Kusintha kwa moyo, zolembapo, ndi opaleshoni ndizo njira zothandizira.
Pamene thupi limatuluka pamalo kapena limachokera pamalo, dontho ili limatchedwa kupweteka . Zilonda za thupi zimatuluka m'thupi. Gwiritsani njira ina, kupweteka kwa thupi kumatenda ndi ziwalo za m'mimba-makamaka chikhodzodzo-kupyolera muzitseko. Chizindikiro chodziwika kwambiri cha pulojekiti ya pakhosi ndikumeneko "chinthu chomwe chimachokera" -chikazi.
Ndizomveka kuti kukhala ndi nthendayi muzimayi kumakhala kovuta komanso kumakhudza thupi, kugonana, komanso khalidwe labwino. Mwamwayi, ngakhale kuti pakati pa 41 peresenti ndi 50 peresenti ya amayi onse amafa, peresenti yokha ndi itatu imafotokoza zizindikiro, ndipo ambiri mwa akaziwa safuna chithandizo. Kwa amayi omwe amafunikira chithandizo, zochitika zapansi pansi, zolembera, ndi opaleshoni ndizo zonse zomwe mungapeze.
Anatomy
Mkazi amafa mozungulira pang'onopang'ono ndi minofu. Nsonga za levator ani zimaphatikizapo mitsempha ya pakhosi, yomwe imapanga chingwe kapena nyundo pamtunda. Mwa amayi, chingwechi chimagwira chiberekero, chikhodzodzo, matumbo, ndi ziwalo zina zapachiwalo m'malo mwake kuti chirichonse chizigwira ntchito moyenera. Kuvulala kapena kufooka pamatumbo a pakhosi kumatha "kugwetsa" ziwalo zamkati mumimba.
Tiyenera kudziŵa kuti chifukwa cha kupweteka kwa thupi kumakhala chifukwa cha zinthu zambiri, ndi kuvulazidwa pamtanda wachitsulo.
Mu kafukufuku wina wa MRI, zinawonetsedwa kuti akazi omwe ali ndi kachilombo kamene amatha kupweteka kwambiri m'kati mwa mamita asanu ndi awiri aliwonse amakhala oposa 7.3 nthawi zambiri omwe amavulaza mitsempha ya nyamayi poyerekeza ndi amayi omwe sali othawa.
Pali mitundu yosiyanasiyana ya mavini:
- Pewani mkati mwa khoma lakunja lakumimba (khoma kutsogolo kwa chikazi) ndi cystocele , kapena herniation ya chikhodzodzo mkati mwa chikazi. Kusiyanitsa uku kumakhala kosavuta chifukwa chikhodzodzo chimakhala patsogolo pa abambo.
- Puloteni ikhoza kutsagana ndi urethrocele , yomwe ndi kugwedezeka kwa urethra, njira yomwe mkodzo umachotsedwera ku chikhodzodzo.
- Kuyeretsa kumtambo (kumbuyo kwa chiberekero cha umaliseche) nthawi zambiri kumakhala kubwezeretsa , kapena kupatsanso kachilombo ka HIV. Kusiyanitsa uku kumakhala kosavuta, komanso, chifukwa kachilombo kamene kali kumbuyo kwa chiberekero.
- Kutaya chithandizo chamagazi pamtunda, kapena pamwamba, cha chiberekero (pafupi ndi chibelekero) kungapangitse kuti thupi likhale lopatsirana , kapena chifuwa chachikulu cha m'mimba. Mwachidziwitso, enteroceles ndiyo yokhayo "yowona" yamtundu wina pakati pa machitidwe osiyana a prolapse wodwala.
- Kutaya chithandizo mu mitsempha yayikulu ya chiberekero (mwachitsanzo, makhadi kapena mitsempha ya uterosacral) ikhoza kuyambitsa chiberekero cha uterine, kapena chiberekero cha chiberekero mu umaliseche. Mitsempha yayikulu ya chiberekero imagwira chiberekero m'malo mwake.
Chofunika kwambiri, mitundu iwiri kapena itatu ya kupweteka kumachitika limodzi mwa amayi omwe ali ndi prolapse. Kuonjezera apo, kupweteka kwa kachilombo kameneka kumachitika nthawi zina ndi mavuto ena a phulusa . Mwachitsanzo, 37 peresenti ya amayi omwe ali ndi vutoli ali ndi chikhodzodzo chopitirira muyeso, 40 peresenti ya amayiwa ali ndi vuto losafuna kusuta, ndipo 50 peresenti ya amayiwa ali ndi chizoloŵezi chosadziletsa.
Zizindikiro
Amayi ambiri omwe ali ndi kachilombo koyambitsa matendawa sakhala ndi zizindikiro.
Kuphatikiza pa chifuwa mu umaliseche, zizindikiro zina zomwe zimachitika pang'onopang'ono zimakhala izi:
- Kulemera, kukhuta, kupweteka, kapena kukoka mukazi (kuwonjezereka kumapeto kwa tsiku kapena panthawi yamagulu)
- Kuvuta kukodza
- Zovuta kuthetsa chikhodzodzo kwathunthu
- Ululu wokodza
- Zovuta zogonana
- Matenda opatsirana kawirikawiri
- Kuthamanga mkodzo pamene akukakokera, kuchita masewera, kapena kuseka
- Kutsekedwa
- Kuthamanga pansi
- Kusokoneza kutaya mpweya
Zindikirani, zizindikiro zenizeni zomwe zimakhalapo zimadalira zomwe ziwalo za m'mimba zimadula mumaliseche.
Mwachitsanzo, cystoceles, zomwe zimatulutsa chikhodzodzo, zimayambitsa zizindikiro za mkodzo.
Mu nkhani ya 2017 yotchedwa "Organic Prolapse Prolapse," Iglesia ndi Smithling amanena izi:
Zilonda za thupi zimakhala zolimba, ndipo zizindikiro ndi zofufuza zimakhala zosiyana tsiku ndi tsiku, kapena mkati mwa tsiku molingana ndi msinkhu wa ntchito ndi chidzalo cha chikhodzodzo ndi kachilombo. Kuimirira, kunyamula, kukokera, ndi kuumirira thupi, ngakhale kuti sizomwe zimayambitsa matenda, zikhoza kuwonjezereka komanso kusokonezeka.
Kukula kwakukulu, kapena zozizwitsa zomwe zimatuluka kunja kwa mkodzo, zingayambitse kutentha kapena zilonda za m'mimba.
Nthawi zambiri vutoli limakhala lovuta kwambiri. Malinga ndi Hazzard's Geriatric Medicine and Gerontology :
Nthaŵi zina, amayi omwe ali ndi makina akuluakulu anganene kuti ayenera kuyika zala zawo kuti azikweza minofu kuti athetsere urethra kuti urinate. Ngakhale zili choncho, kuvomereza kwa amayi ambiri sikokwanira, komanso kukula kwa kapangidwe kake ndi hydronephrosis ndi kuchepa kwa chidziwitso si zachilendo.
Kufufuza Kwambiri
Kuyezetsa thupi n'kofunikira kuti mupeze bwinobwino prolapse. Kuyang'anitsitsa maonekedwe a abambo ndi dokotala nthawi zambiri sikokwanira kuti azindikire vutoli. M'malo mwake, OB-GYN idzagwiritsa ntchito speculum imodzi-tsamba kuti iwononge khoma lakale la mkazi kapena kukhumudwitsa khoma lachikazi la pambuyo pake kuti adziwe matenda. Panthawi yoyezetsa magazi, dokotala wanu angakufunseni kuti chifuwa kapena vuto lanu (Valsalva) liziwoneka bwino. Komanso, mungapemphekenso kuti muime panthawi yofufuza kuti muwone bwino za mitundu ina ya pang'onopang'ono.
Nazi zinthu zina zomwe OB-GYN zimayesa panthawi ya kuyezetsa thupi kwa pulojekiti ya m'thupi:
- Vaginal bulge
- Mucosal abrasions kapena zilonda
- Chiwerengero cha chibadwa (mwachitsanzo, kupitirira pakati pa vaginja kapena kupitirira pa khomo la abambo)
- Thandizo ndi kuyenda kwa chiberekero ndi chiberekero
- Thandizo ndi kuyenda kwa mitsempha ndi chikhodzodzo
- Maphunziro a mitsempha (mwachitsanzo, kutumizira kutayika kwavota ndi kuvomereza)
Zinthu Zowopsa ndi Nthawi Zambiri
Pa nthawi yobereka, minofu ya levator ani imatha kupitirira 200 peresenti kuposa chiwopsezo cha kuvulala kwakukulu, kuchititsa kuti kubadwa kwa abambo kukhale koopsa kwambiri pa chitukuko cha pakhosi. Amayi omwe ali ndi vutoli nthawi zambiri apereka ana oposa mmodzi. Zina mwazidzidzidzi ndizo zotsatirazi:
- Zosintha zamoyo
- Pambuyo pa opaleshoni yeniyeni
- Kunenepa kwambiri
- Kupweteka kosayembekezereka (mwachitsanzo, kuwonjezeka kwa m'mimba mwathupi) kumapeto kwa kudzimbidwa kapena kukhwima
- Hysterectomy
- Kusuta
- Mtundu wovuta wa minofu
Ngakhale amayi a msinkhu uliwonse angathe kukhala ndi pulojekiti ya pakhosi, vutoli limakhudza akazi achikulire. Kwa amayi omwe ali ndi zaka za pakati pa 60 ndi 69, kufalikira kwa chikhalidwe ichi ndi zisanu mwa magawo asanu.
Malinga ndi zofanana, deta yochepa imasonyeza kuti kupuma kwa thupi kumapitirira mpaka kumapeto, ndipo pambuyo pa kutha kwa thupi izi sizikuyenda kapena kuyambiranso. Komanso, zotsatira za kafukufuku wina zimasonyeza kuti amayi omwe ali ochepa kwambiri amatha kupita patsogolo mwamsanga, ndipo kulemera kwake sikungasinthire kupweteka kumeneku.
Chithandizo
Kuchiza kwa kachilombo koyambitsa thupi kumadalira zinthu zingapo, kuphatikizapo zaka, chilakolako cha mimba, kusamba, ndi kugonana.
Chifukwa cha vutoli, kusintha kwa moyo kumathandizira zizindikiro, kuphatikizapo kuchepetsa kuchepetsa thupi, kuphunzitsa minofu yam'mimba (Ie, Kegel), zakudya zamtundu wapatali, ndi zochepetsetsa zochepa.
Zolemba zapakati zimakhala zida zoikidwa mkati mwa vaginomu kuti akhalenso ndi thupi lachibadwa la m'mimba. Amathandizira kuchepetsa zizindikiro zomwe zimayambitsa matendawa. Pafupifupi 67 peresenti ya amayi amayamba kusankha pessary ngati chithandizo chamankhwala, ndipo 77 peresenti akupitiriza kugwiritsa ntchito chipangizochi patatha chaka chimodzi.
Zolembazo zimagwira ntchito kwa amayi omwe ali ndi madigiri osiyana-siyana a pulogalamu ya pelvic-kuchokera kwa iwo omwe ali ndi matenda ochepa mpaka kuwonetsera kwakukulu. Zidazi zingathe kuchepetsa kukula kwa chikhalidwe ichi ndi kuchepetsa kapena kuthetseratu kufunikira kwa opaleshoni.
Nthawi zina zimakhala zopangidwa ndi mankhwala osakaniza mankhwala. Zolemba zingakhale zothandizira kapena malo omwe akukhalamo. Ku United States, pessary ring, mtundu wa pessary wothandizira, ndi wotchuka kwambiri wotsatiridwa ndi malo omwe amagwiritsira ntchito pessaries monga donut pessary kapena Gellhorn pessary. Malo osungirako malo omwe akukhalapo amafunikila kudwala kwambiri.
Pakalipano, akazi omwe ali ndi prolapse pulojekiti, amakhala ndi mayesero amodzi okha omwe ali ndi mayina omwe amadziwika bwino kwambiri poyerekezera ndi pessary ndi Gellhorn pessary komanso mitundu yonse ya pessary.
Maseŵera amatha kukhala m'malo kwa masiku kapena masabata nthawi imodzi. Ma pessaries amathandizidwa ndikuchotsedwa ndi wodwalayo, ndipo zina zimapangitsa kuti kugonana kumalowe. Kugwiritsiridwa ntchito kwa pessaries kwa amayi omwe ali ndi chifuwa chachikulu chaumtima sikungakhale lingaliro labwino chifukwa, ngati panthawiyo sichikhala yosungidwa bwino ndikutsatiridwa bwino, zotsatira zake zimakhala ndi zotsatira zoyipa monga kutentha kwa chikhodzodzo kapena chikhodzodzo.
Azimayi opitirira 85 peresenti omwe akufuna pessary akhoza kukhala oyenera limodzi. Zinthu zomwe zimapangitsa kuti zikhale zovuta kuti zikhale zofanana ndi pessary ndizitali zazitali za mmimba, mbiri ya hysterectomy, kapena kutsegula kwazitali kwa amayi.
Malingana ndi zolinga ndi zokhumba za wodwalayo, opaleshoni ya pulojekiti ya m'thupi ikhoza kukhala yowonjezera kapena yowonongeka. Kusankha pakati pa njirazi kumadalira chilakolako chanu chogonana ndi malingaliro anu pa thupi. Kusokoneza ubongo kapena kusungirako uterine (ie, hysteropexy) ndi njira ziwiri zomwe mungapeze. Kwa amayi omwe safunanso kugonana, njira yabwino yothandizira opaleshoni ndiyo colpocleisis, kapena kuthetsa kwa akazi.
Malinga ndi Iglesia ndi Smithling:
Kwa amayi omwe amasankha kusunga ntchito, amagwiritsanso ntchito opaleshoni yokhayokha ndipo mazira amkati amatha kuimitsidwa pogwiritsa ntchito zida za mkazi komanso sutures kukonza minofu), kapena mauna akhoza kuikidwa m'mimba, kuimitsa pamwamba pa nyini kupita ku sacrum (sacrocolpopexy), kapena transvaginally (transvaginal mesh).
Malingana ndi FDA:
Kuchita opaleshoni kukonzanso POP [pulojekiti ya pelvic organ] ikhoza kupyolera mu ubini kapena mimba, pogwiritsira ntchito zikhomo (sutures) zokha kapena ndi kuwonjezera pa mavare opaleshoni. Zochita za opaleshoni zimaphatikizapo kubwezeretsa malo oyenera a vaginayi, kukonza minofu kuzungulira umaliseche, kutseka chisembwere chosatha komanso popanda kuchotsa chiberekero (colpocleiesis).
Potsirizira pake, kugwiritsa ntchito matope a transvaginal ndi kutsutsana ndipo kwasokonezedwa ndi akatswiri. Akatswiri amati kugwiritsidwa ntchito kwa matope a transvaginal kuyenera kukhala kokha kwa iwo omwe ali ndi mauthenga ovuta, monga pulogalamu yapamwamba kapena yobwerezabwereza kapena omwe ali ndi matenda omwe amachititsa opaleshoni yowopsa kwambiri.
> Zotsatira:
> Iglesia CB ndi Smithling KB. Pulojekiti ya Pelvic. American Family Physician. 2017; 96 (3): 179-185.
> Miller KL, Griebling TL. Matenda a Gynecologic. Mu: Halter JB, Ouslander JG, Studenski S, High KP, Asthana S, Supiano MA, Ritchie C. eds. Hazzard's Geriatric Medicine and Gerontology, 7e New York, NY: McGraw-Hill.
> Pulogalamu ya Pelvic Prolapse (POP). FDA.
> Woo J. Gynecologic Disorders. Mu: Papadakis MA, McPhee SJ, Rabow MW. eds. Kufufuza kwa Zamankhwala Zamakono ndi Chithandizo 2018 New York, NY: McGraw-Hill.