

feedback to the patient, enhancing motor learning

and proprioceptive improvements. It is particularly

invaluable for pelvic floor re-education owing to

lack of knowledge of the muscles’existence, let

alone their function and importance. Specific

exercises to address pelvic floor impairments are

listed in the exercise (Kisner, 2016).

This is in line with a study conducted by Galih in

2015 in his research on the Effect of Pelvic Floor

Exercise with a decrease in Urinary Continuation

conducted 5 repetitions, 3 times a week in the result

of statistical test p-value = 0.005 (p <0.05) which it

means that there is an effect of giving Pelvic Floor

Exercise on Patients with Urinary Incontinence.

Based on the results of research conducted on 15

people on the measurement of the value of SSI after

giving pelvic floor exercise which has a value of

Mean = 3.60 and SD = 1.882.

Sacroiliac pain is localized to the posterior pelvis

and is described as stabbing deep into the buttocks

distal and lateral to L5/S1. Pain may radiate into the

posterior thigh or knee but not into the foot.

Symptoms include pain with prolonged sitting,

standing or walking, climbing stairs, turning in bed,

unilateral standing, or torsion activities. Symptoms

may not be relieved by rest and frequently worsen

with activity. Pubic symphysis dysfunction may

occur alone or in combination with sacroiliac

symptoms, and includes significant tenderness to

palpation at the symphysis, radiating pain into the

groin and medial thigh, and pain with weight

bearing. In addition, excessive separation and

translation of the bone may occur. One study

reported a four times greater incidence of posterior

pelvic pain than low back pain in pregnant women.

Pelvic floor exercise is one of a variety of therapies

used in the management of urinary incontinence.

Pelvic floor exercise is a pelvic floor exercises or

exercises that are useful to strengthen the pelvic

floor muscles, increase the tone of the pelvic floor

muscles, and make the urethra closed tightly by

contracting relaxes that are carried out continuously

or repeatedly (Klausner, 2003).

This exercise is also very effective for

controlling urinary incontinence without drugs or

surgery. Pelvic floor exercise is an easy exercise to

help increase muscle strength and bladder. If done

properly and regularly, this exercise can build and

strengthen pelvic floor muscles to help hold urine

and feces (Jahromi, Talebizadeh, Mirzaei, 2015.

Indications Men and women who have

incontinence problems (unable to resist urination),

Women who have experienced menopause to

maintain pelvic muscle strength from decreased

estrogen levels, Women who experience uterine

prolapse (uterine descent) due to weakening of the

pelvic floor muscles, also to women who experience

sexual problems.

There are various exercises that you can try, and

one of them is a bridge. Start by lying on your back

and bend your knees, and give a fist-sized gap

between your legs. After that, tighten the lower

abdominal muscles and rise the pelvis from the

floor. Stop when the shoulders and knees form a

straight line. Hold for 8 seconds and slowly return

your pelvis to the floor. Try not to turn your head

when the pelvis is lifted because it can strain your

neck. Exercise must be modified so as not to

aggravate the condition. Avoid exercises that require

single-leg weight bearing and excessive hip

abduction or hyperextension. Teach the patient to

activate the pelvic floor and transverse abdominals

when transitioning from one position to another in

order to stabilize the pelvis.

Based on the analysis of the Paired T-Test Test,

the results obtained are Pretest and Posttes Mean =

1.933, with a standard deviation = 0.594. The

analysis results obtained p value = 0,000 (p <0.05)

which means there is

Significant influence between the value of SSI

before and after pelvic floor exercise is given to

patients with urinary incontinence and this

intervention is good to be applied by

physiotherapists in patients with urinary

incontinence for the development of physiotherapy

interventions.

Assumptions according to the authors of this

study that pelvic floor exercise is very effective in

patients with urinary incontinence because this

technique can strengthen pelvic floor muscles by

exercising pelvic floor muscles by contracting and

relaxing that is done repeatedly so that it can reduce

urinary incontinence caused by pelvic floor muscle

weakness. Daily activities should be adapted to

minimize asymmetrical forces acting on the trunk

and pelvis. For example, getting into a car is done by

sitting down first, then pivoting both legs and the

trunk into the car, keeping the knees together; side-

lying is made more symmetrical by placing a pillow

between the knees and under the abdomen, and

sexual positions are altered to avoid full range of hip

abduction. Single-leg weight bearing, excessive

abduction and sitting on very soft surfaces should be

avoided. In addition, caution patients to avoid

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

244

climbing more than one step at a time, swinging one

leg out of bed at a time when getting up, or crossing

the legs when sitting.

When doing Pelvic floor exercise neurological

adaptation, structural adaptation and metabolic

adaptation will occur. Neurological adaptations

occur by activating motor units that innervate

nerves. Structural Adaptation is associated with

muscle hypertension or an increase in muscle size.

As you know, muscle strength is directly

proportional to an increase in muscle size. Muscle

hypertrophy results in an increase in the number and

size of myofibrils, each of which is formed by

contractile units, the sarcomer. Sarcomere

hypertrophy results in density in myofibrils. The

parallel growth of myofibril causes a tension level

(increased tension). This is what causes muscle

strength. Whereas in metabolic adaptation there are

three complex enzymes, namely: phosphocreatine

ATP complex, glycolysis / glycogenolosis complex

and lypolysis complex. This enzyme is very

influential during training. At the time of exercise

these three enzymes have increased so as to increase

muscle strength. All of these have an impact on the

strength of increasing pelvic floor muscle strength

(Radzimińska, Strączyńska, Weber-Rajek, 2018)

Pelvic floor exercise interventions are very

effective to help patients with urinary incontinence.

From an economic point of view this exercise can

also help because pelvic floor exercise training can

not only be done in hospitals but exercises can be

done at home as a home program. Developing the

ability to relax requires awareness of stress and

muscle tension. Techniques of conscious relaxation

allow the individual to control and cope with a

variety of imposed stresses by being mentally alert

to the task at hand while relaxing tense muscles that

are superfluous to the activity. This is particularly

important during labor and delivery when there are

times that the woman should relax and allow the

physiologic processes to occur without excessive

tension in unrelated muscles. Additional relaxation

techniques for managing stress. The following

guidelines are most effective for the pregnant

woman if consistently practiced in preparation for

labor and delivery.

5 CONCLUSION

Urinary incontinence in the elderly at Gransmed

Hospital before most muscle trainingin the moderate

category, after pelvic floor exercise is in the light

category, so there is

influence of pelvic floor exercise methods in

decreasing urinary incontinence on. Incontinence is

a condition in which there is accidental loss of urine

through the urethral meatus which can result in

social problems and observable hygiene. Pelvic floor

exercises with pelvic floor exercise can improve

urination with less risk. Health workers have an

important role in helping clients with urinary

incontinence to restore the function of the urinary

system. In addition, health workers can control the

activities and eating patterns of respondents.

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