Chronic prostatitis- one of the most common diseases among mature men. Inflammation of the prostate significantly reduces the quality of life and becomes a cause of psychosomatic and sexual disorders. Lack of adequate knowledge about the nature of the disease makes the treatment of chronic prostatitis a difficult task that requires a lot of patience from both the patient and the treating physician.
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Classification
The American National Institutes of Health (NIH USA) has developed and recommended the followingclassificationchronic prostatitis:
- chronic bacterial prostatitis;
- chronic non-bacterial inflammation of the prostate (with or without signs of inflammation);
- chronic, asymptomatic prostatitis.
Modern andrologists adhere to this classification in the diagnosis and treatment of inflammatory diseases of the prostate. Acute prostatitis is particularly noticeable. By knowing which category the identified pathology falls into, the physician will be able to select the optimal therapeutic regimen and achieve significant success in treating the disease.
Causes and risk factors
The division into bacterial and non-bacterial chronic prostatitis is not accidental. The different causes of the disease determine the tactics of treatment and greatly influence the outcome of the disease.
Chronic bacterial prostatitis
Chronic bacterial prostatitis occurs in 10-15% of patients. The direct cause of the disease is the penetration of the pathogenic and opportunistic flora into the prostate. By definition, the prostate is free of bacteria. Infection of the prostate is possible through the urethra as well as hematogenous and lymphogenic. The most common microorganisms detected during the test are:
- Escherichia coli (up to 95%);
- Proteus;
- klebsiella;
- pseudomonas.
Representatives of gram-positive flora (staphylococci, streptococci) are quite rare. In some cases, an increase in two or more microorganisms is observed (mixed infection). Possible infection with pathogenic flora (chlamydia, Trichomonas, gonococcus, etc. ).
Most of the microorganisms detected in the study are representative of the normal microflora. They do not normally damage the body and exist peacefully on the mucous membranes of the urinary system and digestive system. Under certain conditions, the conditionally pathogenic flora grows and multiplies, leading to inflammation of the prostate tissue and the appearance of all the symptoms of the disease.
Risk factorsdevelopment of chronic bacterial prostatitis:
- lack of personal hygiene;
- hypothermia;
- genital trauma;
- inflammatory diseases of the urinary system;
- the presence of STIs.
All this leads to a decrease in local and general immunity and a natural proliferation of the opportunistic flora in the prostate. It is possible that the infection may enter the urethra in the case of inflammatory diseases of the genitals. The likelihood of developing prostatitis increases with pre-existing urethritis, cystitis, colliculitis.
Chronic non-bacterial prostatitis
There are several theories about the occurrence of this form of the disease:
- Chemical inflammation theory. . . Discharging into the prostate during urination leads to the deposition of urine and the development of inflammation. Urethro-prostate reflux is caused by narrowing of the urethra (stenosis) and other developmental disorders.
- Immune theory. . . The variant is based on autoimmune damage to the tissues of the prostate gland resulting from exposure to bacterial antigens. The hereditary predisposition to this form of pathology is taken into account.
- Neurogenic theory. . . Violation of the pelvic innervation causes blood to stagnate in the organs and leads to the development of prostatitis.
The following also deserve special attention in the development of non-bacterial prostatitis.risk factors:
- long sitting;
- sedentary lifestyle;
- bad habits;
- stress and emotional overload;
- prolonged sexual abstinence.
These risk factors provoke the development of prostate congestion and lead to a violation of microcirculation in the pelvic organs. The microbial factor plays a role only in the early stages of the disease. In the future, its importance will decrease, autoimmune processes and trophic disorders in the tissues of the prostate will come to the fore.
According to statistics, 85-90% of men have non-bacterial chronic prostatitis (not directly related to infection with pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis occurs mainly in men aged 25-40 years. As the age progresses, the likelihood of developing the disease increases. In old age, inflammation of the prostate gland is often combined with an adenoma - a benign tumor of the prostate.
Signschronic prostatitis:
- dull aching pains in the lower abdomen;
- irradiation of pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during intercourse and defecation.
Urinary incontinence is very common:
- frequent urination;
- excretion of urine in small doses;
- feeling of incomplete emptying of the bladder;
- the appearance or intensification of pain while urinating;
- slow and intermittent urination.
The latter symptom is characteristic of prostate adenoma, which often occurs in the background of chronic prostatitis.
In the case of a long course of the disease, disorders occur in the sexual sphere:
- decreased libido;
- deterioration of erection;
- reducing the duration of intercourse;
- premature ejaculation;
- pulling pains in the lower abdomen after ejaculation;
- lack of spontaneous morning erection.
Chronic prostatitis is one of the leading causes of erectile dysfunction in which a man is unable to achieve and maintain an erection sufficient for complete sexual intercourse. Such a condition can significantly disrupt life, cause depression, and cause other psychoemic disorders.
Chronic, asymptomatic prostatitis occurs without clinical manifestations. The disease is accidentally detected during an examination by a urologist. Despite the absence of symptoms, prostatitis can lead to serious complications, erectile dysfunction and other health problems.
Complications
Initiated prostatitis causes the following conditions:
- abscess of the prostate;
- cystitis and pyelonephritis (inflammation of the bladder and kidneys);
- vesiculitis (inflammation of the seminal vesicles);
- erectile dysfunction;
- infertility.
The sooner the disease is detected and treatment is started, the greater the chance of a favorable outcome of the disease.
Diagnostics
The following methods are used to detect chronic prostatitis:
Urologist examination
Based on a personal discussion, the doctor will focus on the patient’s complaints. The genitals are examined and a digital rectal examination of the prostate is performed. By palpation, the doctor assesses the size and shape of the gland. In chronic prostatitis, the organ becomes slightly enlarged. The procedure is combined with the collection of prostate secretions for microbiological examination.
Four glass samples
The main method that allows the inflammatory process of the prostate to be identified and distinguished from other diseases. Material collection takes place in several stages. In the morning, after 5–6 hours away from the toilet, a man urinates in two vessels - for the first (initial) and second (middle) dose of urine. In the first part the contents of the urethra are washed away, in the second the bladder. A third of the urine is collected after the prostate massage and allows the condition of the prostate gland to be assessed. The secret of the prostate is collected separately for bacteriological culture.
In the analysis of urine, two parameters are evaluated: the number of leukocytes and the number of erythrocytes. In prostate disease, the number of white blood cells in the urine increases. Normally, their number does not exceed 10 in the field of view.
Microbiological examination
The three-glass assay not only evaluates the number of leukocytes, but also takes material for bacteriological inoculation. If chronic prostatitis is suspected, the doctor is particularly interested in a third of the urine. Based on the results of the test, the doctor can identify the pathogen of the disease and select the optimal antibiotic therapy.
Detection of opportunistic bacteria at titers greater than 10 is of diagnostic value.3Detection of CFU / ml or clearly pathogenic micro - organisms in any quantity.
Bacteriological culture of prostate secretion
During the prostate massage, the doctor will take the selected secretion for bacteriological examination before taking the third dose of urine. The result obtained also makes it possible to determine the diagnosis and treatment tactics.
Diagnostic criteria for chronic bacterial prostatitis:
- Identification of opportunistic microorganisms in the third part of urine or prostate secretion above 103CFU / ml.
- Detection of opportunistic bacteria in the third part of the urine or in the secretion of the prostate, the number of which is significantly (10 times) higher than in the second part of the urine.
- Identification of pathogenic microorganisms in the third part of urine or prostate secretion.
Ultrasound
Ultrasound allows the assessment of organ size and the identification of concomitant pathology. Often, chronic prostatitis is combined with a prostate adenoma, a benign tumor.
Management principles
The goal of therapy for chronic prostatitis is to stop the inflammatory process, activate blood flow, and improve the nutrition of the organs. If pathogenic or opportunistic microorganisms are detected in high titers, they are eliminated. Particular attention is paid to lifestyle correction and stimulation of the body’s defenses.
Drug treatment
The following are used to treat chronic prostatitismedicines:
- Antibacterial drugs are selected based on the identified pathogen.
- Anti-inflammatory drugs to reduce inflammation and relieve pain.
- Urinary aids (alpha-blockers that relax the muscles of the urethra and stimulate the outflow of urine).
- Devices that increase blood flow in the pelvic organs.
The choice of antibiotic depends on the pathogen identified. The ability to penetrate the haematoprostatic barrier and accumulate in prostate tissue should be considered when selecting a drug. These conditions are met by devices belonging to the group of fluoroquinolones. Macrolides and tetracyclines are also used to treat chronic inflammation of the prostate.
The European Association of Urology recommends that the course of antibacterial therapy should be at least 2 weeks after the preliminary diagnosis.
After receiving the results of bacteriological research and confirming the bacterial nature of the disease, the treatment lasts for 4-6 weeks. This approach makes it possible not only to get rid of the pathogen of the disease but also to prevent the recurrence of prostatitis.
Unfortunately, antibiotic therapy is not always effective. Many microorganisms have long been successful in prostate secretion and are becoming resistant to antibiotics. Bacteria form special biofilms and form colonies of microorganisms covered with a complex polysaccharide structure. Most antibacterial drugs are unable to cross this biological barrier, significantly reducing the effectiveness of therapy. This problem can be avoided by using modern antibiotics, which can not only penetrate and accumulate in the tissue of the prostate, but also pass through biofilms and infect such severely protected bacteria.
Non-drug therapy
Among non-drug treatments, special attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate, eliminates congestion and facilitates the secretion of secretions. The combination of massage and long-term use of antibacterial drugs is the main way to get rid of the unpleasant symptoms of chronic prostatitis.
In the treatment of chronic prostatitis, physiotherapeutic methods are used in conjunction with therapeutic effects. The use of ultrasound, laser beam, radio waves and electromyostimulation has a good effect. Prostate shock wave massage (UHM) is very popular. Physiotherapy is especially recommended for erectile dysfunction as a complication of prostatitis.
Particular attention is paid to diet in the treatment of prostatitis. The following foods should be excluded from the diet:
- alcohol;
- spicy food;
- fried and fatty foods (including fatty meats and fish).
Consumption of salt is limited to 5 g per day. Preference is given to fresh vegetables and fruits, herbs. Steaming is recommended.
Diet accelerates healing, strengthens the immune system, and helps the body cope with the stress caused by antibiotics in treating the disease.
ethnology
Not all men see a doctor when they develop symptoms of prostatitis. Men often treat them in more folk ways, using the knowledge base of many forums, relying on the advice of friends, relatives and neighbors. Neglect of one’s own health, rejection of rational antibiotic therapy and other traditional methods of exposure threatens to lead to complications and worsening of the general condition. Prostatitis that does not heal in time can cause erectile dysfunction. Is it worth taking the time to see a doctor in time and solve the problem with minimal loss?
Of course, there are aspects among the methods of traditional medicine that deserve special attention. Modern urology recognizes the efficacy of many herbs in the treatment of chronic prostatitis. Experts recommend herbal preparations consisting of the following ingredients:
- pumpkin seed oil;
- round leaf evergreen;
- garden parsley;
- St. John's wort perforate;
- Canadian goldenrod;
- licorice;
- echinacea.
Individually or in combination, these components stimulate blood flow to the pelvic organs, relieve congestion, and stimulate the immune system.
Herbs do not rid the body of pathogenic bacteria, but they help to remove the symptoms of the disease.
Combined with antibacterial drugs and prostate massage, herbal remedies significantly improve overall condition and speed healing.
Prophylaxis
The following will help reduce your risk of developing chronic prostatitis: recommendations:
- Hypothermia of the whole body and of the genitals, pelvis and lower extremities should not be allowed. It is worth wearing thermal underwear in the cold season.
- It is necessary to follow intimate hygiene rules and use a condom to protect against STIs. The best prevention of infection is to avoid casual sex.
- You need to be mindful of your health and treat your diseases of the genitals in a timely manner.
- There will be no need to follow a diet (stop eating spicy, fried and fatty foods) and keep your body in good shape (sports, fitness, walking).
It is recommended for all men over the age of 30 to have a regular urological examination (at least once a year). If you notice any unpleasant symptoms, you should see a doctor as soon as possible.
F. A. Q
Can Chronic Prostatitis Be Cured?
Contrary to popular belief, chronic prostatitis can be successfully treated. If you follow all the recommendations of your doctor, you can get rid of the unpleasant symptoms of prostatitis and significantly improve your quality of life.
Can chronic prostatitis be asymptomatic?
Yes, this variant of the disease is only detected after examination by a urologist.
Is a partner's chronic prostatitis dangerous for a woman?
Sexually transmitted infections often cause chronic prostatitis. If a pathogen is identified, treatment should be performed by both partners. Otherwise, there is a risk of infection and the effectiveness of the therapy is reduced due to relapse.
Is sexual intercourse possible with chronic prostatitis?
Yes, if the general condition allows and there is no problem in the sexual sphere (erectile dysfunction).
Is it possible to conceive a child with chronic prostatitis?
Yes, if the prostate function is maintained and its secret is fully developed. It is recommended that a urologist be examined and treated before conception. An infection that causes inflammation of the prostate can be easily passed on to a woman. Intrauterine infection of the fetus can cause developmental abnormalities and termination of pregnancy.
How does chronic prostatitis affect potency?
Chronic inflammation of the prostate threatens to cause erectile dysfunction. With such pathology, a decrease in libido is observed, the frequency and intensity of erections are reduced, and orgasm becomes painful. In advanced cases, sexual activity becomes impossible.
Can chronic prostatitis be cured without antibiotics?
Antibiotic therapy is one of the most important treatments for chronic prostatitis. In most cases, it is impossible to cope with the disease without antibiotics.
Can chronic prostatitis be treated with folk remedies?
Chronic prostatitis cannot be eliminated with conventional medicine. In order to achieve the optimal effect, complex treatments with antibiotics, herbal preparations, anti-inflammatory agents and physiotherapeutic methods are performed.