Whilst self-care programme involving comprehensive lifestyle plans including  physical and behavioural interventions have reported  positive outcomes for the aged suffering from urinary incontinence (UI), very few programmes have been implemented amongst Iranian nursing home residents, particularly in men. 
 The aim of this study was to examine the effect of a self-care programme on UI and self-esteem in elderly men dwelling in nursing homes in Iran.

Sixty-one elderly men (aged 60 to 75 years of age), at two different  sites and living in nursing homes in the west of Iran, suffering from urinary incontinence were included in this study.  were selected using convenience sampling and based on selected and randomized criteria were divided into two groups, experimental group (n=30) and control group (n=31). Inclusion criteria included; male residents aged between 60 and-75 years of age, a UI score of ≥ 3, clinical symptoms of UI for the last six months and willing to participate in the study. Exclusion criteria included; Female residents, residents with serious psychological disorders and cognitive impairment, lower urinary system malignancy and those who had not participated in more than 2 sessions of self-care program.  Data collection tools included Mini-Mental State Examination (MMSE), Rosenberg Self-Esteem Scale Questionnaire (RSES), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and demographic information form. 
The intervention for the experimental group included eight 45 to 60-minute sessions during an eight week period . Each session was held once a week and patients were visited every other day by the research team. In each session, first, light strengthening exercises and the pelvic floor exercise encompassing 5-second contractions were performed, followed by 10 seconds of rest with a frequency of 60 times per day. In addition, training was provided, by way of lectures, discussing in groups, and role-play, on ways to improve UI and the role of behavioural and lifestyle factors in the health of the urinary system. 
The study proposal was approved by the regional ethics committee of ..... University of Medical Sciences. All patients who participated in the study provided informed consent.
Data were analyzed using SPSS vesion18.

There was a statistically significant decrease in the mean scores of UI severity in the experimental compared to both baseline and the control group at 12 weeks (P<0.001 and P<0.001 respectively), (table 3). There was also a significant increase in the experimental group self-esteem scores versus baseline and versus the control group at 12 weeks (P<0.001 and P<0.001, respectively). ).  
Table ... shows severity of UI based on ICIQ- SF categories in both experiment and control groups at the baseline and 12 weeks. The majority of participants in the experimental and control group had severe UI at the baseline. However, there was a statistically significant separation between these two groups at week 12 whereby and most of the participant in the experiment group had moderate UI.

This study sought to examine the effect of a self-care programme on both UI and self-esteem in elderly men dwelling in nursing homes in the west of Iran.  A number of studies suggest a higher prevalence of UI among elderly women than that of men. Consistent with our findings, Jahromi et al., (2013) in Iran and Jacomo et al., (2014) in Brazil, also report positive effects of pelvic floor exercise on UI and self-esteem in elderly women. Tennstedt et al., (2010) in Spain also examined the relationship between UI with self-esteem and quality of life and found that as the severity of UI increases, self-esteem and quality of life decreases significantly. Our findings also indicate that the self-care programme was effective in decreasing the severity of UI symptoms. The effect of non-pharmacological interventions including conservative interventions and exercise on UI has been investigated in clinical studies previously. Interventions such as proper nutrition, prevention of constipation, weight loss and physical activity have been specified as ways to improve UI symptoms. Most of the participants within this study reported that they felt embarrassed about their UI problems and were not comfortable discussing their UI symptoms before this intervention. The intervention was provided mainly in groups with the elderly men themselves playing a role in the provision of education. This method of training allowed them to share their experiences and increased social participation. Given that older people living in nursing homes experience more social isolation than their community dwelling counterparts, such interventions, in addition to positive effects on the elder physical health, also improve self-esteem, quality of life and motivation for positive changes.

The findings of this study revealed that the self-care programme was effective in improving UI among elderly men living in nursing homes with limited resources for management and treatment of urinary tract disorders. The UI self-care programme was effectively implemented in nursing homes with male residents. Nursing homes in Iran usually have limited financial and specialist resources. Such interventions in these care settings may have many benefits for the elderly suffering from chronic conditions such as UI and also have benefits on their self-esteem and therefore impact positively on their quality of life.

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