Ukuguqulwa kwezinto zokuphila, ama-pessaries, kanye nokuhlinzwa kukhona ongakhetha kukho ukwelashwa.
Uma ingxenye yomzimba ishiya isikhundla noma ivela endaweni, le donsi ibizwa ngokuthi i- prolapse . I-spelvic organ organ prolapse ibhekisela ekudluleleni kwezitho zomzimba. Faka enye indlela, i-prolapse ye-pelvic organ is a hernia yezitho zomzimba-ikakhulukazi isisu-ngokuvula kwesisu. Isibonakaliso esicacile kakhulu se-prolapse yesikhumba se-pelvic sinomuzwa wokuthi "into ephuma" -isiswini.
Kuyaqondakala ukuthi ukuba ne-hernia esiswini sakho kungabangela ukucindezeleka futhi kuthinte isithombe somzimba, umsebenzi wezocansi, kanye nekhwalithi yokuphila. Ngenhlanhla, nakuba kunezinga elithile le-prolapse elikhona phakathi kwamaphesenti angu-41 namaphesenti angu-50 kubo bonke abesifazane, amaphesenti amathathu kuphela abika izimpawu, futhi abaningi balaba besifazane abadingi ukwelashwa. Kulabo besifazane abadinga ukwelashwa, umzimba we-pelvic umzimba, ama-pessaries, kanye nokuhlinzwa yizo zonke izinketho ezikhona.
Anatomy
I- vagina ilele ngokuzungezile ngaphesheya kwezilwane ze-lever. Imisipha ye-levator ani ingxenye yayo ihlanganisa imisipha ye-pelvic, eyenza ukuthungatha noma ukugubha isikhumba esikhwameni. Kulaba besifazane, lesi slingiso sithinta isibeletho, isisu, isilonda, nezinye izitho zomzimba zesikhumba ukuze konke kusebenze ngendlela efanele. Ukulimala noma ubuthakathaka emisipha ye-pelvic kungaba "ukwehla" izitho zomzimba ezithombeni.
Kumele kuqashelwe ukuthi imbangela ye-prolapse ye-pelvic organ ngokuvamile ivela ngenxa yezici eziningi, ngokulimala esiteji se-pelvic kuyiyona engcono kakhulu.
Kwesinye isifundo se-MRI, kuboniswe ukuthi abesifazane ababenesitho socansi bawela ngaphansi kwekhilomitha eyodwa yezinga le-hymen kwakunezikhathi ezingu-7.3 ngaphezulu zokulimala izithunjwa ze-levator uma kuqhathaniswa nabesifazane abangenayo i-prolapse.
Kunezinhlobo ezahlukene zezinsikazi zesisu:
- I-prolapse ekhoneni langaphakathi lomugqa (udonga olungaphambili lwesisu) li- cystocele , noma i-herniation yesigqila ngaphakathi kwesiswini. Lesi sahluko sinengqondo ngoba isilonda sinama phambi kwesifazane.
- I-cystocele ingahambisana ne- urethrocele , okuyi-sagging of the urethra, umzila lapho umchamo uphonswa khona.
- I- Herniation emdongeni ongasese we- vaginal (ubude obusemuva wesifazane) ngokuvamile ukubuyisela emuva , noma ukugcoba kwe-rectum ngaphakathi kwesiswini. Lesi sahluko sinengqondo, futhi, ngoba i-rectum itholakala ngemuva kwesifazane.
- Ukulahlekelwa ukusekelwa kwe-pelvic esiphezulu, noma phezulu, kwesiswini (eduze komlomo wesibeletho) kungaholela ekutheni i- enterocele , noma i-hernia yesiguli esincane singene emzimbeni. Ngokuvamile, i-enteroceles yiyona kuphela "i-hernia" ye-hernia kuphela phakathi kokuphindaphindiwe okuhlukile kwe-prolapse yomzimba we-pelvic.
- Ukulahlekelwa ukwesekwa emithanjeni emikhulu yesibeletho (okungukuthi, izigulane zamakhadiyali noma i-uterosacral) kungaholela ekutheni i-uterine prolapse, noma i-hernia yesisu esiswini. Imigqa emikhulu yesibeletho ibamba isibeletho endaweni.
Okubaluleke kakhulu, izinhlobo ezimbili noma ezintathu ze-prolapse zingenzeka ndawonye kwabesifazane abane-prolapse organ prolapse. Ukwengeza, i-prolapse ye-pelvic yocingo ngokuvamile iyenzeka nezinye izinkinga zeplasvic . Ngokwesibonelo, amaphesenti angu-37 abesifazane abanesisindo esingasebenzi ngokweqile, amaphesenti angu-40 alaba besifazane agcizelele ukungahambisani nomzimba, kanti amaphesenti angu-50 alaba besifazane abanamahloni.
Izimpawu
Abaningi besifazane abanesifo se-pelvic bangenazo izimpawu.
Ngaphandle kokuqhakaziza kwesiswini, ezinye izimpawu ezivamile ze-prolapse yegciwane lesigungu zihlanganisa okulandelayo:
- Ukukhulula, ukugcwala, ukucindezela, noma ukudonsa esiswini (ukuwohloka ekupheleni kosuku noma ngesikhathi sokunyakaza kwesisu)
- Kunzima ukuchama
- Kunzima ukuvala isikhumba ngokuphelele
- Ubuhlungu ekuchama
- Izinkinga zobulili
- Izifo ezithathelwanayo ze-urinary
- Ukuvuza umchamo ngenkathi ukukhwehlela, ukuzivocavoca noma ukuhleka
- Ukuqokwa
- Ukuhamba ngesitokisi
- Inkinga yokulawula igesi
Okuphawulayo, izimpawu ezithile ezithintekayo zithembele ukuthi yiziphi izitho zomzimba ezitholakala ngaphakathi kwesifazane.
Isibonelo, i-cystoceles, ebizwa ngokuthi isisu, ibangela izimpawu zamanzi.
Esihlokweni se-2017 esibizwa ngokuthi "I-Pelvic Organ Prolapse," u-Iglesia noSmithling bathi lokhu okulandelayo:
Isifo se-spelvic prolapse sishukumisayo, futhi izimpawu nokuhlolwa okuhlolwayo kungashintsha usuku nosuku, noma kungakapheli usuku kuye ngokuthi izinga lomsebenzi nokugcwala kwesisu nesigubhu. Ukuma, ukuphakamisa, ukukhwehlela, nokuzikhandla ngokomzimba, yize kungekho izici ze-causal, kungandisa ukwanda nokungahambi kahle.
Ukunyakaza okukhulu, noma izinyathelo ezithatha ngaphandle komgudu wamanzi wesisu, zingaholela ekukhuliseni noma ukucinwa kwesisu ngaphakathi kwe-vaginal mucosa.
Izimo ezimbi zokwehla zivamile. Ngokusho kwe -Geriatric Medicine kanye ne-Gerontology :
Kwezinye izimo, abesifazane abane-cystoceles enkulu bangase babike ukuthi kufanele bafake iminwe yabo emaseni ukuze baphakamise izicubu ukuze baqondise urethra ukuze baguqule. Naphezu kwalokhu, ukuvinjelwa kwezinga eliphezulu kwabesifazane akuvamile, futhi ukuthuthuka kokulimala okukhulu nge-hydronephrosis nokuntuleka kwengqondo akuvamile.
Ukuhlolwa Kwemvelo
Ukuhlolwa komzimba kubalulekile ukuze uhlolisise kahle i-prolapse ye-pelvic organ. Ukuhlola okubonakalayo kwesifazane ngesidakamizwa ngokuvamile akwanele ukuxilonga lesi simo. Esikhundleni salokho, i- OB-GYN izosebenzisa i-speculum eyodwa-blade ukuze iphakanyise udonga lwangaphakathi lomzimba noma iphoqe udonga olusemva lwendoda ukuze kuqinisekiswe ukuthi i-pathology. Ngesikhathi sokuhlolwa, udokotela wakho angase akucele ukuthi ukhwehlela noma uhlwitha (Valsalva) ukuze ubheke kahle ukuthi i-prolapse iyini. Ngaphezu kwalokho, ungase uceliwe ukuba ume phakathi nokuhlolwa kokuboniswa kangcono kwezinhlobo ezithile ze-prolapse.
Nazi ezinye izinto i-OB-GYN ehlola ngesikhathi sokuhlolwa komzimba we-prolapse yegciwane lesitho:
- Inqwaba yama-vaginal
- Ama-mucosal abrasions noma izilonda
- I-degrees of desccent (isibonelo, ngaphesheya kwesiphakathi kwendoda noma ngaphesheya kokungena kwesifazane)
- Ukusekela nokuhamba komlomo wesibeletho nesisu
- Ukusekela nokuhamba kwe-urethra nentamo yesinye
- Izifundo ze-Urine (isb., Ukuthunyelwa kwevolumu yokusala kanye nokuhlungwa kwe-urinalysis)
Izingozi Nezikhathi Zengozi
Ngesikhathi sokubeletha, imisipha ye-levator ani ingakwazi ukwelula amaphesenti angaphezu kuka-200 kunesivimbela ukulimala okulula, okwenza ukubeletha kwesisu kuyingxenye enkulu yengozi ekuthuthukiseni i-prolapse ye-pelvic organ. Abesifazane abanalesi simo bavame ukuletha abantwana abangaphezu kweyodwa. Ezinye izinto eziyingozi zihlanganisa lokhu okulandelayo:
- I-Genetic predisposition
- Ngaphambi kokuhlinzekwa kwe-pelvic
- Ukukhuluphala
- Ukucindezeleka okungapheli (okungukuthi, ukunyuka kwengcindezi yangaphakathi kwesisu) kwesinye isikhathi sokuqothulwa noma ukukhwehlela
- Hysterectomy
- Ukubhema
- Ikhwalithi yezintiti ezimbi
Nakuba abesifazane kunanoma isiphi isikhathi bengakwazi ukuhlakulela i-prolapse yegciwane lesitho, lesi simo ngokuvamile sithinta abesifazane asebekhulile. Kubesifazane abaneminyaka engama-60 no-69 ubudala ubudala, ukusabalala kwalesi simo kungamaphesenti amahlanu.
Encwadini ehlobene, idatha elinganiselwe ibonisa ukuthi i-prolapse yegciwane lesigungu iyaqhubeka kuze kube yilapho sekuya esikhathini sokuya esikhathini , futhi ngemuva kokumiswa kwesikhathi lesi simo asiqhubeki noma sibuyele phambili. Ngaphezu kwalokho, imiphumela evela ocwaningweni olulodwa ibonisa ukuthi abesifazane abakhuluphele cishe banokuthuthuka okuphuthumayo, futhi ukulahlekelwa isisindo akusho ukuguqula le nhlekelele.
Ukwelapha
Ukwelashwa kwe-prolapse ye-pelvic organ kuncike ezintweni eziningana, kufaka phakathi ubudala, isifiso sokukhulelwa, ukuya esikhathini nokulala.
Ezimweni ezinzima zalesi simo, ukuguqula indlela yokuphila kungasiza ngezimpawu, kufaka phakathi ukunciphisa isisindo, ukuqeqesha imisipha yomzimba (Ie, Kegel umzimba), ukudla okuphezulu-fibre, nokunciphisa imisebenzi noma ukuphakamisa.
Ama-pessary amadivaysi abekwe ngaphakathi kwesiswini ukuze avuselele isakhiwo esivamile se-pelvic. Basiza ukunciphisa izimpawu ezibangelwa i-prolapse ye-pelvic organ. Cishe amaphesenti angu-67 abesifazane azoqala ukukhetha i-pessary njengendlela yokwelashwa, ngamaphesenti angu-77 aqhubeka esebenzisa le divayisi ngemuva konyaka owodwa.
Ama-pessaries asebenza kwabesifazane abanezilinganiso ezihlukahlukene ze-pelvic organ prolapse-kulabo abanesifo esibucayi nakwezethulo ezingathí sina. Lawa madivayisi anganciphisa ukuqhubeka kwalesi simo futhi abambezele noma aqede isidingo sokuhlinzwa.
Izikhathi zezinyanga zivame ukwenziwa ngamabhilikhi webanga lobuchwepheshe. Ama-pessary angase asekele noma isikhala siphelele. E-United States, i-pessary ye-ring, uhlobo lwe-pessary yokusekela, iyithandwa kakhulu elandelwa yi-space-occuping pessaries njenge-donut pessary noma i-gesshorn pessary. Izindawo zokuchitha isikhala ezidingekayo zendawo zidinga ukugula okuphambili.
Kuze kube manje, kulaba besifazane abane-prolapse organ prolapse, kuvele kuphela ukulingwa okulawulwa ngokungahleliwe okulinganiselwe okuqhathaniswa ne-pessary ye-ring ne-Gesshorn pessary (uhlobo lwe-pessary ye-space) futhi bobabili izinhlobo ze-pessary baboniswa ukuthi bangafaniswa.
Ama-pessaries angahlala endaweni izinsuku noma amasonto ngesikhathi. Ama-pessaries asekelwa njalo afakwa futhi asuswe yisiguli, futhi ezinye izikhathi zokuzilibazisa zivumela ngisho nobulili bobulili. Ukusetshenziswa kwama-pessaries kwabesifazane abane-dementia kungase kungabi umbono omuhle ngoba, uma kungenakulondolozwa futhi kulandelwe kahle, i-pessary ingabangela imiphumela emibi kakhulu efana nokuguguleka kwesinye isisu.
Abesifazane abangaphezu kwamaphesenti angama-85 abafisa i-pessary bangafakwa eyodwa. Izinto ezenza kube nzima ukulingana ne-pessary zihlanganisa ubude obuncane besifazane, umlando we-hysterectomy, noma ukuvulwa okubanzi kwesisu.
Ngokuya ngezinhloso kanye nezifiso zesiguli, ukuhlinzeka nge-prolapse ye-pelvic organ kungaba ukuvuselela noma ukubhubhisa. Isinqumo phakathi kwale nqubo sincike esifisweni sakho sokulala ngokobulili nemibono yomuntu ngomzimba womzimba. I-hysterectomy noma ukulondolozwa kwe-uterine (okungukuthi, i-hysteropexy) yizinketho ezimbili ezikhona. Kulabo besifazane abangeke besifise ubulili bobulili, ukukhetha ukwelashwa okungcono kunazo zonke kuyi-colpocleisis, noma ukuchithwa kwesisu.
Ngokusho kuka-Iglesia noSmithling:
Kulabo besifazane abakhetha ukugcina umsebenzi wobuciko, ukuhlinzekwa kabusha kufanele kwenziwe futhi i-vaginal pepe ingamiswa ngokusebenzisa izicubu zomuntu wesifazane kanye nesisindo somzimba wesilwane), noma ukufakwa kwesisu kufakwe esiswini, ukumiselela phezulu kwesiswini ku-sacrum (i-sacrocolpopexy), noma i-transvaginally (i-mesh yangaphakathi).
Ngokusho kwe-FDA:
Ukwelashwa ukulungisa i-POP [i-propy organ organ] kungenziwa ngokusebenzisa ubulili noma isisu, usebenzisa iziqu (sutures) yedwa noma nge-add mesh yokuhlinzwa. Izinketho zokugqoka zihlanganisa ukubuyisela isikhundla esivamile sesiswini, ukulungisa izicubu ezungeze isiswini, ukuvala unomphela umthamo wesisu noma ngaphandle kokukhipha isisu (colpocleiesis).
Okokugcina, ukusetshenziselwa imfashini ye-transvaginal kuyimpikiswano futhi kuye kwachithwa ochwepheshe. Ochwepheshe basikisela ukuthi ukusetshenziswa komcengezi we-transvaginal kufanele kulinganiselwe kulabo abanezethulo eziyinkimbinkimbi, njenge-prolapse ephakeme noma ephindaphindiwe noma labo abanezimo zezokwelapha ezenza ukuhlinzwa okungeyona inhlekelele engavamile.
> Imithombo:
> I-Iglesia CB no-Smithling KB. I-Pelvic Organ Prolapse. I-American Family Physician. 2017; 96 (3): 179-185.
> Miller KL, Isikhalazo TL. Ukuphazamiseka kwe-Gynecologic. Ku: Halter JB, Ouslander JG, Studenski S, High KP, Asthana S, Supiano MA, Ritchie C. eds. I-Geriatric Medicine and Gerontology, i-7e eNew York, i-NY: iMcGraw-Hill.
> I-Pelvic Organ Prolapse (POP). I-FDA.
> Woo J. Gynecologic Disorders. Ku: Papadakis MA, McPhee SJ, Rabow MW. ama-eds. Ukuxilongwa Kwezokwelapha Nokwelashwa Kwamanje 2018 eNew York, NY: McGraw-Hill.