Chronic prostatitis is one of the most common diseases among mature men. Inflammation of the prostate gland significantly impairs quality of life and becomes a cause of psychosomatic and sexual disorders. Due to the lack of sufficient information about the nature of the disease, the treatment of chronic prostatitis is a difficult task that requires great patience from both the patient and the physician.
Prostatitis is an inflammatory-degenerative lesion of the prostate gland.
Classification
The American National Health Institute (NIH USA) has developed and recommended the following classification of chronic 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 stands out. 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 various 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 pathogenic and opportunistic flora into the prostate. By definition, the prostate gland is free of bacteria. Infection of the prostate is possible through the urethra as well as by hematogenous and lymphogenic pathways. 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, multiplication of two or more microorganisms is observed (mixed infection). Possible infection with pathogenic flora (chlamydia, Trichomonas, gonococcus and others).
Most of the microorganisms detected in the study are representative of the normal microflora. Under normal conditions, they do not damage the body and exist peacefully on the mucous membranes of the urinary and digestive systems. Under certain conditions, the conditionally pathogenic flora grows and multiplies, leading to inflammation of the prostate tissues and the appearance of any symptoms of the disease.
Risk factors for the development of chronic bacterial prostatitis:
- non-compliance with personal hygiene;
- hypothermia;
- genital trauma;
- inflammatory diseases of the urinary system;
- the presence of STI.
All this leads to a decrease in local and general immunity and a natural proliferation of the opportunistic flora of the prostate. It cannot be ruled out that the infection may enter the urethra in the case of inflammatory diseases of the genital tract. The probability of developing prostatitis increases with existing urethritis, cystitis, colliculitis.
Chronic, non-bacterial prostatitis
There are several theories about the occurrence of this form of the disease:
- Chemical inflammation theory. . . Throwing urine into the prostate during urination leads to the deposition of urea and the development of inflammation. Urethro-prostate reflux is facilitated by urethral stenosis (stenosis) and other developmental disorders.
- Immune theory. . . The variant is based on autoimmune damage to prostate tissues due to exposure to bacterial antigens. The hereditary predisposition of this form of pathology is taken into account.
- Neurogenic theory. . . Violation of innervation in the pelvic region causes blood stagnation in the organs and leads to the development of prostatitis.
When developing non-bacterial prostatitis, the following risk factors also deserve special attention:
- long sedentary work;
- sedentary lifestyle;
- bad habits;
- stress and emotional overload;
- prolonged sexual abstinence.
These risk factors provoke the development of prostate congestion, leading 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 and autoimmune processes and trophic disorders in the tissues of the prostate gland 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.
Signs of chronic prostatitis:
- dull painful pains in the lower abdomen;
- irradiation of pain in the lumbar region, scrotum, perineum, lower back, sacrum;
- increased discomfort during intercourse and defecation.
Disorders of urination are very common:
- frequent urination;
- excretion of urine in small doses;
- feeling of incomplete emptying of the bladder;
- the appearance or increase of pain when 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, there are disorders in the sexual sphere:
- decreased libido;
- deterioration of erection;
- reducing the duration of intercourse;
- premature ejaculation;
- pain 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 person is unable to achieve and maintain an erection sufficient for complete sexual intercourse. Such a condition can significantly disrupt the course of life, cause depression and other psychoemotional disorders.
Chronic asymptomatic prostatitis occurs without clinical manifestations. The disease is accidentally detected during an examination by a urologist. Despite the lack of symptoms, inflammation of the prostate can lead to serious complications, erectile dysfunction and other health problems.
Complications
Initiated prostatitis provokes the development of such conditions:
- abscess of the prostate;
- cystitis and pyelonephritis (inflammation of the bladder and kidneys);
- vesiculitis (inflammation of the bladder);
- erectile dysfunction;
- infertility.
The earlier 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
In a face-to-face meeting, the doctor focuses on the patient’s complaints. The genitals are examined and a digital rectal examination of the prostate is performed. At touch, the doctor assesses the size and shape of the gland. In chronic prostatitis, the organ becomes slightly enlarged. The procedure is combined with collecting prostate secretion 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 a stay of 5-6 hours, after entering the toilet, the person urinates in two bottles - the first (initial), the second (middle) part 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 gland is collected separately for bacteriological culture.
During the analysis of urine, two parameters are evaluated: the number of leukocytes and the number of erythrocytes. In prostate disease, white blood cell counts increase in the third part of the urine. Normally, their number does not exceed 10 in the field of view.
Microbiological examination
In a three-glass test, not only is the number of leukocytes measured, but material is also taken for bacteriological inoculation. If chronic prostatitis is suspected, the doctor is particularly interested in the third part of the urine. Based on the results of the test, the doctor can determine the pathogen of the disease and select the optimal antibiotic therapy.
The identification 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
<2_img_rxx>Bacteriological rejection of prostate fluid makes it possible to assess the nature of the process (infectious or not) and to determine the type of pathogen.
Before taking a third of the urine during a prostate massage, the doctor will take the secretion of your choice for bacteriological examination. The result obtained also makes it possible 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 in titers 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 (ten 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 prostate adenoma - a benign tumor.
Management principles
The goal of therapy for chronic prostatitis is to eliminate the inflammatory process, activate blood flow, and improve the nutrition of the organs. If pathogenic or opportunistic microorganisms are detected at high titers, they are eliminated. Particular attention is paid to lifestyle correction and stimulation of the body’s defenses.
Drug treatment
The following medicines are used to treat chronic prostatitis:
- Antibacterial drugs are selected based on the identified pathogen.
- Anti-inflammatory drugs to reduce inflammation and relieve pain.
- Devices that make it easier to urinate (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 hematoprostatic barrier and accumulate in prostate tissue should be considered when selecting a drug. These conditions are met by the group of fluoroquinolones. Macrolides and tetracyclines are also used to treat chronic prostatitis.
According to the recommendations of the European Urological Association, antibacterial treatment 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 up to 4-6 weeks. This approach not only makes it possible 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 been successfully secreting the prostate for a long time and gaining resistance to antibiotics. Bacteria form special biofilms and colonies of microorganisms covered with a complex polysaccharide structure. Most antibacterial drugs are unable to cross this biological barrier, which significantly reduces the effectiveness of therapy. This problem can be avoided by using modern antibiotics that can not only penetrate and warm up in the tissue of the prostate gland, but also pass through biofilms and infect such severely protected bacteria.
Non-drug therapy
Of the non-drug treatments, special attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate gland, eliminates congestion and facilitates the secretion of secretions. The long-term combination of massage and antibacterial drugs is the main way to relieve a person from the unpleasant symptoms of chronic prostatitis.
Physiotherapeutic methods of influencing are used in conjunction with the therapeutic effects of chronic prostatitis. It can have a good effect on the use of ultrasound, laser beam, radio waves and electrostimulation. Prostate shock wave massage (UHM) is very popular. Physiotherapy is indicated in particular by the presence of erectile dysfunction as a complication 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 meats and fish).
Salt consumption is limited to 5 g per day. Priority is given to fresh vegetables and fruits, herbs. Steaming is recommended.
Eating a diet speeds up recovery, strengthens immunity, and helps the body cope with the stress caused by antibiotics while treating a disease.
ethnoscience
Not all men seek medical attention when symptoms of prostatitis appear. Often, men prefer to treat them in 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 methods of exposure threatens to develop complications and worsen the general condition. Prostatitis that does not heal in time can cause erectile dysfunction. Is it worth the risk if you can see a doctor in time and solve the problem with minimal loss?
Of course, among the methods of traditional medicine, there are some aspects that deserve special attention. Modern urology recognizes the efficacy of many herbs in the treatment of chronic prostatitis. Experts recommend herbal preparations based on the following ingredients:
- pumpkin seed oil;
- round leaf evergreen;
- garden parsley;
- St. John's wort perforate;
- Canadian goldenrod;
- licorice root;
- echinacea.
These, individually or in combination, stimulate blood flow to the pelvic organs, eliminate congestion, and stimulate the immune system.
Phytopreparations do not rid the body of pathogenic bacteria, but help to remove the symptoms of the disease.
Combined with antibacterial drugs and prostate massage, herbal medications significantly improve overall condition and speed healing.
Prevention
The following recommendations will help reduce your risk of developing chronic prostatitis:
- Hypothermia of the whole body and genitals, pelvis and lower extremities is not allowed. It is worth wearing thermal underwear in the cold season.
- It is necessary to follow the rules of intimate hygiene and use condoms to protect against STIs. The best prevention of infection will be the rejection of casual sex.
- You need to monitor your health and treat any diseases of the genitals in a timely manner.
- There will be no need to follow a diet (give up spicy, fried and fatty foods) and keep your body in good shape (sports, fitness, walking).
It is recommended that all men over the age of 30 be examined regularly by a urologist (at least once a year). If you experience any unpleasant symptoms, see your 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 are often the cause of 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 the relapse 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 secret is fully established. It is recommended that the urologist be examined and treated before conception. The infection that causes prostatitis can easily spread to a woman. Intrauterine infection of the fetus can cause developmental abnormalities and abortion.
How does chronic prostatitis affect potency?
Chronic inflammation of the prostate gland threatens the development of erectile dysfunction. With such pathology, libido is reduced, the frequency and strength of erections are reduced, orgasm becomes painful. In advanced cases, sexual activity becomes impossible.
Can chronic prostatitis be cured without antibiotics?
Antibiotic therapy is considered 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 cured with folk remedies?
Getting rid of chronic prostatitis will not result in traditional medicine alone. To achieve the optimal effect, complex treatments are performed using antibiotics, herbal preparations, anti-inflammatory and physiotherapeutic methods.