요실금 여성의 질회음 근육운동 효과

Abstract

[한글]

본 연구는 여성의 긴장성 요실금을 질회음 근육운동으로 조절할 수 있는지 검증하고자 시도하였다. 또한 간호사들이 간호현장에서 질회음 근육운동의 효과를 측정할 수 있는 방법을 제시하고자 본 연구를 시도하였다.

연구설계는 비등질 대조군 사전-사후 조사의 유사실험 설계였다. 연구기간은 1993년 7월 15일부터 10월 15일까지 였으며, 대상자는 광주시와 전남지역 도시에 거주하는 긴장성 요실금 증상을 가진 여성으로 실험군 21명, 대조군 24명을 연령별로 배합하여 무작위 할

당하였다. 사전조사로는 건강사정, 긴장성 요실금 정도의 주관적 측정과 객관적 측정(수지 측정, 압력계 측정)을 하였다. 실험처치는 연구자가 개발한 질회음 근육운동을 녹음테이프의 지시에 따라 6주 동안 가정에서 실시하였다. 사후조사는 사전조사와 동일하게 측정하였다.

실험 효과의 사전-사후 측정을 위하여 본 연구자가 수정 보완한 Hendrickson(1981)의 긴장성 요실금 측정도구, Worth, Dougherty와 Mckey(1986)의 질회음근육 탄력성 측정도구, 질회음근육 수축압을 측정하는 전자 monitor를 사용하였다. 자료분석은 실험군 대조군

의 일반적, 신체적, 산과적, 요실금관련 특성의 유사성을 분석하기 위하여 x**2 검증과 t검증을 하였다. 질회음 근육운동 전-후 긴장성 요실금 상황점수, 수지 측정한 질회음근육 탄력성 점수 및 압력계 측정한 질회음근육의 평균 질수축압과 최정점 질수축압은 각각 t검증을 하였고, 요실금 양과 요실금 빈도의 변화는 Wilcoxon rank sum 검증으로 분석하였다.

연구결과는 다음과 같다.

1) 긴장성 요실금 여성의 요실금 상황점수는 0-60점 범위 중 23.5점으로 중등도의 요실금 상황점수였다.

2) 긴장성 요실금 여성의 질회음근육 탄력성을 수지 측정한 탄력성 점수는 1-12점 범위 중에서 평균 9.5점으로 중간 정도였다.

3) 긴장성 요실금 여성의 질회음 근육기능을 압력계 측정한 평균 질수축압은 20.5mmHg, 최정점 질수축압은 29.1mmHg로 비교적 낮았다.

4) 실험군과 대조군의 일반적, 산과적, 신체적 특성은 통계적으로 차이가 없는 집단이었고, 질회음 근육운동전 요실금 양, 질회음근육 탄력성 점수, 최정점 질수축압도 두 군간에 유의한 차이가 없었다.

5) 제 1가설, "긴장성 요실금 여성 중 질회음 근육운동을 실시한 여성과 실시하지 않은 여성은 요실금 상태에 차이가 있을 것이다"는 요실금 빈도는 낮아졌으나 유의한 차이는 아니었고, 요실금 양은 유의하게 감소하여 부분적으로 지지되었다(요실금 빈도 Z=0.899,

p>.05 : 요실금 양 Z=-4.518, p<.0001) .

6) 제 2가설, "긴장성 요실금 여성 중 질회음 근육운동을 실시한 여성은 실시하지 않은 여성보다 요실금 상황점수가 낮을 것이다"는 지지되었다(주관적 요실금 상황점수 t=-9.681, p<.0001).

7) 제 3가설, "긴장성 요실금 여성 중 질회음 근육운동을 실시한 여성은 실시하지 않은 여성보다 질회음근육 수축압이 높을 것이다"는 지지되었다(평균 질수축압 t=-2.173, p<.005: 최정점 질수축압 t=-6.767, p<.0001).

8) 제 4가설, "긴장성 요실금 여성 중 질회음 근육운동을 실시한 여성은 실시하지 않은 여성보다 질회음근육의 탄력성 점수가 높을 것이다"는 지지되었다(질회음근육 탄력성 점수 t=4.226, p<.0001).

9) 요실금 여성의 질회음 근육운동 효과는 요실금 조절뿐만 아니라 쾌정서, 안녕감, 성 만족의 증진을 나타냈다. 그 외에 질회음 근육운동 과정동안 남편의 지지가 유발되었으며. 대상자는 환자역할 이외에 요실금이 있는 친구나 친지에게 운동은 직접 교육하거나

권장하는 조력자 역할도 나타냈다.

10) 여성의 요실금 조절을 위한 운동방법은 누운 자세로 질회음 근육만을 10초씩 최대로 수축하고 이완하는 운동을 녹음테이프의 지시에 따라 가정에서 매주 3일 이상 실시하는 것이다. 운동횟수는 첫 주에 9회부터 시작하며, 매주마다 5회씩 증가하여 최소한 6주간 운동하고 최대 운동시간은 준비운동을 포함하여 25분이었다.

이상의 연구결과를 종합해보면 긴장성 요실금 여성은 질회음 근육운동을 실시한 후 요실금 양과 요실금 상황점수가 감소되었고, 질회음 근육기능이 증진되어 평균 질수축압과 최정점 질수축압이 상승되고, 질회음근육의 탄력성이 높아졌으므로 질회음 근육운동은 여

성의 긴장성 요실금 조절을 위한 효과적인 간호중재임이 검증되었다. 또한 긴장성 요실금 여성의 질회음 근육운동 효과를 검증하는 측정변수들 간에는 유의한 상관관계를 나타냈다. 그러므로 전자 모니터가 없는 간호현장에서도 주관적 측정이나 수지 측정으로 요실금

정도와 질회음근육의 탄력성을 측정할 수 있고, 질회음근육 운동이 요실금에 미치는 효과를 평가할 수 있다고 해석된다. 따라서 본 연구결과는 여성의 요실금 문제 해결을 위한 간호방법으로써 질회음 근육운동 활용의 타당성을 제시했다고 본다.

Effects of Circumvaginal Muscle Exercise in Stress Incontinence Women

Lee, Young-Sook

Department of Nursing, The Graduate School, Yonsei University

(Directed by Professor Choi, Yun-Soon Ph Ed.)

Weak circumvaginal muscle(CVM) is associated wi th urinary stress incontinence

that may occur after childbirth. The effect of CVM exercises to control stress

incontinence has not been investigated by currently accepted research methods, nor

have appropriate instruments and techniques to carry out such investigation been

available. The purpose of this research was to study the effect of CVM exercise on

stress incontinence and to test three different methods of CVM function after CVM

exercises. The research tools used were a modified Hendrickson's stress

incontinence questionnare, a CVM rating scale and a pressure sensitive intravaginal

balloon device, This research was conducted in Korea in Kwangju-City and in the

Chonnam Province from 15th July to 12th October, 1993.

The research used a non-equivalent control pre-post test quasi-experimental

design. Forty-five healthy married female volunteers wi th stress incontinence,

aged 30-58, and were randomly by age using the matching fixed-length blocks. An

experimental group consisted of 21 women who assigned to a 25-minute per day CVM

home exercise program for six weeks. There was a control group of 21 women without

CVM home exercises. The CVM home exercise was adopted by the reseacher from

Dougherty(1989a ).

Data were analyzed by X**2 test, Wilcoxon rank sum test, t-test, Spearman

product-moment correlation using SAS/PC**+.

The results were summarized as follows :

1. There were no significant differences in the characteristics of the subjects

between the experimental and control groups before CVM home exercises

2. Hypothesis 1 that women having stress incontinence who participated in CVM

home exercises have less the stress incontinece(Sl) on the CVM function than in

those who did not participate in home exercise was partly supported( sujective

frequency of SI, z=0.899, p>.05 : subjective amount of SI(Z=-4.518, p<.0001).

3. Hypothesis 2 that women having stress incontinence who participated in CVM

home exercises will have lower stress incontninece score(SIS) on the CVM function

than in those who did not participate in home exercises was supported (subject SIS,

t=-9.681 P<.0001).

4. Hypothesis 3 that women having stress incontinence who participated in CVM

home exercises will have hi호er vaginal pressure on the CVM function than in those

who did not participate in home exercises was supported (mean maximum pressure,

t=-2.173 P<.005 : peak maximum pressure, t=-6.767 p<.0001)

5. Hypothesis 4 that woven having stress incontinence who participated in CVM

home exercise will have higher CVM rating scale total score on the CVM function

than in those who did not participate in home exercises was supported( CVM rating

scale total score, t=4.226 P<.0001).

6. There will be a significant correlation between the results measured by the

subjective , pressure and digital methods on the CVM function after home exercises.

(sujective SIS and mean maximum pressure, r=-0.579, p<.0001 : sujective SIS and

peak maximum pressure, r=-0.587, p<.0001 : subjective SIS and CVM rating scale

total, r=-0.574, p<.0001 : CVM rating scale total & mean maximum pressure r=0.427,

p<.005 : CVM rating scale total & peak maximum pressure r=0.452, p<.005) .

A six weeds CVM home exercise program using a tape recording showed that CVM can

be improved. Results of this study with women having stress incontinence who

exercise on a regular basis for six weeks decrease their symptoms and increase the

mean maximum pressure and peak maximum pressure(tested by electronic monitor), and

CVM rating scale total score(measured by digital palpation) of CVM function. There

was a significant difference in results from the subjective, digital and pressure

measuring methods on the CVM function after home exercises. Also, a statistically

significant correlation was noted between the results measured by three different

methods on the CVM function after CVH exercises.

In conclusion, the CVM exercise is effective in restoring function and relieving

CVM stress incontinence symptoms. The digital and subjective measurements of CVM

function can be easily applied to prevention, detection and to control of stress

incontinence for women in all nursing areas without using the electronic monitor.

[영문]

Weak circumvaginal muscle(CVM) is associated wi th urinary stress incontinence that may occur after childbirth. The effect of CVM exercises to control stress incontinence has not been investigated by currently accepted research methods, nor have appropriate instruments and techniques to carry out such investigation been available. The purpose of this research was to study the effect of CVM exercise on stress incontinence and to test three different methods of CVM function after CVM exercises. The research tools used were a modified Hendrickson's stress

incontinence questionnare, a CVM rating scale and a pressure sensitive intravaginal balloon device, This research was conducted in Korea in Kwangju-City and in the Chonnam Province from 15th July to 12th October, 1993.

The research used a non-equivalent control pre-post test quasi-experimental design. Forty-five healthy married female volunteers wi th stress incontinence, aged 30-58, and were randomly by age using the matching fixed-length blocks. An experimental group consisted of 21 women who assigned to a 25-minute per day CVM

home exercise program for six weeks. There was a control group of 21 women without CVM home exercises. The CVM home exercise was adopted by the reseacher from Dougherty(1989a ).

Data were analyzed by X**2 test, Wilcoxon rank sum test, t-test, Spearman product-moment correlation using SAS/PC**+.

The results were summarized as follows :

1. There were no significant differences in the characteristics of the subjects between the experimental and control groups before CVM home exercises

2. Hypothesis 1 that women having stress incontinence who participated in CVM home exercises have less the stress incontinece(Sl) on the CVM function than in those who did not participate in home exercise was partly supported( sujective

frequency of SI, z=0.899, p>.05 : subjective amount of SI(Z=-4.518, p<.0001).

3. Hypothesis 2 that women having stress incontinence who participated in CVM home exercises will have lower stress incontninece score(SIS) on the CVM function than in those who did not participate in home exercises was supported (subject SIS,

t=-9.681 P<.0001).

4. Hypothesis 3 that women having stress incontinence who participated in CVM home exercises will have hi호er vaginal pressure on the CVM function than in those who did not participate in home exercises was supported (mean maximum pressure, t=-2.173 P<.005 : peak maximum pressure, t=-6.767 p<.0001)

5. Hypothesis 4 that woven having stress incontinence who participated in CVM home exercise will have higher CVM rating scale total score on the CVM function than in those who did not participate in home exercises was supported( CVM rating scale total score, t=4.226 P<.0001).

6. There will be a significant correlation between the results measured by the subjective , pressure and digital methods on the CVM function after home exercises.

(sujective SIS and mean maximum pressure, r=-0.579, p<.0001 : sujective SIS and peak maximum pressure, r=-0.587, p<.0001 : subjective SIS and CVM rating scale total, r=-0.574, p<.0001 : CVM rating scale total & mean maximum pressure r=0.427, p<.005 : CVM rating scale total & peak maximum pressure r=0.452, p<.005) .

A six weeds CVM home exercise program using a tape recording showed that CVM can be improved. Results of this study with women having stress incontinence who exercise on a regular basis for six weeks decrease their symptoms and increase the mean maximum pressure and peak maximum pressure(tested by electronic monitor), and CVM rating scale total score(measured by digital palpation) of CVM function. There was a significant difference in results from the subjective, digital and pressure measuring methods on the CVM function after home exercises. Also, a statistically

significant correlation was noted between the results measured by three different methods on the CVM function after CVH exercises.

In conclusion, the CVM exercise is effective in restoring function and relieving CVM stress incontinence symptoms. The digital and subjective measurements of CVM function can be easily applied to prevention, detection and to control of stress

incontinence for women in all nursing areas without using the electronic monitor.