Whakaheke Toto Mai I Te Tara

He whākōkī whakaheke he tuwhera motuhake e hanga ana i waenga i te weronga me tetahi atu whekau, penei i te pūngāwerewere, te kōroke, te tūpae rānei. Āta kōrero ai tō kaimahi hauora mō te whākōkī whakaheke hei rua i roto i te weronga e tuku ana i te mimi, te hau, te paru rānei ki te haere mā te weronga.

Ka taea te hanga i ngā whākōkī whakaheke i muri i te whānautanga, i muri rānei i te whara, te pokanga, te mate, te maimoatanga radiation rānei. Pea ka hiahia koe ki te pokanga hei whakatika i te whākōkī.

He maha ngā momo whākōkī whakaheke. I whakahuatia rātou i runga i te wāhi o te whākōkī me ngā whekau e pā ana:

• Te whākōkī pūngāwerewere-whakaheke. Te huinga ano he whākōkī pūngāwerewere, ka hanga tēnei tuwhera i waenga i te weronga me te pūngāwerewere mimi. Ko tēnei tetahi o ngā whākōkī tino noa.
• Te whākōkī ureterovaginal. Ka puta tēnei momo whākōkī ina hangaia he tuwhera motuhake i waenga i te weronga me ngā tūpū e kawe ana i te mimi mai i ngā whatukuhu ki te pūngāwerewere. Ko ēnei tūpū te ingoa ko ngā ureters.
• Te whākōkī urethrovaginal. Ka hanga te tuwhera i waenga i te weronga me te tūpū e kawe ana i te mimi ki waho o te tinana, te ingoa ko te urethra. Ka kiia hoki tēnei momo whākōkī he whākōkī urethra.
• Te whākōkī tūpae-whakaheke. I roto i tēnei momo whākōkī, kei waenga i te weronga me te wāhanga raro o te puku nui, te ingoa ko te tūpae.
• Te whākōkī kōroke-whakaheke. Ka puta te tuwhera i waenga i te weronga me te kōroke.
• Te whākōkī enterovaginal. Ko te tuwhera kei waenga i te puku iti me te weronga.

Ngā tohu o te fistula whakaheke ka uru ki:

• Te rere o te mimi, te paru, te hau rānei, i roto i te tara.
• Ngā mate pūnaha mimi e puta ana i te wā maha.
• Te mimi he kakara ke, he toto rānei kei roto.
• Te wai tara e kiia nei he whakaheke, he ahua ke rānei, he kakara ke rānei.
• Te mamae i te wā o te moe wahine.
• Te mamae, te pupuhi, te mamae rānei i te wāhi i waenganui i te tara me te tara, e kiia nei ko te perineum.
• Ngā mate tara e puta ana i te wā maha.

Ko ngā tohu tika e pā ana ki te tangata e whakawhirinaki ana ki te wāhi o te fistula.

Haere ki te tātaritanga hauora mena ka whakaaro koe kei a koe ngā tohu o te fistula whakaheke. Korero atu ki tō kaimahi hauora mena kei a koe ngā tohu e pā ana ki tō oranga o ia rā, ngā whanaungatanga, te hauora hinengaro rānei.

He tokomaha ngā take ka puta ai ngā fistula whakaheke, tae atu ki ētahi āhuatanga hauora me ngā raruraru ka puta mai i te pokanga. Kei roto i ēnei take ngā mea e whai ake nei:

• Ngā raruraru pokanga. Ka taea e ngā pokanga e pā ana ki te pakitara o te whakaheke, te tara, te tūtae rānei te whakaputa i ngā fistula whakaheke. Ka taea hoki e te pokanga i te wāhi i waenganui i te whakaheke me te tara, e kiia nei ko te perineum. Ka taea te hanga i ngā fistula mō ngā take pēnei i ngā whara i te wā e pokanga ana me ngā mate pukupuku i muri i te pokanga. Ka taea e ngā tākuta pokanga pūkenga te whakatika i ngā whara i te wā e mahi ana, ā, ka whakaiti i te tūponotanga o te fistula. Engari he maha atu ngā raruraru pēnei i ngā fistula i muri i te pokanga i ngā tāngata e mate huka ana, i ngā tāngata rānei e whakamahi ana i te tapeka.

He tauira te pokanga hei tango i te kopu, e kiia nei ko te hysterectomy, o te mahi ka taea te whakapiki i te tūponotanga o te fistula whakaheke. Ka nui ake te tūponotanga ki te uaua ake te hysterectomy. Hei tauira, ka piki ake te tūponotanga ki te roa atu i te rima haora te pokanga, ki te nui ake rānei te ngau toto, ki te tango rānei i te tini atu o ngā kōpū e karapoti ana.

• Ngā whara whānau tamariki. Ka puta mai pea te fistula whakaheke i te pakaru e puta ana i te wā e puta mai ana te ūtū o te pēpi i te waha o te whakaheke. Rānei ka taea te hanga i te fistula nā te mate pukupuku o te kotinga pokanga i mahia i waenganui i te whakaheke me te tara hei āwhina i te whānau tamariki. Kāore i te noa tēnei take i ngā whenua whānui.

Ko te roa o te wā i te whānau tamariki nā te kore e taea e te pēpi te neke ki te kaupapa whānau tamariki ka taea te whakapiki i te tūponotanga o te fistula whakaheke, te nuinga i ngā whenua e whanake ana. Koia tētahi wāhanga nā te iti o te uru atu ki ngā tikanga whānau tamariki āwhina pēnei i te C-section.

• Te mate a Crohn. Ka pā tēnei āhuatanga ki te kōpū e taupoki ana i te ara kai. Ki te whai koe i tō mahere maimoatanga Crohn, kāore pea koe e whiwhi i te fistula whakaheke. He momo mate pukupuku kopū (IBD) te Crohn. He momo IBD anō e kiia nei ko te mate pukupuku ulcerative ka taea hoki te arahi ki ngā fistula whakaheke, engari he iti ake te tūponotanga o taua mea.
• Ētahi mate pukupuku me te rongoā radiation. Ka taea e te mate pukupuku o te tara, te tūtae, te whakaheke, te cervix rānei te arahi ki te fistula whakaheke. Ka taea hoki e te kino mai i te rongoā radiation mō te maimoatanga o te mate pukupuku i te rohe pelvic.
• Te mate diverticulitis. Kei roto i tēnei āhuatanga ngā putea iti, pupū i te ara kai. He maha atu te diverticulitis e arahi ana ki te fistula whakaheke i ngā tāngata pakeke.
• Te nui o te tūtae e mau ana i te tūtae. E mohiotia ana tēnei āhuatanga ko te fecal impaction. He maha atu hoki te tūponotanga ki te whakaputa i te fistula whakaheke i te tangata pakeke.

Kāore he tohu morearea mārama mō te fistula whakaheke.

Ka taea e ngā fistula whakaheke te arahi ki ētahi atu āhuatanga hauora e kiia nei ko ngā raruraru. Kei roto i ngā raruraru o ngā fistula whakaheke:

• Ngā fistula e hoki mai tonu ana.
• Ngā mate pukupuku kei te haere tonu.
• Te whakaiti o te tara, o te tara, o te tūtaratanga. E kiia ana tēnei ko te stenosis.
• Te raruraru ki te hapu.
• Te ngaro o te haputanga i muri i te 20 wiki, e kiia ana hoki ko te whānau mate.

Kāore he mahi hei whakamātau kia ārai ai i te fistula whakaheke.

He maha ngā huarahi e taea ai e tō kaimahi hauora te kimi mena ko te fistula whakaheke te take o ō tohu. Ka ui atu rātou ki a koe mō ō hītori hauora. Ka whiwhi koe i te whakamātau tinana, ā, ka uru pea tētahi whakamātau i te kopu. Ka hiahia pea koe ki ētahi atu whakamātau.

I te wā o te whakamātau tinana, ka tirotirohia e tō kaimahi hauora te taha o waho o tō tara, o tō tara, me te wāhi kei waenganui i ngā rua, e kiia nei ko te perineum. Ka rapu tō kaimahi hauora i ngā tohu pēnei i te toka, te tukunga tara koretake, te rerenga mimi, te paru rānei, me ngā putea puru e kiia nei ko ngā abscesses.

Mēnā kaore i kitea te fistula whakaheke i te wā o te whakamātau tinana, ka hiahia pea koe ki ētahi atu whakamātau. Ka uru pea ēnei ki ngā mea e whai ake nei:

• Whakamātau tae. I roto i tēnei whakamātau, ka whakakiia e tō kaimahi hauora tō putea mimi ki te otinga tae, ka tono ki a koe kia tohe, kia pēhia rānei. Ki te pēhea koe he fistula whakaheke, ka puta te tae ki tō tara. Ka kitea pea e koe ngā tohu o te tae i te tampon i muri i te whakakori tinana.
• Cystoscopy. I te wā o tēnei whakamātau, ka whakamahi tō kaimahi hauora i tētahi taputapu kōhū e whai karārehe ana. Ko te taputapu e kiia nei ko te cystoscope. Mā te cystoscope, ka taea e tō kaimahi hauora te kite ki roto i tō putea mimi. Ka taea hoki te kite i te taha o roto o te pūnaha iti e kawe ana i te mimi ki waho o te tinana, e kiia nei ko te urethra. Ka taea ai e tō kaimahi hauora te tirotiro i ngā raruraru.
• Retrograde pyelogram. I roto i tēnei whakamātau, ka whakauruhia e tō kaimahi hauora tētahi mea ki tō putea mimi me ngā pūnaha e hono ana i te putea mimi ki ngā whatukuhu, e kiia nei ko ngā ureters. Katahi ka tangohia he X-ray. Ka taea e te whakaahua X-ray te whakaatu ki tō kaimahi hauora mena he tuwhera kei waenganui i te ureter me te tara.
• Fistulogram. He whakaahua X-ray o te fistula te fistulogram. Ka āwhina pea tēnei whakamātau i tō kaimahi hauora ki te kite mena he nui atu i te kotahi fistula. Ka taea pea e tō kaimahi hauora te kite i ngā atu whekau kopu ka pā pea ki te fistula.
• Flexible sigmoidoscopy. I te wā o tēnei whakamātau, ka whakamahi tō kaimahi hauora i tētahi pūnaha angiangi, ngawari, he kamera iti kei te pito. Ko te taputapu e kiia nei ko te sigmoidoscope. Ka taea ai e tō kaimahi hauora te tirotiro i te tara me te rectum.
• Computerized tomography (CT) urogram. I roto i tēnei whakamātau, ka whakauruhia ki a koe tētahi mea whakapae ki roto i te uaua. Katahi ka whakamahi tō kaimahi hauora i te CT scan hei hanga i ngā whakaahua o te tara me te ara mimi.
• Magnetic resonance imaging (MRI). Ka whakamahi te MRI i te mara hiko me ngā ngaru reo hei hanga i ngā whakaahua taipitopito o ngā whekau me ngā kiko o te tinana. Mā te MRI kopu, ka taea e tō kaimahi hauora te kite i te huarahi o te fistula kei waenganui i te tara me te rectum.
• Colonoscopy. Ka whakamahia tēnei i tētahi pūnaha ngawari, he pito kamera hei tirotiro i ngā huringa i te puku nui me te rectum.

Mēnā ka kitea e ngā whakamātau whakaahua he fistula whakaheke, ka tango pea tō kaimahi hauora i tētahi tauira iti o te kiko. E kiia ana tēnei ko te biopsy. Ka tirotirohia e te taiwhanga te tauira biopsy mō ngā tohu o te mate pukupuku. Kāore i te noa, engari ko ētahi fistula whakaheke ka puta mai i te mate pukupuku.

Ka hiahia pea koe ki ngā whakamātau taiwhanga hei awhina i te kimi i te take o ō tohu. Ka uru pea ēnei ki ngā whakamātau o tō toto me tō mimi.

Ko te rongoā mō te fistula whakaheke wahine e whakahaeretia ana e ngā take penei i te momo fistula kei a koe, tōna rāhi me te hauora o te kiko e karapotia ana.

Mo te fistula whakaheke wahine ngāwari, tetahi rānei e torutoru ana ngā tohu, ka āwhina pea etahi tikanga kia ora ake te fistula. He fistula whakaheke wahine ngāwari pea tētahi e iti ana, tetahi rānei kaore i hono atu ki te mate pukupuku, ki te rongoā radiation rānei. Kei roto i ngā tikanga hei āwhina i te ora o te fistula whakaheke wahine ngāwari:

• Te whakanoho i te catheter mimi. He taputapu hauora te catheter ka taea pea te whakaora i ngā fistula iti i waenganui i te tara me te putea mimi. He pūtu rapa ngawari te catheter mimi e whakaheke ana i te putea mimi. Me whakamahi pea koe i te mea neke atu i te toru wiki.
• Te whakauru i te stent ureteral. Ka taea e tēnei tikanga te whakaora i ētahi fistula i waenganui i te tara me ngā ureters. Ka whakanohoia he pūtu kaupapa e kiia nei he stent ki roto i te ureter kia tuwhera tonu.

Mo te fistula ngāwari i waenganui i te tara me te tūtae, me whakarereke pea koe i tō kai. Ka tūtohu pea hoki tō kaiāwhina hauora i ngā taapiri hei whakamahi i te tūtae kia ngawari ake te puta.

I te nuinga o te wā, me mahi te pokanga hei whakaora i te fistula whakaheke wahine. I mua i te mahi pokanga, me whakaora ngā mate pāwera, ngā pupuhi rānei i te kiko e karapotia ana te fistula whakaheke wahine. Ki te pangia te kiko e te mate pāwera, ka taea e ngā rongoā e kiia nei ko ngā antibiotics te whakakore i te mate pāwera. Ki te pupuhi te kiko nā te āhuatanga penei i te mate a Crohn, ka whakamahia ngā rongoā penei i ngā biologics hei whakahaere i te pupuhi.

Ko te whāinga o te pokanga mō te fistula whakaheke wahine ko te tango i te ara fistula me te tuitui i te kiko hauora kia kati te wahi tuwhera. I etahi wā, ka whakamahia he papa i hangaia mai i te kiko hauora hei āwhina i te kati i te wāhi. Ka taea te mahi pokanga mā te tara, mā te puku rānei. I te nuinga o te wā, ka taea te mahi i tētahi momo pokanga e whakauru ana i tetahi, neke atu rānei i te kotahi ngā tapahi iti. E kiia ana tenei ko te pokanga laparoscopic. Ka whakahaere hoki ētahi taote i ngā ringa robotic me te kamera me ngā taputapu pokanga e hono atu ana.

Ko ētahi tangata e pangia ana e ngā fistula i waenganui i te tara me te tūtae me mahi te pokanga hei whakatika i te pakaru o te porowhita o te uaua e tata ana e kiia nei ko te anal sphincter. Ina hauora te anal sphincter, ka pupuri i te tūtae kia kati te tara i te wā e kohikohi ana te tūtae ki roto i te tūtae.

I te iti o te wā, ko ngā tangata e pangia ana e ngā fistula i waenganui i te tara me te tūtae me mahi tētahi tikanga e kiia nei ko te colostomy i mua i te pokanga. Mā te colostomy, ka hangaia he wahi tuwhera ki te puku ka taea ai te puta te tūtae mai i te tinana me te kohikohi ki roto i te putea. Ka āwhina tenei i te ora o te fistula. Ko te tikanga he mea wātea noa. Ka kati te wahi tuwhera colostomy i muri i ngā marama torutoru i muri i te pokanga fistula. Ko te iti rawa, he mea pumau te colostomy.

Ko te pokanga hei whakatika i te fistula whakaheke wahine he angitu i te nuinga o te wā, ina koa ki te kore koe i roa te pangia e te fistula. Engari, ko ētahi tangata me mahi neke atu i te kotahi pokanga kia ora ai.

Kaore he uauatanga