Chronic prostatitis is one of the most common diseases among adult men. Inflammation of the prostate gland significantly reduces the quality of life, causing psychosomatic and sexually transmitted diseases. Lack of knowledge about the nature of this disease makes the treatment of chronic prostatitis a difficult task that requires a lot of patience from both the patient and the doctor.
Prostatitis is an inflammatory-degenerative lesion of the prostate gland.
Classification
The American National Institutes of Health (NIH) has developed and proposed the following classification of chronic prostatitis:
- chronic bacterial prostatitis;
- chronic non-bacterial prostatitis (with and 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 distinguished. A doctor who knows the category of the identified pathology will be able to choose the optimal therapy regimen and achieve significant success in the treatment of the disease.
Causes and risk factors
The division into bacterial and non-bacterial chronic prostatitis is not accidental. Different causes of the disease determine the tactics of treatment and mainly affect the outcome of the disease.
Chronic bacterial prostatitis
Chronic bacterial prostatitis occurs in 10-15% of patients. The immediate cause of the development of the disease is the penetration of pathogenic and opportunistic flora into the prostate. By definition, the prostate gland is free of bacteria. Infection of the prostate is possible through the urinary tract, as well as hematogenous and lymphogenic. The following microorganisms are most often detected during the examination:
- Escherichia coli (up to 95%);
- Proteus;
- klebsiella;
- pseudomonas.
Representatives of Gram-positive flora (staphylococci, streptococci) are very rare. In some cases, the growth of two or more microorganisms is noted (mixed infection). Possible infection with pathogenic flora (chlamydia, Trichomonas, gonococci and others).
Most of the microorganisms detected during the examination are representatives of the normal microflora. Under normal conditions, they do not harm the body and are easily present in the mucous membranes of the urinary system and digestive system. Under certain conditions, conditionally pathogenic flora grows and multiplies, which leads to inflammation of the prostate tissue and the appearance of all the symptoms of the disease.
Risk factors for the development of chronic bacterial prostatitis:
- non-observance of personal hygiene;
- hypothermia;
- sexual trauma;
- inflammatory diseases of the urinary system;
- Presence of CYBs.
All this leads to a decrease in local and general immunity and the natural proliferation of opportunistic flora in the prostate. In inflammatory diseases of the genital tract, it is possible that the infection can pass through the urinary tract. Existing urethritis, cystitis, colliculitis increase the likelihood of developing prostatitis.
Chronic non-bacterial prostatitis
There are several theories about the occurrence of this form of the disease:
- Chemical inflammation theory. . . Urination of the prostate during urination leads to the deposition of urate and the development of inflammation. It is facilitated by urethro-prostate reflux, narrowing of the urethra (stenosis) and other developmental abnormalities.
- Theory of immunity. . . The version is based on autoimmune damage to prostate tissue as a result of exposure to bacterial antigens. This pathological form is considered a hereditary predisposition.
- Neurogenic theory. . . Disruption of innervation in the pelvic region leads to stagnation of blood in the organs and the development of prostatitis.
The following risk factors in the development of non-bacterial prostatitis also deserve special attention:
- long sedentary work;
- sedentary lifestyle;
- bad habits;
- stress and emotional overload;
- long-term sexual abstinence.
These risk factors lead to the development of prostate obstruction, which leads to disruption 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 decreases, and autoimmune processes and trophic diseases in the tissues of the prostate gland come to the fore.
According to statistics, 85-90% of men have non-bacterial chronic prostatitis (not directly associated with pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis mainly occurs in men aged 25-40 years. With age, the likelihood of developing the disease increases. In old age, inflammation of the prostate gland is often associated with an adenoma - a benign tumor of the prostate.
Symptoms of chronic prostatitis:
- dull aching pains in the lower abdomen;
- radiation of pain in the groin, scrotum, perineum, waist, sacrum;
- Increased anxiety during sexual intercourse and bowel movements.
Urinary incontinence is very characteristic:
- frequent urination;
- urination in small portions;
- feeling of incomplete emptying of the bladder;
- appearance or intensification of pain when urinating;
- slow and intermediate urine flow.
The latter symptom is characteristic of prostate adenoma, which often occurs against the background of chronic prostatitis.
There are sexual disorders with a long course of the disease:
- decreased libido;
- worsening of erection;
- reduction in contact time;
- premature ejaculation;
- pain in the lower abdomen after ejaculation;
- lack of spontaneous morning erection.
Chronic prostatitis is one of the main causes of erectile dysfunction, when a man cannot achieve an erection enough for full sexual intercourse. Such a situation significantly disrupts the lifestyle and can lead to depression and other psycho-emotional disorders.
Chronic asymptomatic prostatitis occurs without any clinical manifestations. The disease is discovered by chance during a urologist's examination. Although there are no symptoms, inflammation of the prostate gland can lead to serious complications, erectile dysfunction and other health problems.
Complications
Onset prostatitis causes the development of the following conditions:
- prostate abscess;
- 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 better the chances of a favorable outcome of the disease.
Diagnostics
The following methods are used to detect chronic prostatitis:
Urologist's examination
In a personal meeting, the doctor focuses on the patient's complaints. External genitalia are examined and a digital rectal examination of the prostate is performed. During palpation, the doctor assesses the size and shape of the gland. In the case of chronic prostatitis, the body will grow a little. The procedure is combined with the collection of prostate secretions for microbiological examination.
Sample of four bottles
The main method that allows to identify the inflammatory process in the prostate and distinguish it from other diseases. Material collection takes place in several stages. In the morning, 5-6 hours after refraining from going to the toilet, a man excretes urine in two jars - for the first (first) and second (middle) part of the urine. In the first part, the contents of the urethra, in the second - the bladder is washed. A third of the urine is collected after a prostate massage and allows the condition of the prostate gland to be assessed. The secretion of the prostate gland is collected separately for bacteriological culture.
Urine analysis evaluates two parameters: leukocyte and erythrocyte count. With prostate disease, the number of white blood cells in the third part of the urine increases. Normally, their number does not exceed 10 in the field of view.
Microbiological examination
During the three-bottle test, not only the number of leukocytes is assessed, but also the material for bacteriological vaccination. If you suspect chronic prostatitis, your doctor is especially interested in the third part of the urine. Based on the results of the examination, the doctor can determine the cause of the disease and choose the optimal antibiotic therapy.
Detection of opportunistic bacteria in more than 10 titers is of diagnostic value.3Detection of CFU / ml or a certain amount of pathogenic microorganisms.
Bacteriological culture of prostate secretion
Bacteriological semen of prostate fluid allows you to assess the nature of the process (infectious or non-infectious) and determine the type of pathogen.
During a prostate massage, before taking a third of the urine, the doctor takes the secretion for bacteriological examination. The result also allows to determine the diagnosis and treatment tactics.
Diagnostic criteria for chronic bacterial prostatitis:
- Detection of opportunistic microorganisms in the third part of urine or prostate secretion at titers above 103CFU / ml.
- Detection of opportunistic bacteria in the third part of the urine or prostate, the number of which is much higher (10 times) than in the second part of the urine.
- Detection of pathogenic microorganisms in the third part of urine or prostate secretion.
Ultrasound
Ultrasound examination allows you to assess the size of the body and identify the accompanying pathology. Chronic prostatitis is often associated with prostate adenoma - a benign tumor.
Principles of treatment
The goal of treatment for chronic prostatitis is to eliminate the inflammatory process, activate blood flow and improve organ nutrition. When pathogens or opportunistic microorganisms are detected at high titers, they are eliminated. Particular attention is paid to improving lifestyle and stimulating the body's defenses.
Drug treatment
The following drugs are used to treat chronic prostatitis:
- Antibacterial drugs are selected taking into account the identified pathogen.
- Anti-inflammatory drugs to reduce inflammation and reduce pain.
- Urinary facilitators (alpha-blockers that relax the muscles of the urethra and stimulate urine flow).
- Means that increase blood flow to the pelvic organs.
The choice of antibiotic will depend on the identified pathogen. When choosing a drug, it is necessary to take into account the ability to penetrate the hematoprostatic barrier and accumulate in the tissues of the prostate gland. These conditions are derived from the group of fluoroquinolones. Macrolides and tetracyclines are also used to treat chronic prostatitis.
According to the recommendations of the European Union of Urology, the course of antibacterial therapy should last at least 2 weeks after the initial diagnosis.
After confirming the results of bacteriological studies and the bacterial nature of the disease, treatment lasts up to 4-6 weeks. This approach allows not only to get rid of the causative agent of the disease, but also to prevent the recurrence of prostatitis.
Unfortunately, antibiotic therapy is not always effective. Many microorganisms have been successfully present in the secretion of the prostate for a long time and become resistant to antibiotics. Bacteria form special biofilms and form colonies of microorganisms covered by a complex polysaccharide structure. Most antibacterial drugs are unable to penetrate this biological barrier, which significantly reduces the effectiveness of therapy. This problem can be avoided by the use of modern antibiotics, which can penetrate the tissue of the prostate gland and keep warm inside, as well as pass through biofilms and infect bacteria that are under such strict protection.
Non-drug treatment
Among non-drug treatments, special attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate gland, removes blockages and facilitates the removal of secretions. The combination of massage and long-term use of antibacterial drugs is the main way to relieve a man of the unpleasant symptoms of chronic prostatitis.
In the treatment of chronic prostatitis, in addition to drug effects, physiotherapeutic methods are also used. The use of ultrasound, laser beams, radio waves and electromyostimulation has a good effect. Prostate shock wave massage (UHM) is very popular. Physiotherapy is especially indicated in the presence of erectile dysfunction as one of the complications of prostatitis.
In the treatment of prostatitis, special attention is paid to diet. The following foods should be excluded from the diet:
- alcohol;
- spicy, spicy food;
- fried and fatty foods (including fatty meat and fish).
Salt consumption is limited to 5 g per day. Fresh vegetables, fruits and herbs are preferred. Steaming is recommended.
Eating a diet will speed healing, strengthen the immune system, and help the body fight the stress caused by antibiotics when treating a disease.
ethnology
Not all men see a doctor when they have symptoms of prostatitis. Men often prefer to be treated with folk remedies, using a database of numerous 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 action threatens the development of complications and worsening of the general condition. Untreated prostatitis can lead to erectile dysfunction. Is it worth the risk if you can see a doctor in time and solve the problem with minimal losses?
Of course, there are some aspects of traditional medicine that deserve special attention. Modern urology recognizes the effectiveness of many herbs in the treatment of chronic prostatitis. Experts recommend herbal preparations based on the following ingredients:
- pumpkin seed oil;
- winter green with round leaves;
- garden parsley;
- St. John's wort perforatum;
- Canadian goldenrod;
- licorice root;
- echinacea.
Individually or together, these components stimulate blood flow to the pelvic organs, remove blockages and stimulate the immune system.
Phytopreparations will not free the body from pathogenic bacteria, but will help to eliminate the symptoms of the disease.
Herbal medicines, along with antibacterial drugs and prostate massage, significantly improve the overall condition and speed up recovery.
Prevention
The following recommendations will help reduce the risk of developing chronic prostatitis:
- Hypothermia of the entire body and genital area, pelvis and lower extremities should not be allowed. It is worth wearing thermal underwear in the cold season.
- In order to protect against sexually transmitted diseases, it is necessary to follow the rules of intimate hygiene and use condoms. The best way to prevent infection is to avoid casual sex.
- You need to take care of your health and treat genital diseases in a timely manner.
- It is no longer necessary to follow a diet (avoid spicy, fried and fatty foods), as well as to keep your body in good shape (exercise, fitness, walking).
It is recommended that all men over the age of 30 have regular check-ups by a urologist (at least once a year). If you experience any unpleasant symptoms, you should consult your doctor as soon as possible.
Questions
Can chronic prostatitis be treated?
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 detected only after examination by a urologist.
Is chronic prostatitis in a partner dangerous for a woman?
Sexually transmitted infections are often the cause of chronic prostatitis. When a pathogenic agent is detected, treatment on both sides is necessary. Otherwise, there is a risk of infection and the effectiveness of therapy is reduced due to recurrence of the disease.
Is it possible to have sex with chronic prostatitis?
Yes, if the general condition allows and there are no problems in the sexual sphere (erectile dysfunction).
Is it possible to conceive a child with chronic prostatitis?
Yes, if the function of the prostate is preserved and the secretion is fully developed. It is recommended that a child be examined and treated by a urologist before becoming pregnant. The infection that causes the development of prostatitis is easily transmitted to a woman. Infection of the fetus in the uterus can lead to developmental abnormalities and termination of pregnancy.
How does chronic prostatitis affect your potential?
Chronic inflammation of the prostate gland threatens the development of erectile dysfunction. With such a pathology there is a decrease in libido, the frequency and intensity of erections decreases, orgasm becomes painful. In advanced cases, sexual activity becomes impossible.
Can chronic prostatitis be treated without antibiotics?
Antibiotic therapy is one of the main 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?
Getting rid of chronic prostatitis with traditional medicine alone will not work. Complex treatment is carried out using antibiotics, herbal medicines, anti-inflammatory drugs and physiotherapy methods to achieve the optimal effect.