Ukuguqulwa kwendlela yokuphila, iipessaries, kunye nokuhlinzwa ngonyango.
Xa iqela lomzimba likhupha kwindawo okanye liwa kwindawo, eli phawu libizwa ngokuba yi- prolapse . I-profivic organ body prolapse ibhekisela ekutshatyalaliswa kwamalungu epilvic. Beka enye indlela, i-pelvic organ prolapse i-hernia yeenxalenye ze-pelvic-ngokuqhelekileyo i-bladder-ngokusebenzisa ukuvulwa kwesondo. Uphawu olukhethekileyo lwe-pelvic organ prolapse luvakalelwa kukuba "into ephuma kuyo" -isisini.
Ngokuqondakalayo, ukuba ne-hernia kwisisini somfazi kungabangela uxinzelelo kwaye kuthintele umfanekiso womzimba, umsebenzi wesini kunye nomgangatho wobomi. Ngethamsanqa, nangona i-degree e-prolapse ikhoyo phakathi kwama-41 ekhulwini kunye nama-50 ekhulwini kuwo onke amabhinqa, kuphela iipesenti ezithathu zengxelo, kwaye abaninzi balaba bafazi abadingi unyango. Kubasetyhini abafuna unyango, i-pelvic floor exercises, i-pessaries, kunye nokuhlinzwa zizo zonke iinketho ezikhoyo.
Anatomy
Ibhinqa lilala ngokukodwa kwi-leverator muscle. I-levator ani muscle inxalenye iquka imisipha ye-pelvic, eyenza i-sling okanye i-hammock kwi-pelvis. Kula mabhinqa, le ngxube ibamba isibeleko, isilonda, isilwane, kunye nezinye izitho zeplavic endaweni ukuze yonke into isebenze ngendlela efanele. Ukulimala okanye ubuthathaka kwimisipha yomzimba we-pelvic "kunokuwisa" izitho ze-pelvic kwisisu.
Kufuneka kuqatshelwe ukuba imbangela ye-pelvic organ prolapse ibangelwa ngenxa yeziganeko ezininzi, kunye nokulimala kumgangatho we-pelvic ubaluleke kakhulu.
Kwesifundo esisodwa se-MRI, kuboniswe ukuba abafazi ababenomzimba we-pelvic bawela ngaphakathi kweyentimitha enye yezinga le-hymen babenamaxesha angama-7.3 ukuba banokulimaza i-leverator muscle xa kuthelekiswa nabasetyhini abangenayo i-prolapse.
Kukho iintlobo ezahlukeneyo zeengcambu zesisu:
- I-prolapse ekhoneni langasese langaphakathi ( ububanzi obungaphambili bendoda ) yintsimbi ye- cystocele , okanye i-herniation ye-bladder kwi-vaginal. Ukwahlula kunengqiqo kuba isilonda silele phambi kwesini.
- I-cystocele inokuhamba kunye ne- urethrocele , okuyi-sarging of the urethra, umzila apho umchamo uphonyelwa khona.
- I-Herniation kwisalathisi esingasemva kwesigxina (udonga lwangasemva kwesisu) ngokuqhelekileyo ukubuyiswa kwakhona , okanye ukuhlanjululwa kwe-rectum kwi-vaginal. Oku kwahlula kunengqiqo, nangona kunjalo, kuba i-rectum ikhona emva kwesondo.
- Ukulahlekelwa kwenkxaso ye-pelvic kwi-pepe, okanye phezulu, kwesisini (kufuphi nomlomo wesibeleko) kunokubangela ukuba kubekho i- hernia , okanye i-hernia yesilwanyana esincinci esiswini. Ngokwenene, i-enteroceles yodwa "yinyaniso" ye-hernia phakathi kweentlobo ezahlukeneyo ze-pelvic organ prolapse.
- Ukulahlekelwa yenkxaso kwiigaments ezinkulu zesisu (oko kukuthi, izigulane zamakhadiyali okanye i-uterosacral) zingakhokelela kwi-prolapse ye-uterine, okanye i-hernia yesisu esiswini. Iigamente ezinkulu ze-uterus zibambe isibeleko endaweni.
Kubaluleke kakhulu, ezimbini okanye ezintathu iintlobo ze-prolapse zingenzeka kunye kubasetyhini abanegciwane le-pelvic prolapse. Ukongezelela, i-pelvic organ prolapse iqhubekile ikhona kunye nezinye iingxaki zeplasvic . Ngokomzekelo, ama-37 ekhulwini kwabasetyhini abaneli meko nabo banamafutha angaphezulu, ama-40 ekhulwini ala mabhinqa agxininisa ukungabikho komzimba, kwaye iipesenti ezingama-50 zala mabhinqa zinezintlu.
Iimpawu
Uninzi lwabasetyhini abanomzimba we-pelvic bahamba bengenazo iimpawu.
Ukongezelela kwindoda ebhinqa, ezinye iimpawu eziqhelekileyo ze-pelvic organ prolapse ziquka ezi zilandelayo:
- Ubunzima, ukuzaliseka, ukuguga, okanye ukudonsa kwisini (ukugqithisa ekupheleni kosuku okanye ngexesha lokunyakaza kwesisu)
- Unzima ukuchama
- Ulukhuni ukuvalela ngokupheleleyo i-bladder ngokupheleleyo
- Ubuhlungu ngokucoca
- Ubunzima bezesondo
- Usulelo lwezonyango zomgudu
- Ukucima umchamo ngexesha lokukhwehlela, ukusebenzisa, okanye ukuhleka
- Ukutyunjwa
- Ukuhamba
- Ingxaki yokulawula igesi
Ingqalelo, iimpawu ezithile ezithe zaxhomekeke ekubeni ziphi izitho zeplavic ezityhila ngesisu.
Ngokomzekelo, i-cystoceles, eyaziwayo, isiphumo se-urinary.
Kwinqaku le-2017 elibizwa ngokuthi "iPlovic Organ Prolapse," u-Iglesia noSmithling balandelayo oku:
I-profivic organ prolapse ishintshi, kwaye iimpawu kunye nokufunyaniswa kweemviwo ziyakwazi ukuhluka imihla ngemihla, okanye ngaphakathi kwimihla kuxhomekeke kwinqanaba lomsebenzi kunye nokuzaliswa kwesibindi kunye ne-rectum. Ukuma, ukuphakamisa, ukukhwehlela, kunye nokuzikhandla ngokomzimba, nangona kungabikho izinto ezinobangela, kunokunyusa ukwanda kunye nokungahambi kakuhle.
Ukugqithisa okukhulu, okanye izilwanyana ezongezelelekileyo ngaphandle kwenzalo yamanzi, zingakhokelela ekukhusweni komzimba okanye kwisilonda esiswini se-vaginal mucosa.
Iziganeko ezinzima ze-prolapse aziqhelekanga. Ngokutsho kweMpilo yamaGriatric and Gerontology :
Kwezinye iimeko, abafazi abanama-cystocel ezinkulu bangabika ukuba bafake iminwe yabo kwisiswini ukuze baphakamise izicubu ukuze baqonde urethra ukuze bavine. Nangona kunjalo, ukuphazamiseka kwamabanga aphezulu kwabasetyhini kuyinto engavumelekanga, kwaye ukuphuculwa kwephepha eliphezulu kunye ne-hydronephrosis kunye nokungafezeki kwamanzi akuqhelekanga.
Uvavanyo lweMzimba
Ukuhlolwa komzimba kubalulekile ukufumanisa kakuhle i-pelvic organ prolapse. Ukuhlola okubonakalayo kwindoda ngugqirha akakho okwaneleyo ukuxilonga le meko. Endaweni yoko, i- OB-GYN iya kusebenzisa i-speculum enye-blade ukuze iphakame udonga lwangaphakathi lwesini okanye uxinzelele udonga olusezantsi lwalowo wesifazane ukuze uqinisekise ukukhubazeka. Ngethuba loviwo, ugqirha wakho unokucela ukuba ukhwehlela okanye uxinzelelo (Valsalva) ukuba ukhangele kangcono ukugqithisa. Ukongezelela, unokuphinda ucelwe ukuba ume ngexesha loviwo lokubonakalisa okungcono iintlobo ezithile ze-prolapse.
Nazi ezinye izinto i-OB-GYN ezivavanya ngexesha lokuhlolwa komzimba kwilungu le-pelvic prolapse:
- I-Vaginal bulge
- I-mucosal abrasions okanye izilonda
- Umgangatho wezala (umzekelo, ngaphaya komda webhinqa okanye ngaphaya komnyango wesini)
- Inkxaso kunye nokuhamba komlomo wesibeleko kunye nesisu
- Inkxaso kunye nokuhamba kwe-urethra kunye nentamo yebladder
- Izifundo zee-Urine (umzekelo, ukuthunyelwa kwevolumu ekhoyo kunye nokuhlaziywa kwe-urinalysis)
Izinto zobungozi kunye nokuPhepha
Ngethuba lokunikezelwa, i-levator ani muscle inokwelula i-200 ekhulwini kunomyinge wokulimala okwelula, okwenza ukuzalwa kwesisu kube yingozi enkulu ekuphuhliseni i-pelvic organ prolapse. Abasetyhini abaneli meko bahlala beveze ngaphezu kweyodwa intsana. Ezinye izinto ezibeka ingozi zibandakanya oku kulandelayo:
- I-Genetic predisposition
- Ngaphambi kokuba utyunjwe
- Ukunyanya
- Ukuxinzelela okungapheliyo (oko kukuthi, ukwanda kwengcinezelo ye-intra-esiswini) kwinqanaba lokuqhaqha okanye ukukhwehlela
- Hysterectomy
- Ukutshaya
- Ubunzima beethambo
Nangona abasetyhini kunanoma yiphina ubudala bangahlakulela isifo se-pelvic, le meko ihlala ichaphazela abafazi abadala. Kubasetyhini abaneminyaka engama-60 ukuya kwe-69 ubudala ubudala, ukubaluleka kwalo mqathango kubangama-5 ekhulwini.
Kwinqaku echanekileyo, idatha echanekileyo ibonisa ukuba isitho se-pelvic siphumelela phambili kuze kube yimihla yokuphela komzimba , kwaye emva kokumiswa kwexesha le meko ayiqhubeki okanye iqhube phambili. Ngaphezu koko, iziphumo zoluphando olulodwa lubonisa ukuba abafazi abagqithiseleyo banokufumana ukunyuka okukhawulezileyo, kwaye ukulahleka kwesisindo akuyikuguqula le nkqubela.
Unyango
Unyango lwe-pelvic organ organ prolapse kuxhomekeke kwimibandela emininzi, kubandakanya ubudala, umnqweno wokukhulelwa, ukuya esikhathini, kunye nesondo.
Kwiimeko ezinzima zale meko, ukuguqulwa kwendlela yokuphila kunokuncedisa iimpawu, kubandakanywa ukunciphisa ubunzima, ukuqeqeshwa kwe-pelvic muscle (Ie, uKegel umzimba), ukutya okuphezulu-fiber, kunye nokunciphisa izinto okanye ukuphakamisa imisebenzi.
Iipessaries zixhobo ezifakwe ngaphakathi kwisini ukuze kuqaliswe kwakhona isistim ye-pelvic evamile. Zinceda ukunciphisa iimpawu ezibangelwa yipilvic pro organ. Phantse ama-67 ekhulwini kwabasetyhini baya kuqala bakhethe i-pessary njengendlela yokonyango, kunye neepesenti ezingama-77 eziqhubekayo ukusebenzisa le fowuni emva konyaka omnye.
Iipessaries zisebenza kubasetyhini abanee-degrees ezahlukeneyo ze-pelvic organ prolapse-ukusuka kulabo abanezifo ezincinci ukuya kwiingxelo ezinzulu. Ezi zixhobo zinganciphisa ukuqhubela phambili kwesi simo kwaye zilibale okanye ziphelise isidingo sokuhlinzwa.
Iipessaries zivame ukuba zenziwe nge-silicone yebanga lonyango. Iipessaries zingaba inkxaso okanye indawo ehlala kuyo. EUnited States, ipessary ring, uhlobo lwe-pessary exhasayo, yinto ethandwa kakhulu elandelwa yindawo-yokuhlala iipessary ezifana ne-donut pessary okanye i-Gellhorn pessary. Izithuba zokuhlala kwindawo zendawo zidinga ukugula okungaphezulu.
Okwangoku, kubasetyhini abanegciwane le-pelvic prolapse, kukho kuphela isilingo esilawulwa ngokungahleliwe ngokulinganisa i-pessary ye-ring kunye ne-Gesshorn pessary (uhlobo lwe-pessary-space occupancy) kwaye zombini iintlobo ze-pessary ziboniswa ukuba ziyafana.
Iipessaries zihlala kwindawo yeentsuku okanye iiveki ngexesha. Iipessaries zenkxaso zihlala zifakwe kwaye zisuswe ngumguli, kwaye ezinye iipessaries zivumeleke ukuba ulalane ngesondo. Ukusetyenziswa kweefesari kubasetyhini abanomdemokhrasi kungabi yinto efanelekileyo kuba, ukuba ingagcinwa kwaye ilandelwe ngokufanelekileyo, i-pessary ingakhokelela kwimiphumo emibi efana nokuguguleka kwi-vestile okanye i-rectum.
Amaphesenti angaphezu kwama-85 amabhinqa anqwenela i-pessary angafakwa omnye. Izinto ezenza kube nzima ukuba zilungele i-pessary zibandakanya ubude besisu, imbali ye-hysterectomy, okanye ukuvula ububanzi obukhulu.
Ngokuxhomekeka kwiinjongo kunye neminqweno yesigulane, ukuhlinzwa ngokutsha kwelungu le-pelvic kungaba yinto yokwakha okanye yokutshabalalisa. Isigqibo phakathi kwale nkqubo sixhomekeke kwiminqweno yakho yokulala ngesondo kunye neembono zobuqu kumzimba womzimba. I-Hysterectomy okanye ukulondolozwa kwe-uterine (okt, hysteropexy) zizinto ezimbini ezikhoyo. Kubasetyhini abangasenqweneli ukulala ngesondo, intetho yokunyanga engcono kakhulu yonyango i-colpocleisis, okanye i-vaginal obliteration.
Ngokutsho kuka-Iglesia noSmithling:
Kubasetyhini abakhetha ukugcina umsebenzi wokubambisana, ukuhlinzwa ngokutsha kufuneka kwenziwe kwaye i-vaginal pepe ingasimiswa ngokusetyenziswa kwamathambo kunye ne-sutures ukulungiswa kwezicubu zenyama), okanye i-mesh ingafakwa kwisisu, ukumisa umphezulu wesini kwisigremu (sacrocolpopexy), okanye i-transvaginally (ingxowanxu yangaphakathi).
Ngokutsho kwe-FDA:
Ugqirha ukulungisa i-POP [i-pelvic organ prolapse] inokwenziwa ngokusetyenziswa kwesini okanye isisu, usebenzisa i-stitches (i-sutures) yodwa okanye kunye nokongezwa kwengubo yokucoca. Izinketho zokuphanda ziquka ukubuyiselwa kwesimo esivamile sesisini, ukulungisa izicubu ezijikeleze isondo, ukuvala ngokusisigxina isalathisi sangasese kunye okanye ngaphandle kokususa isisu (colpocleiesis).
Ekugqibeleni, ukusetyenziswa kwemfono engapheliyo kuyimpikiswano kwaye kuye kwachithwa iingcali. Iingcaphephe zibonisa ukuba ukusetyenziswa kwemfono engapheliyo kufuneka kulandelwe kulabo abaneentetho eziyinkimbinkimbi, ezifana neprolapse ehamba phambili okanye ephindaphindiweyo okanye abo abaneemeko zonyango ezenza ukwenziwa komngcipheko olungenayo.
> Imithombo:
> Iglesia CB kunye Smithling KB. I-Pelvic Organ Prolapse. WaseMerika ugqirha. 2017; 96 (3): 179-185.
> Miller KL, I-Griebling TL. Izifo ezibangelwa yiGynecologic Disorders. Ku: I-Halter JB, i-Ouslander JG, i-Studenski S, i-KP ephezulu, i-Asthana S, i-Supiano MA, i- Ritchie C. eds. I-Gazethi ye-Geriatric Medicine neGerontology, i-7e eNew York, i-NY: iMcGraw-Hill.
> I-Pelvic Organ Prolapse (POP). FDA.
> Woo J. Gynecologic Disorders. Ku: Papadakis MA, McPhee SJ, Rabow MW. eds. Ukuxilongwa kweZonyango kunye neNyango ye-Treaty 2018 eNew York, NY: iMcGraw-Hill.