According to statistics, about 40% of men with symptoms of prostatitis do not see a doctor. However, the consequences of the disease, including the risk of male infertility, are very severe. Find out what symptoms you need to see a doctor and what you need to do to avoid getting sick.
What is prostatitis
Prostatitis is an inflammation of the prostate or prostate, it is one of the most common "male" diseases. Prostatitis is very different, they can occur with and without infection, with insufficient sexual activity and excess, and so on. This article will help you understand the basic nuances of the disease.
About 10% of men experience symptoms of chronic prostatitis, but only about 60% seek medical attention (Nickel JC et al. , 2001).
Prostatitis affects men of all ages and its prevalence is steadily increasing. Men under the age of 50 account for 65, 2% of patients, and according to various sources, the overall prevalence of the disease among men is 13, 2–35% (Lummus W. F. , 2001; Meares E. M. , 1990). According to other data, 8-35% of men aged 20-40 suffer from prostatitis. Among older men, the real picture is "obscured" by the incidence of benign prostatic hyperplasia (prostate adenoma) because their symptoms are largely the same. Up to 65% of patients with adenoma are operated on with recognized prostatitis. (Nickel JC et al. , 2007). Given that inflammatory diseases of the genitals are common causes of male infertility, scientists are talking about a threat to the nation’s reproductive health.
What is prostatitis
Simple acute and chronic divisions are not enough to characterize prostatitis, the disease has a number of syndromes with different clinical course. Consider what forms of the disease are segregated according to modern classification (Krieger JN et. Al, 1999).
Category I: Acute bacterial prostatitis. . . It is a relatively rare species, accounting for only 5% of cases. This is a consequence of a urinary tract infection, in the background of predisposing factors (impaired urine output, suppressed immunity). In 5% of cases, it becomes chronic bacterial prostatitis.
Category II: Chronic bacterial prostatitis. . . It is also a rare disease that is considered a recurrent urinary tract infection, the main focus being on the prostate.
Category III: Chronic prostatitis / chronic pelvic pain syndrome. . . Previously, this disease was termed chronic abacterial prostatitis, and it accounts for 95% of all prostatitis diagnosed (Habermacher GM, 2006). Chronic pain syndrome combines pathologies characterized by urological pain in the absence of urinary tract infection. It does not include urethritis, cancers, urethral stricture, neurological damage to the bladder. Divided into categories IIIa and IIIb: with signs of inflammation and not with signs of inflammation. These signs are determined by laboratory tests, primarily the presence of leukocytes in the urine or prostate secretion.
Category IV: Asymptomatic inflammatory prostatitis. . . Random finding during patient examination. It is most commonly diagnosed when men are tested for infertility or elevated levels of the PSA marker in the blood. We do not examine this type of disease in detail, as scientists have not yet developed a unified picture of this form (Nickel JC, 2011).
Symptoms of prostatitis
Symptoms of acute prostatitis
The disease begins sharply, there is pain in the perineum, and the body temperature rises. Urinary stimuli are common (at least 5-7 per night), urination becomes painful and difficult. Urine is produced in intermittent doses, there is no satisfaction with urination. Blood is found in the last parts of the urine. The pain is worse than defecation. It is a serious illness that needs urgent help.
Complications of acute prostatitis:
- acute urinary retention;
- abscess of the prostate (formation of purulent focus);
- paraprostatitis (inflammation of the tissue around the gland, caused by a breakthrough abscess);
- paraprostatic venous plexus phlebitis (inflammation of the surrounding veins).
Symptoms of chronic prostatitis
All types of chronic prostatitis (both bacterial and chronic pelvic pain syndrome) are similar. The picture of the disease is very variable, the symptoms of which can vary in severity are listed below.
- Pain:
- pain or discomfort in one of the characteristic areas (groin, subcutaneous tissue, testicles, penis, lower back, abdomen, rectum);
- pain when urinating or increased pain when urinating;
- pain during or after ejaculation;
- increased sensitivity of the perineum muscles;
- neuropathic pain;
- pain due to intestinal irritation.
- Urinary symptoms:
- lower urinary tract symptoms (LUTS) with urination (desire to empty the bladder, incontinence, urination, nocturnal urination, pain when urinating);
- Obstructive LUTS (poor urine pressure, intermittent flow, pressure requirement);
- burning sensation in the urethra;
- recurrent urinary tract infections.
- Sexual dysfunctions:
- erectile dysfunction;
- violation of ejaculation (premature or delayed ejaculation, blood in semen);
- decreased libido.
- Psychosocial symptoms:
- anxiety;
- depression;
- cognitive and behavioral disorders;
- deteriorated quality of life.
Men with chronic pelvic pain syndrome are more likely to experience psychological stress and sexual dysfunction (A. Mehik, 2001).
If you develop symptoms of prostatitis and chronic pelvic pain syndrome, you should see a urologist or andrologist. In case of severe symptoms of acute prostatitis, you should seek emergency help to prevent urinary retention and other complications.
Causes of prostatitis
Inflammation of the prostate is caused by a number of factors. In the absence of predisposing factors, a healthy gland is able to resist infection and inflammation. The onset of the disease is facilitated by a decrease in immunity, a violation of the outflow of secretions from the prostate, improper sexual order, difficulty in the outflow of urine, and deterioration of blood circulation in the pelvic organs. Other risk factors include a cold climate, alcohol consumption and a sedentary lifestyle.
Acute prostatitis is a bacterial inflammation, the most common pathogens of which are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter, and a few others. The disease develops when the infection enters the gland by throwing urine, rising infection, through the lymph nodes in the rectum, or by blood from other foci of the infection. Sexual transmission of pathogens plays an important role.
Risk factors for acute bacterial prostatitis:
- phimosis;
- Urinary tract infections;
- acute epididymitis (inflammation of the epididymis);
- unprotected anal intercourse;
- bladder catheterization;
- operations through the urethra;
- biopsy of the prostate;
- violation of the secretion and secretion of prostate juice.
Risk factors and pathogens for chronic bacterial prostatitis are similar to acute. Of particular importance are the pathogens of genital infections: Trichomonas, chlamydia, ureaplasma, mycoplasma.
Chronic pelvic pain syndrome is not currently considered a homogeneous disease; it is difficult for doctors to name the main cause. Inflammatory changes in the prostate were revealed during biopsy in only one-third of these patients. It is believed to play a leading role in the development of immune, neurological and endocrine disorders.
Among the causes of the syndrome, scientists:
- infections
- autoimmune disorders;
- chemical inflammation due to the ingress of urine;
- disorders of the immune system;
- throwing urine into the prostate ducts;
- pain in the pelvic floor muscles due to their abnormal tension;
- nerve capture;
- psychological stress.
Diagnosis of prostatitis
Diagnosisacute prostatitisis based on:
- complaints;
- medical examination;
- urine tests, which must include bacteriological culture to identify the pathogen.
In complex cases, prostate imaging is usually not required. Transrectal ultrasound (ultrasound) or computed tomography (CT) of the pelvis is performed if urinary retention is severe and if a prostate abscess is suspected. The PSA test is also not recommended, as its level will definitely increase in the case of acute illness. Prostate biopsy is contraindicated due to the high risk of pain and complications.
To facilitate diagnosischronic prostatitisphysicians use several special questionnaires that determine the history of the disease, changes in quality of life, and details of symptoms. During the examination, the doctor feels the abdomen, performs a digital examination of the prostate gland (through the rectum), and assesses the condition of the pelvic floor muscles. In most cases, the diagnosis is made on the basis of a medical examination and bacteriological and clinical examination of urine or sperm. Criteria for diagnosing chronic bacterial prostatitis include recurrent urinary tract infections and a tenfold increase in bacterial levels of prostate secretions, sperm culture, or urinalysis after prostate massage (Budía A; 2006).
If analysis of prostate and urine secretion does not provide sufficient information in the presence of symptoms of chronic prostatitis, the following additional tests shall be performed:
- 2 glass samples (urine test to determine the site of infection);
- 4 glass samples;
- urine flow rate;
- determination of residual urine;
- cytological analysis of urine.
The following tests are also used in the differential diagnosis (to exclude prostate stones, abscesses, cancer):
- discarding smear from the urethra;
- screening for sexually transmitted diseases;
- analysis for PSA;
- uroflometry;
- cystoscopy;
- biopsy of the prostate;
- retrograde urethrography;
- Ultrasound of the kidney;
- magnetic resonance imaging, computed tomography.
Treatment of prostatitis
Treatment of bacterial prostatitis
Ideally, antibiotic therapy should be based on bacteriological data. But it usually starts before the results are obtained, assuming that the most common pathogens are intestinal bacteria. According to the European guidelines for the treatment of urological infections, the drugs of choice in the treatment of acute and chronic bacterial prostatitis are antibiotics from the group of fluoroquinolones, macrolides, tetracyclines. Once the pathogen has been determined, the antibiotic can be replaced.
Complicated acute bacterial prostatitis sometimes requires surgery. In the case of an abscess, the surgery is performed through the rectum or urethra. In the case of acute urinary retention, when it is impossible to pass the catheter through the urethra, a cystostomy is performed, the catheter is placed above the abdominal wall above the vulva.
Additional treatments for acute prostatitis include pain relief, fever, heavy fluid intake, and stool softeners. Alpha-blockers are also used to improve urine flow. After treatment of acute prostatitis, patients should abstain from sexual intercourse for one week.
Treatment of chronic prostatitis / chronic pelvic pain syndrome
As we have pointed out, the cause of this syndrome is very difficult to determine. Therefore, difficulties in selecting therapy. Usually, the doctor will start treatment by prescribing 1-2 drugs, which can be changed if the effectiveness is insufficient. European guidelines for the treatment of chronic pelvic pain offer the following medicines and treatments:
- Alpha-blockers relax the bladder and prostate, significantly relieving symptoms.
- Antibiotics can also be prescribed because empirical experience shows that they can be effective.
- Anti-inflammatory drugs improve quality of life and relieve pain.
- 5-alpha reductase inhibitors alleviate the symptoms of prostatitis.
- Muscle relaxants have a similar effect on alpha-blockers.
- Phytotherapy. The bioflavonoid quercetin and many other drugs have anti-inflammatory and antioxidant properties to relieve pain.
In chronic pelvic pain syndrome, placebo helps relieve symptoms by 30% (D. A. Shoskes, 1999)
Drug-free treatment:
- Prostate massage. It is done with a finger through the rectum, courses are recommended 1-3 times a week for 3-4 weeks.
- Physical methods:
- electromagnetic therapy;
- microwave heat therapy;
- extracorporeal shock wave therapy.
- Surgical treatment involves endoscopic incision of the bladder neck, transurethral resection of the prostate gland, and even removal if other methods have failed. This method of treatment is rarely used.
- Psychological treatment. Deterioration in quality of life and patients ’attitudes toward difficult situations require the intervention of a psychologist.
Prevention
As a warningacute prostatitisIt is necessary to treat all urological diseases in a timely manner, to remember safe sex and to avoid infection of the genitals. Partial prevention should be performed by physicians without prescribing unnecessary invasive procedures (biopsies, cystoscopy) and radical cure of urinary tract infections.
Key points in the prevention of chronic prostatitis:
- Personal hygiene. Intimate areas should be kept clean to prevent infections.
- Physical activity. Sitting in the pelvic area for a long time, the blood stagnates, which can contribute to inflammation of the prostate gland. You have to get up and move at every opportunity. Stretching, aerobic exercise gives a good effect. Physical activity, among other things, reduces the anxiety often associated with prostatitis.
- Normal sexual activity according to age.
- Liquid. You need to drink enough to help clear bacteria from your urinary tract.
- Diet. It is recommended to limit the use of foods that irritate the prostate gland: coffee, tea, carbonated drinks, spices, pickles, canned food, fried foods and alcohol. The proportion of fruits and vegetables in the diet should be increased. These recommendations are also important in the treatment of the disease.
- Maintaining a healthy weight.
- Stress control. To do this, you can talk to a specialist (psychotherapist), learn how to relax.
- Safe sex to prevent infections.
- Avoid hypothermia.
- See your doctor in time when dangerous symptoms occur: painful urination, frequent urge, discomfort in the lower abdomen and perineum.