Comparison of the Efectiveness Of Therapy Abdominal Strecthing Exercise

and Watermelon Against Dysmenorrhea

Hasnah1, Harmina2, La Ode Agustino Saputra, Andi Budiyanto Adi Putra
1 and 2
Nursing Program Study of Faculty Medicine and Health Science UIN Alauddin Makassar
Email: 1 hasnah.nur@uin.alauddin.ac.id
Email: 2 harmina0606@gmail.com

Introduction: Dysmenorrhea is lower abdominal pain that is felt just before or during
menstruation. This Dysmenorrhea can disrupt a person's activity and can indirectly affect the
productivity and quality of life. Dysmenorrhea can be resolved with non-pharmacological
therapies, one of that is with Abdominal Stretching Exercise therapy and Watermelon.
Methods: This study by the method of the research a Quasi - Experimental Non - Randomized
Control group pretest – posttest. Conducted in February 2016. Interventions were performed
with abdominal therapy stretching exercise with watermelon for 10 to 15 minutes, pain
intensity measurement using Numeric Rating Scale (NRS) instrument for three days. Analysis
of data using statistical test of t-test. Respondents were 20 people studies, ten people as
intervention group and ten people as control group and collected data by purposive sampling
method. The study was approved by the university ethics committee.
Results : Based on test results obtained statistical p value = 0.004, which means that there are
significant differences dysmenorrhea pre-test to post-test after abdominal stretching exercise
therapy with watermelon.
Conclusion: It can be concluded that treatment with watermelon abdominal stretching
exercise effective against Dysmenorrhea and this therapy could be an alternative for someone
who has Dysmenorrhea.
Keywords: Abdominal Stretching Exercise, Watermelon, Dysmenorrhea.

Introduction
Dysmenorrhea is defined as the flow of menstruation that causes pain and habits causing
painful cramps during menstruation. This cramp may produce uterine pressure over 60 mmHg,
which causes pain (Nages, et al, 2017). Occurs on the first day to several days during
menstruation. Dysmenorrhea that often occurs is functional dysmenorrhea (fair) that occurs on
the first day or before the first day due to the emphasis on the cervical canal (cervix). Usually
dysmenorrhea will disappear or improve over the next day of menstruation. Nonfunctional
(abnormal) dysmenorrhea causes severe pain that is felt continuously both before, during
menstruation, even afterwards. If this happens, the most commonly suspected cause is
endometriosis or ovarian cysts (Kurniawati, 2011). Menstruation is a normal periodic bleeding
of the uterus and is a physiological function that occurs only in women. Menstruation usually
begins between the ages of ten to 16, depending on various factors, namely women's health,
nutritional status and body weight to height (Benson, 2009).
 A systematic review reported that 75% of adolescents experience dysmenorrhea (Harlow,
2004). The prevalence of dysmenorrhea is between 74% to 86.1% in Iran (Shahr and Hossaini,
2012). Sustainable research in 2008 showed the prevalence of dysmenorrhea in Indonesia of
64.25 percent consisting of 54.89 percent primary dysmenorrhea and 9.36 percent secondary
dysmenorrhea. According to the MOH in 2010, the prevalence rate of menstrual pain in
Indonesia is around 55 percent in productive age (Shinta, 2014).
There is no exact number of dysmenorrhea prevalence in South Sulawesi. However, from
the case analysis conducted by Susanto in 2008 in Makassar City from 997 adolescent girls
who became respondents, there were 93.8 percent of them experienced primary dysmenorrhea.
From the results of research conducted by Andi in 2012, 40 respondents found that 65 percent
of respondents experienced dysmenorrhea with different levels of pain. Respondents with
dysmenorrhea who felt mild pain 57.7 percent, moderate pain 38.5 percent and severe pain of
3.8 percent. This shows the high prevalence of dysmenorrhea occurrence in South Sulawesi
(Utami, 2012).
Currently, various ways of treatment, both pharmacology and non pharmacology have
been studied to overcome dysmenorrhea. Non-pharmacological management is safer to use
because it does not cause side effects like drugs. Non pharmacological treatments that can be
performed such as warm compresses, massage, distraction, physical exercise (exercise),
adequate sleep, low-salt diet, and increased use of natural diuretics such as soup leaves and
watermelon (Bobak, 2005).
Based on the data of nursing student of UIN Alauddin Makassar force of 2012 a number
of 91 people, where there are 78 women and 13 men. Based on the results of observations and
interviews of researchers, it was found that most students during menstruation have
dysmenorrhea. The purpose of this study was to determine the effectiveness of abdominal
therapy stretching exercise with watermelon on dysmenorrhea in nursing students of UIN
Alauddin Makassar.
Methods
This study used Quasi Experimental method with nonrandomized control group pretest-
post test approach with 20 samples, ten intervention group and ten control group, sample
selection using purposive sampling technique. The variables in this study consisted of
dependent variable in the form of dysmenorrhea and independent variable in the form of
abdominal therapy stretching exercise with watermelon. The research instrument uses
Numeric Rating Scale (NRS). This research was conducted at the Faculty of Medicine and
Health Sciences UIN Alauddin Makassar for 1 month. Interventions were performed by giving
abdominal therapy stretching exercise with watermelon for 10 to 15 minutes. The study was
approved by a faculty-level ethical committee.
The inclusion criteria include: clients with dysmenorrhea, clients aged 18 to 25 years,
clients with mild to severe dysmenorrhea intensity, cooperative clients and in a compositional
state, clients willing to follow the research procedure, clients willing to be respondents. While
the exclusion criteria, clients who have dysmenorrhea but are accompanied by other diseases
(secondary dysmenorrhea) such as uterine infection, cysts or polyps, tumors or abnormal
abnormalities of the uterus, clients who use anti-pain medications in the treatment of
dysmenorrhea.
In this study the treatment group was given abdominal stretching exercise with three days
of watermelon, while the control group was given only three days of abdominal stretching
exercise. On the first day of menstruation pain intensity measurement using Numeric Rating
Scale (NRS) instrument. The treatment group was then given abdominal stretching exercise
therapy with watermelon, then again performed pain intensity measurement using Numeric
Rating Scale (NRS) instrument for three consecutive days at 07.00 until 10.00 AM. While in
the control group, the measurement of pain intensity using Numeric Rating Scale (NRS)
instrument on the first day of the day, then given abdominal stretching exercise therapy, then
again performed pain intensity measurement using Numeric Rating Scale (NRS) instrument
for three consecutive days at 07.00 to 10.00 AM.
Data processing by using statistical software with Wilcoxon t-test. The result of data
processing are presented into the frequency and distribution tables and explanation in narrative
form.

Results
Table 1. Distribution of Pain Intensity Before Abdominal Therapy Stretching Exercise
and Watermelon (Pre-Test) in Intervention and Control Group

Pain Intensity Pre Group of Respondents

Total
Intervention Intervention Groups Control Groups
F % F % F %
No pain 0 0 0 0 0 0
Mild pain 2 10 1 5 3 15
Medium pain 8 40 9 45 17 85
Severe pain 0 0 0 0 0 0
Very severe pain 0 0 0 0 0 0
Amount 10 50 10 50 20 100

Table 2. Distribution of Pain Intensity After Abdominal Therapy Stretching Exercise

and Watermelon (Post-Test) in the Intervention and Control Group

Pain Intensity Post Group of Respondents

Total
Intervention Intervention Groups Control Groups
F % F % F %
No pain 7 35 2 10 9 45
Mild pain 2 10 6 30 8 40
Medium pain 1 5 2 10 3 15
Severe pain 0 0 0 0 0 0
Very severe pain 0 0 0 0 0 0
Amount 10 50 10 50 20 100
 Table 3. Comparison Test Result of Pain Intensity of Pre-Test and Post-Test in Intervention
Group (Wilcoxon Test)

Intervention
Groups N Mean SD Std.Error Mean p
Pre Test 10 3, 80 0,422 .133 0,004

Post Test 10 1, 40 0,699 .221

Table 4. Comparison Test Result of Pain Intensity of Pre-Test and Post-Test in Control Group
(Wilcoxon Test)

Control Groups N Mean SD Std.Error Mean p

Pre Test 10 3,90 0,316 .100 0,004

Post Test 10 2,00 0,667 .211

Based on table 1 above shows that students who experience mild pain on intervention
group as many as two students or 10 percent and moderate pain as many as eight students or
40 percent. While in the control group, student who experienced mild pain as much as one
student or 5 percent and moderate pain as many as nine students or 45 percent and no one had
severe pain either in the treatment group or in the control group.
Based on table 2 above shows that the intensity of student pain after abdominal therapy
stretching exercise and watermelon in the intervention group as many as seven students or 35
percent did not experience pain, two students or 10 percent with mild pain and one student or
5 percent with moderate pain. While the pain intensity in the control group as much as two
students or 10 percent did not experience pain, six students or 30 percent had mild pain and as
many as two students or 10 percent had moderate pain.
Based on table 3 with statistical tests using Wilcoxon Test, the pretest and posttest of the
intervention groups obtained p = 0.004 or p <0.05 means there was a significant difference in
pain intensity in pretest intervention group between posttest intervention group.
Based on table 4 with statistical test using Wilcoxon Test on pretest and posttest control
group obtained p = 0,004 or p <0,05 mean there was significant difference of pain intensity at
pretest of control group with post test of control group.
After data processing and quantitative test results using statistical test Wilcoxon Test
obtained p value = 0.004 or p <0.05 then interpreted that there is a significant difference
between the intensity of pain before and after abdominal therapy stretching exercise with
watermelon in the intervention group. So abdominal therapy stretching exercise with
watermelon is effective to decrease the intensity of menstrual pain in the nursing students of
UIN Alauddin Makassar.
 The results of this study are also in line with Wong's opinion, et al (2002) who stated such
exercises as moving the pelvis, with the knee to the chest, and breathing exercises can be
useful for reducing dysmenorrhea pains (Ningsih, 2011).

Discussion
Exercise is one of the non pharmacological management that has been safe to use because
it uses physiological process (Ningsih, 2011). By doing exercise, the body will produce
endorphins. Endorphins are produced in the brain and spinal cord. This hormone serves as a
natural sedative, so it gives a sense of comfort. Increased levels of endorphins in the body can
relieve pain during contractions. Exercise / physical exercise proved to increase levels of
endorphins four to five times in the blood, so the more exercise will be the higher endorphin
levels. When an individual exercises, the endorphins will be produced in the brain by the
pituitary gland. Increased endorphins are shown to be closely related to decreased pain,
increased memory, improved appetite, sexual ability, blood pressure and breathing. So
physical exercise can be effective in reducing pain problems, especially dysmenorrhea pain.
Physical exercise is a physical activity to make the body improve its health and maintain
physical health (Ningsih, 2011). Physical exercise has a significant relationship with decreased
levels of muscle fatigue. Adolescents with dysmenorrhea will experience muscle cramps,
especially in the cervical lower abdomen cyclically caused by strong and long contractions of
the uterine wall resulting in muscle fatigue and physical inactivity, then exercise is necessary
to remove the muscle cramps. This means that by exercising will reduce fatigue / muscle
fatigue, especially in the lower abdomen, so the intensity of pain can be decreased.
Another opinion suggests that exercise performed during dysmenorrhea to increase
muscle strength, endurance and muscle flexibility can improve fitness, optimize capture,
improve mental and physical relaxation, promote awareness, reduce muscle tension (cramp),
reduce muscle pain, reducing pain during dysmenorrhea, improving blood circulation,
reducing anxiety, feeling depressed and making feelings better. So, exercise is expected to
reduce menstrual pain (dismenorrhea) in women.
Abdominal stretching exercise is a movement that is believed to reduce and eliminate
dysmenorrhea. Abdominal stretching exercise performed for 10 to 15 minutes for three
consecutive times when pain begins to be felt, can relax the uterine muscles and increase
blood perfusion to the uterus, so there is no anaerobic metabolism that produces lactic acid.
This results in a pain impulse received by Type C fibers being inadequate. As a result, the p
substance expenditure is inhibited, so the gate substansia gelantinosa (SG Gate) is closed and
there is no or decreased information on pain intensity perceived to the cerebral cortex (Utami,
2014).
The calories of watermelon is very low, so watermelon can be function as a diuretic
(Prajnanta, 2003). The use of natural diuretics is expected with frequently urination, then the
body will respond to the balance of body fluids. In addition, diuretics also have the effect of
relaxing the muscles so the abdominal cramp during menstruation becomes weak. Watermelon
is one of the fruits recommended by Prophet Muhammad SAW to be consumed. This fruit is
called to have a number of benefits for the health of the body. Rasulullah SAW said:

ْ‫اْوبَردَْ َهذَا‬ ِ ‫ب ْفَيَقُو ُل ْنَك‬

َ َ‫س ُر ْح هَر ْ َهذَاْبِبَر ِد ْ َهذ‬ َ ْ‫سله َم ْيَأ ُك ُل ْالبِ ِطي َخ ْبِالر‬
ِ ‫ط‬ َ ‫علَي ِه‬
َ ‫ْو‬ ‫صله ه‬
َ ْ ُ‫ىَّْللا‬ َ ْ ِ‫َّْللا‬
‫سو ُل ه‬ َ َ‫َّْللا ُ ْعَنهَاْقَالَت ْكَان‬
ُ ‫ْر‬ َ َ‫عَنْ ْعَائِشَة‬
‫ْر ِض َي ه‬
‫بِح َِرْ َهذَا‬
Meaning:
From Aisyah, she said: Rasulullah SAW ever ate watermelon with freshly ripe dates. He then
said, "We crushed (reduced) the heat of this food with the coldness of this food and we
crushed the coldness of this food with the heat of this food " (hadith history by Abu Daud).

It means, dates are tend to be hot while watermelons are tend to be cold, and will
correspond to each other. In addition it will neutralize the danger between the two. To
neutralize the effects of foods that tend to be hot, done with cold substance and otherwise or
dry foods with moist food and also otherwise. This step will produce a softer substance, which
is also considered to be one method of treatment and the best prevention. So depart from the
theory of element balancing, can be found the basis of the eating habits of the Messenger of
Allah (Al-Jauziah, 2007).

Conclusions
Abdominal stretching exercise therapy by watermelon is effective to against dysmenorrhea
at nursing students of UIN Alauddin Makassar with p value = 0,004 (p<0,05). So this therapy
can be one alternative for someone who has dysmenorrhea, because this therapy is very easy
to do and can be done independently by the patient. For further researchers who want to
investigate more, about the effectiveness of abdominal therapy stretching exercise with
watermelon, this research can be used as a basis, by using a larger sample and sampling
techniques with probability sampling, that is simple random sampling.

Acknowledgements
We would like to thank for the students participation in the research. Hasnah and Harmina
as the researchers. La Ode Agustino Saputra as a translator. Andi Budiyanto Adi Putra as a
submitter.

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