Lifestyle modification, pessaries, uye chirwere ndiwo maitiro ekurapa.
Apo chikamu chemuviri chinodonha kubva panzvimbo kana chidonhera kubva panzvimbo, iyo donyo inonzi inopera . Chirwere chepelvic chinonzi prolapse chinoreva kupera kwezvikamu zvepachiviri. Isa imwe nzira, chirwere chepilvic chinokonzerwa nhengo yepilvic-kunyanya chirwere-kuburikidza nemukadzi. Chiratidzo chinonyanya kuzivikanwa chemuviri wepelvic chinokonzerwa ne "bulge-" chimwe chinhu chinobuda "-mukadzi.
Zvinonzwisisika kuti kuva nehavha mune zvepabonde kunogona kuva kunetseka uye kunokanganisa mumuviri wemuviri, basa repabonde, uye hupenyu hwehupenyu. Nenzira yakanaka, kunyange zvazvo imwe nzira yekupera inenge iripo pakati pe 41 muzana uye 50 muzana yevakadzi vose, vatatu chete muzana vanozivisa zviratidzo, uye vazhinji vevakadzi ava havadi kurapwa. Kune vakadzi vanoda kurapwa, pelvic saka muviri maitiro, pessaries, nekuvhiya zvose zvinowanikwa.
Anatomy
Izvo zvinyorwa zvisinganzwisisiki zviri pamusoro pechivako ani musungo. Ikoviti ani musumbu mune chimwe chikamu inosanganisira misoro yepasi, iyo inogadzira simbo kana hammock kudarika mapepa. Madzimai, tsvina iyi inobata chibereko, chikwata, maronda, uye dzimwe nhengo dzepachivi panzvimbo ino kuitira kuti zvinhu zvose zviite sezvinofanira. Kukuvadza kana kushaya simba mumatumbo epasiki pasi kunogona "kudonha" nhengo dzepelvic kupinda mumudzimai.
Zvinofanira kuonekwa kuti chinokonzera chirwere chepilvic chinowanzoitika nekuda kwezvinhu zvakawanda, nekukuvadzwa pasi pepadvic ndiyo inonyanya kukosha.
Mune imwe yedzidzo yeMRI, yakaratidzwa kuti vakadzi vaiva nechirwere chepachivi chinoputika mukati memamita anenge masere emuzinga we hymen vaiva 7.3 nguva yakawanda yakawanda yekukuvadzai levator ani musumbu kana ichienzaniswa nevakadzi vasina kupera.
Kune marudzi akasiyana emadzimai emukadzi:
- Pira inowanikwa mukati memadziro emadzimai (pamberi pekunze kwemukadzi) ndeye cystocele , kana kuti herniation yechipfuva mumuviri. Ichi chikamu chinonzwisisika nokuti chidimbu chinonyengera pamberi pemukadzi.
- A cystocele inogona kuendeswa nechirwere ichi, icho chiri kuputika kwechiremba, dzira iyo iyo urinho inodzingwa kubva mumucheka.
- Kunyoresa mumashure ekudzivirira kumadzimai (kumashure kumashure emadzimai) kazhinji kunodzokorora , kana kuti kunamirwa kwekwakadzika mumudzimai. Iyi kusiyana kunonzwisisika, zvakare, nokuti rectum inowanikwa mushure memukadzi.
- Kurasikirwa kwepecvic pamusana, kana kuti pamusoro, zvechikadzi (pedyo nemukirini) kunogona kukonzera kukonzera , kana hutachiona hwemukoko mutsva mumudzimai. Nenzira dzekuti, enteroceles ndiyo chete "yechokwadi" inowanikwa mukati mekushandurwa kwakasiyana-siyana kweprolapse organ prolapse.
- Kurasikirwa kwekusimbiswa mumakumbo makuru emuviri (kureva, makadhiiniti kana uterosacral ligaments) zvinogona kutungamirira kuhutachi hwehutachiona, kana chibereko chechibereko mukati memukadzi. Miti mikuru yechipfuva inobata chiberekero panzvimbo.
Zvinonyanya kukosha, maviri kana zvitatu zvekupera zvinogona kuitika pamwe chete kuvakadzi vane chirwere chinonzi provicvic prolapse. Uyezve, chimiro chepachiviri chinowanzoitika-chinowanikwa nemamwe matambudziko epasi pepelvic . Semuenzaniso, 37 muzana yevakadzi vane chirwere ichi vane chirwere chinopisa, 40 muzana yevakadzi ava vanodedera urinary incontinence, uye 50 muzana yevakadzi ava vane fecal incontinence.
Zviratidzo
Vazhinji vakadzi vane nhengo yepachevic vanokanganisa havazivi zviratidzo zvachose.
Mukuwedzera kune chirwere mumudzimai, zvimwe zviratidzo zvinowanzoitika zvemuviri wepilvic chinosanganisira zvinotevera:
- Kusuruvara, kuzara, kunyunyuta, kana kuvhomora mumudzimai (kuwedzera pakuguma kwezuva kana panguva yekufamba kwechirwere)
- Zvakaoma kurinha
- Zvakaoma kuvhara bladder zvachose
- Pain on urination
- Zvinetso zvepabonde
- Vanoramba vachiita urinhi zvipembenene
- Kusvetuka mumucheka paunenge uchikwiridzira, uchiita muviri, kana kuseka
- Constipation
- Kubuda chigaro
- Chinetso chekutonga gasi
Nyaya, zviratidzo zvakananga zvinowanikwa pane izvo zvikamu zvepachiviri zvakarodza mumudzimai.
Semuenzaniso, cystoceles, iyo inofanirwa nemukaka, inoguma zviratidzo zvekuvhenekera.
Muchikamu che 2017 chinonzi "Pelvic Organ Prolapse," Iglesia naSmithling vanotaura zvinotevera:
Chirwere chepelvic chinowedzera, uye zviratidzo uye kuongororwa kwekuongorora zvinogona kuchinja zuva rimwe nerimwe, kana mukati mezuva zvichienderana nehuwandu hwebasa uye kuzara kwechirwere uye rectum. Kumira, kusimudza, kukwezva, uye kuedza muviri, kunyange zvisingaiti zvikonzero, zvinogona kuwedzera kukura uye kusagadzikana.
Kukura kwakakura, kana kunamatira kunowedzera kunze kwechikadzi, kunogona kukonzera kukwegura kana kuonda kwechikadzi mucosa.
Zviitiko zvakakomba zvekupfura hazviwanzoitiki. Maererano neHazzard's Geriatric Medicine neGerontology :
Mune zvimwe zviitiko, vakadzi vane magirasi makuru vanogona kuudza kuva nekuisa minwe yavo mumudzimai kuti vawedzere maronda kuitira kuti vagadzirise urethra kuti urinate. Pasinei neizvi, kuvhiringidzika kwepamusoro kwevakadzi kuwanana, uye kukurudzirwa kwepamusoro kwegadziriswa ne hydronephrosis uye kusagadzikana kwechikadzi hakuwanzoitiki.
Kuongorora Panyama
Kuongorora mumuviri kunokosha kuti uwane hutachiona hwemuviri hwepilvic. Kutarisa kuonekwa kwechikadzi nechiremba kazhinji hazvikwanisi kuti uongorore chirwere ichi. Pane kudaro, anonzi OB-GYN achishandisa sulumusi-blade imwechete kuti isimudze rusvingo rwemapapiro rwemadzimai kana kuti kudzvinyirira rusvingo rwemashure rwemadzimai kuti uwane hutachiona. Munguva yekuongorora, chiremba wako angakukumbira kuti iwe kukohwa kana kushungurudza (Valsalva) kuti uone zviri nani kupera. Uyezve, iwe unogonawo kubvunzwa kuti umire panguva yekuongororwa kwekutarisa zviri nani kune dzimwe nzvimbo dzekupera.
Heano zvimwe zvinhu izvo OB-GYN inoongorora panguva yekuongorora kwemuviri wepilvic organ prolapse:
- Vaginal bulge
- Mucosal abrasions kana kuonda
- Dhiyabhorosi yemadzinza (somuenzaniso, kunze kwepakati pepakati pemudzimai kana kupfuura pamusuo wemukadzi)
- Kutsigira nekufamba kwechibereko chechibereko uye chibereko
- Kutsigira uye kufamba kwechiremba uye mushumba wechipfuva
- Zvidzidzo zveUriine (semuenzaniso, kuendesa mberi kwekusiya simba uye urinalysis)
Njodzi Zviitiko uye Kurwiswa
Munguva yekuberekwa, levator ani musumbu inogona kutambanudza 200 muzana yakakura kudarika chikumbaridzo chekukuvara kukuru, zvichiita kuti vaginhi vaberekwe dambudziko guru rekugadzirwa kwenhengo yeplavic prolapse. Vakadzi vane chirwere ichi vanowanzowedzera vana vanopfuura. Zvimwe zvinokonzera ngozi zvinosanganisira zvinotevera:
- Genetic predisposition
- Usati wambovhiyiwa
- Kuwedzera muviri
- Kurwara kusingagumi (kureva, kuwedzerwa mukati-mumimba kudzvinyirirwa) kuchipiri pakuvhara muviri kana kukwezva
- Hysterectomy
- Kusvuta
- Utachiona hwehutu hwehutano
Kunyange zvazvo vakadzi venguva ipi zvayo vanogona kukura nhengo yeplvic, inowanzoitika kune vakadzi vakwegura. Madzimai ari pakati pemakore makumi matanhatu nematanhatu nemakore makumi matatu nemashanu, kupararira kwechiitiko ichi chikamu chezana.
Pane imwe nhoroondo yakabatana, nhamba shoma inoratidza kuti nhengo yepilvic inowedzera kusvika pakuguma , uye mushure mokunge apera mamiriro ezvinhu izvi hazvifambi kana kuchinja. Uyezve, zvinobva kune imwe chidzidzo zvinoratidza kuti vakadzi vanorema vanogona kunge vachikurumidza kufambira mberi, uye kurasikirwa kwemazivi hakusi kuderedza kupera uku.
Kurapa
Kurapwa kwepurojekiti yemuviri wepachevic kunoenderana nezvimwe zvinhu, kusanganisira makore, chido chekuzvitakura, kuenda kumwedzi, uye zvepabonde.
Kune zviitiko zvakaoma zvechiitiko ichi, kuchinja mararamiro kunogona kubatsira nemararamiro, kusanganisira kuderedza kuyerwa, kudzidzisa kwepisvic mushure (Ie, Kegel maitiro), kudya kwepamusoro-fibhi, uye kusagadzikana kusinganisa kana kusimudza mabasa.
Pessaries pane mazano akaiswa mukati memudzimai kuti agadzirise zvakare hutachiona hwema-pelvic. Vanobatsira kuderedza zviratidzo zvinokonzerwa nehupenzi hwepilvic. Vanenge 67 kubva muzana yevakadzi vachatanga kusarudza pessary senzira yekurapa, uye 77 muzana vachienderera mberi kushandisa kadhi iyi mushure megore rimwe chete.
Pessaries inoshanda kuvakadzi vane zvidimbu zvakasiyana-siyana zvepilvic organ prolapse-kubva kune avo vane chirwere chiduku kusvika pane zvakataurwa zvakakomba. Izvi zvinogona kuderedza kufambira mberi kwechiitiko ichi uye kunonoka kana kubvisa chido chekuvhiyiwa.
Pessari inowanzoitwa yehutano-grade grade. Pessaries inogona kunge inotsigira kana nzvimbo inogara. MuUnited States, ring ring pessary, rudzi rwekutsigira pessary, ndiyo yakakurumbira inoteverwa nenzvimbo-yekugara pessaries yakafanana ne donut pessary kana Gellhorn pessary. Space-occupying pessaries inodiwa nokuda kwehutano hwakanyanya.
Kusvika iye zvino, kune vakadzi vane chirwere chepilvic chinokonzera, pane kungova nemhando imwe chete yakarongedzwa yakaenzana nekuenzanisa mhete pessary neGellhorn pessary (rudzi rwepace-occupying pessary) uye mapoka ose epessary akaratidzwa kufanana.
Pessaries inogona kugara munzvimbo kwemazuva kana masvondo panguva. Kutsigira pessaries kunowanzoiswa uye kubviswa nemurwere, uye mamwe mapeji anokwanisa kubvumira zvepabonde. Kushandiswa kwepessaries kuvakadzi vane chirwere chekuita nehutano hwepfungwa hakusi pfungwa yakanaka nekuti, kana isina kuchengetedzwa uye kuteverwa zvakanaka, pessary inogona kuguma nemigumisiro yakaipisisa yakadai sokudengenyeka mukati mechidzitiro kana rectum.
Vanopfuura 85 muzana yevakadzi vanofarira pessary vanogona kugadzirirwa kune rimwe. Zvinhu zvinoita kuti zvive zvakaoma kuti zvive zvakakwana nepessary zvinosanganisira nguva shomanana yemadzimai, nhoroondo ye hysterectomy, kana kuti yakazara kuvhura kwaro.
Zvichienderana nezvinangwa uye zvido zvemu murwere, kuvhiyiwa kwechirwere chepachiviri chinogona kupedzisira kugadzirisa kana kuparadza. Chisarudzo pakati pemitemo iyi chinoenderana nechishuwo chako chekuita zvepabonde nemafungiro evanhu pamufananidzo wemuviri. Hysterectomy kana uterine kuchengetedza (kureva, hysteropexy) zvinhu zviviri zviripo. Madzimai avo vasingachadi kurara pabonde, kurapa kwakanakisisa kunoshandiswa kurapa ndiyo colpocleisis, kana kuti kubata kwekudzivirira.
Maererano naIglesia naSmithling:
Kune vakadzi vanosarudza kuchengetedza basa rekushanda, kuvhiyiwa kwekugadzirisa kunofanira kuitwa uye kumadzivirira kwepachiviri kunogona kusimiswa kushandiswa kwemadzimai ezvimedu uye sutures zvakagadziriswa mishonga yekugadzira), kana mesh inogona kuiswa mumimba, kusimudza kumusoro kwemukadzi kusvika ku sacrum (sacrocolpopexy), kana kutenderera (transvaginal mesh).
Maererano neCDA:
Kuvhiya kunogadzirisa POP [chirwere chepilvic prolapse] chinogona kuitwa kuburikidza nemudzimai kana mudumbu, uchishandisa mashizha (sutures) oga kana nekuwedzera kwemashini ekuvhiya. Zvokuvhiya zvinosanganisira kushandura nzvimbo yakatarwa yemudzimai, kugadzirisa mhuka dziri kumativi ose emudzimai, kupedza zvachose vaginal canal kana kuti pasina kubvisa chibereko (colpocleiesis).
Pakupedzisira, kushandiswa kwemasvini ekudarika kunokonzera kukakavara uye kwakaparadzaniswa nenyanzvi. Nyanzvi dzinotaura kuti kushandiswa kwemaseni ekudarika kunofanira kuve kune avo vane zvirevo zvakakomba, zvakadai se prolapse yakakurumbira kana yakadzoka kana avo vane mishonga inoita kuti upiyona hunovhiringidza huve nyore.
> Sources:
> Iglesia CB uye Smithling KB. Pelvic Organ Prolapse. American Family Physician. 2017; 96 (3): 179-185.
> Miller KL, Kutambudzika TL. Gynecologic Disorders. Mu: Halter JB, Ouslander JG, Studenski S, High KP, Asthana S, Supiano MA, Ritchie C. eds. Hazzard's Geriatric Medicine uye Gerontology, 7e New York, NY: McGraw-Hill.
> Pelvic Organ Prolapse (POP). FDA.
> Woo J. Gynecologic Matambudziko. Mu: Papadakis MA, McPhee SJ, Rabow MW. eds. Kurapa Kwazvino Kwemishonga uye Kurapa 2018 New York, NY: McGraw-Hill.