Prostatitisis an inflammatory disease of the prostate gland. It is manifested by frequent urination, pain in the penis, scrotum, rectum, sexual disorders (erection dysfunction, premature ejaculation, etc. ), sometimes urinary retention, blood in the urine. The diagnosis of prostatitis is established by a urologist or andrologist according to a typical clinical picture, the results of a rectal examination. In addition, an ultrasound of the prostate, bakposev of prostate secretion and urine is performed. Treatment is conservative - antibiotic therapy, immunotherapy, prostate massage, lifestyle correction.
General information
Prostatitis is an inflammation of the seminal gland (prostate) - the prostate. It is the most common disease of the genitourinary system in men. It most often affects patients aged 25-50 years. According to various data, 30-85% of men over 30 years old suffer from prostatitis. Possible formation of abscess of the prostate gland, inflammation of the testicles and appendages, which threatens infertility. Infection leads to inflammation of the upper genitourinary system (cystitis, pyelonephritis).
The pathology develops with the penetration of an infectious agent that enters the prostate tissue from the organs of the genitourinary system (urethra, bladder) or from a distant inflammatory focus (with pneumonia, flu, tonsillitis, furunculosis).
Causes of prostatitis
As an infectious agent in an acute process, Staphylococcus aureus (Staphylococcus aureus), Enterococcus (Enterococcus), Enterobacter (Enterobacter), Pseudomonas (Pseudomonas), Proteus (Proteus), Klebsiella (Klebsiella) and Escherichiali (Escherichiali). Most microorganisms belong to conditionally pathogenic flora and cause prostatitis only in the presence of other predisposing factors. Chronic inflammation is usually due to polymicrobial associations.
The risk of developing the disease increases with hypothermia, a history of specific infections and conditions associated with congestion in prostate tissue. There are the following predisposing factors:
- General hypothermia (one-time or permanent, related to working conditions).
- A sedentary lifestyle, a specialty that forces a person to sit for a long time (computer operator, driver, etc. ).
- Persistent constipation.
- Violations of the normal rhythm of sexual activity (excessive sexual activity, prolonged abstinence, incomplete ejaculation during "ordinary" sexual intercourse without emotional coloring).
- The presence of chronic diseases (cholecystitis, bronchitis) or chronic infectious foci in the body (chronic osteomyelitis, untreated caries, tonsils, etc. ).
- Past urological diseases (urethritis, cystitis, etc. ) and sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea).
- Conditions that cause suppression of the immune system (chronic stress, irregular malnutrition, regular lack of sleep, excessive training in athletes).
It is assumed that the risk of developing pathology increases with chronic intoxication (alcohol, nicotine, morphine). Several studies in the field of modern andrology prove that chronic perineal trauma (vibration, shock) in drivers, motorcyclists and cyclists is a provoking factor. However, the vast majority of experts believe that all these circumstances are not the real causes of the disease, but only contribute to the worsening of the latent inflammatory process in the prostate tissue.
A decisive role in the occurrence of prostatitis is played by congestion in the prostate tissue. Violation of capillary blood flow causes an increase in lipid peroxidation, edema, exudation of prostate tissue and creates conditions for the development of an infectious process.
Symptoms of prostatitis
Acute prostatitis
There are three stages of acute prostatitis, which are characterized by the presence of a certain clinical picture and morphological changes:
- Acute catarrh. Patients complain of frequent, often painful urination, pain in the sacrum and perineum.
- Acute follicular. The pain becomes more intense, sometimes radiating to the anus, aggravated by defecation. Urination is difficult, urine flows in a thin stream. In some cases, there is urinary retention. A subfebrile state or moderate hyperthermia is typical.
- Acute parenchymal. Severe general intoxication, hyperthermia up to 38-40°C, chills. Dysuric disorders, often - acute urinary retention. Severe, throbbing pains in the perineum. Difficulty in defecation.
Chronic prostatitis
In rare cases, chronic prostatitis becomes the result of an acute process, however, as a rule, a chronic primary course is observed. The temperature occasionally rises to subfebrile values. The patient notices a slight pain in the perineum, discomfort during urination and defecation. The most characteristic symptom is a small flow from the urethra during defecation. The main chronic form of the disease develops over a considerable period of time. It is preceded by prostatosis (blood stagnation in capillaries), gradually turning into abacterial prostatitis.
Chronic prostatitis is often a complication of the inflammatory process caused by the causative agent of a specific infection (chlamydia, trichomonas, ureaplasma, gonococcus). Symptoms of a specific inflammatory process in many cases mask the manifestations of prostate damage. Perhaps a slight increase in pain during urination, slight pain in the perineum, little discharge from the urethra during defecation. A slight change in the clinical picture often goes unnoticed by the patient.
Chronic inflammation of the prostate gland can be manifested by a burning sensation in the urethra and perineum, dysuria, sexual disorders, increased general fatigue. The consequence of violations of power (or the fear of these violations) often becomes mental depression, anxiety and nervousness. The clinical framework does not always include all the listed groups of symptoms, it varies in different patients and changes over time. There are three main syndromes characteristic of chronic prostatitis: pain, dysuric, sexual disorders.
There are no pain receptors in the prostate tissue. The cause of pain in chronic prostatitis becomes almost inevitable due to abundant innervation of pelvic organs, involvement in the inflammatory process of nerve pathways. Patients complain of pain of varying intensity - from weak, painful sleep to intense and disturbing sleep. There is a change in the nature of the pain (intensification or weakening) with ejaculation, excessive sexual activity or sexual abstinence. The pain radiates to the scrotum, sacrum, perineum, sometimes in the lumbar region.
As a result of inflammation in chronic prostatitis, the volume of the prostate increases, squeezing the urethra. The lumen of the ureter is reduced. The patient has a frequent need to urinate, a feeling of incomplete emptying of the bladder. As a rule, dysuric phenomena are expressed in the early stages. Then compensatory hypertrophy of the muscular layer of the bladder and ureters develops. Symptoms of dysuria during this period weaken and then increase again with the decompensation of adaptive mechanisms.
In the initial stages, dyspotency may develop, which manifests itself differently in different patients. Patients may complain of frequent erections at night, blurring of orgasm or worsening of erection. Accelerated ejaculation is associated with a decrease in the level of the orgasmic center excitation threshold. Painful sensations during ejaculation can cause rejection of sexual activity. In the future, sexual dysfunctions become more pronounced. In the advanced stage, impotence develops.
The degree of sexual disorder is determined by many factors, including the sexual constitution and psychological mood of the patient. Violations of potency and dysuria can be due both to changes in the prostate gland and to the suggestibility of the patient, who, if he has chronic prostatitis, expects the inevitable development of sexual disorders and urination disorders. Especially often psychogenic dyspotency and dysuria develop in suggestible and anxious patients.
Impotence, and sometimes the very threat of possible sexual disorders, is difficult for patients to tolerate. Often there is a change in character, irritability, disgust, excessive concern for one's health, even "care for the disease. "
Complications
In the absence of timely treatment of acute prostatitis, there is a significant risk of developing a prostate abscess. With the formation of a purulent focus, the patient's body temperature rises to 39-40 ° C and can become inflamed in nature. Periods of heat alternate with strong chills. Strong pains in the perineum make it difficult to urinate and make defecation impossible.
Increased prostate edema leads to acute urinary retention. Rarely, an abscess spontaneously bursts into the urethra or rectum. When opened, purulent, cloudy urine with an unpleasant pungent odor appears in the urethra; when opened, the stool contains pus and mucus in the rectum.
Chronic prostatitis is characterized by an undulating course with periods of long-term remissions, during which the inflammation in the prostate is latent or manifests itself with extremely weak symptoms. Patients who are not bothered by anything often stop treatment and return only when complications develop.
The spread of infection through the urinary tract causes pyelonephritis and cystitis. The most common complication of the chronic process is inflammation of the testicles and epididymis (epdidymo-orchitis) and inflammation of the seminal vesicles (vesiculitis). The result of these diseases is often infertility.
Diagnosing
The characteristic clinical framework simplifies the diagnostic process in acute and chronic prostatitis. It is mandatory that:
Treatment of prostatitis
Treatment of acute prostatitis
Patients with an uncomplicated acute process are treated by a urologist on an outpatient basis. With severe intoxication, suspicion of a purulent process, hospitalization is indicated. Antibacterial therapy is performed. Preparations are selected taking into account the sensitivity of the infectious agent. Antibiotics that can penetrate prostate tissue well are widely used.
With the development of acute urinary retention on the background of prostatitis, they use the installation of a cystostomy, and not a urethral catheter, since there is a risk of the formation of a prostate abscess. With the development of an abscess, a transrectal or transurethral endoscopic opening of the abscess is performed.
Treatment of chronic prostatitis
Treatment of chronic prostatitis should be complex, including etiotropic therapy, physiotherapy, correction of immunity:
- Antibiotic therapy. The patient is prescribed long courses of antibacterial drugs (within 4-8 weeks). The selection of the type and dose of antibacterial drugs, as well as the determination of the duration of the treatment course is carried out individually. The drug is selected based on the sensitivity of the microflora according to the results of urine culture and prostate secretion.
- Prostate massage.Massage of the gland has a complex effect on the affected organ. During the massage, the inflammatory secretion accumulated in the prostate gland is squeezed into the channels, then enters the urethra and leaves the body. The procedure improves blood circulation in the prostate, which minimizes congestion and ensures better penetration of antibacterial drugs into the tissues of the affected organ.
- Physiotherapy.Laser exposure, ultrasonic waves and electromagnetic vibrations are used to improve blood circulation. If it is impossible to perform physiotherapeutic procedures, the patient is prescribed warm medicinal microclysters.
In chronic, long-term inflammation, consulting an immunologist is indicated to choose immunocorrective therapy tactics. The patient is given advice on lifestyle changes. Making some changes in the lifestyle of a patient with chronic prostate is a curative and preventive measure. The patient is recommended to normalize sleep and wakefulness, adopt a diet, perform moderate physical activity.
For the treatment of prostatitis, antibiotic therapy is most effective. Phytotherapy, immunocorrectors and hormonal preparations can also be used according to the doctor's recommendation.
In the absence of acute symptoms, prostatitis can be treated with physiotherapy methods. In case of abscesses and suppurations, surgical intervention is recommended.
Drug treatment
Treatment of prostatitis through antibiotic therapy should begin with bakposev, the purpose of which is to assess the organism's sensitivity to this type of antibiotic. In violation of urination, a good result is the use of anti-inflammatory drugs.
Medicines are taken in tablets, in acute cases - in the form of droppers or intramuscularly. For the treatment of chronic forms of prostatitis, rectal suppositories are effective: with their help, drugs reach their goal faster and have a minimal effect on other organs.
Blood thinners and anti-inflammatories are also well proven.
Antibacterial therapy
Antibiotics are an effective drug in the fight against bacterial prostatitis. In order to achieve the desired effect and not harm the body, the choice of medicine, dose and treatment regimen should be handled by a doctor. For the correct selection of the most effective drugs, he will have to find out which type of pathogen caused prostatitis, and also check the patient for tolerance to antibiotics of a particular group.
For the effective treatment of chronic prostatitis, antibiotics of the fluoroquinolone group have been well proven. Their action is aimed at suppressing a bacterial infection and strengthening the body's immunity. In addition, a bacteriostatic antibiotic is recommended for the prevention and treatment of concomitant diseases of the genitourinary system.
Treatment of prostatitis caused by mycoplasma and chlamydia can also be carried out with macrolide and tetracycline drugs, which slow the spread of the infection.
The duration of taking antibacterial drugs is from 2 to 4 weeks. In case of positive dynamics, the course can be extended.
Physiotherapy
Physiotherapy methods in the treatment of prostatitis are aimed at activating blood circulation in the pelvic area, improving metabolic processes in the prostate gland and cleaning the channels. If physiotherapy is combined with taking antibiotics, then the effect of the latter increases.
The main methods include:
- magnetic therapy;
- laser therapy;
- electrophoresis;
- warm up;
- ultrasound;
- mud treatment;
- high frequency radiation;
- physiotherapy.
One of the oldest methods - transrectal massage of the prostate, according to modern research, has no proven effectiveness.
Non-specific treatments
Non-specific treatments for prostatitis include:
- hirudotherapy;
- curative fasting;
- acupuncture;
- diet according to Ostrovsky's method;
- alkalinization of the body according to Neumyvakin's method.
All non-traditional methods of prostatitis treatment are strongly recommended to be coordinated with your doctor.
Surgery
Surgical methods are used in complex and urgent cases:
- for the drainage of purulent abscesses, which are removed by laparoscopic methods through a puncture;
- in violation of urination due to damage to the urinary tract;
- with a large volume of the affected area;
- with a significant number of stones in the body of the gland.
Stones and sclerosed tissues are removed by endoscopic methods. With a large area of damage or multiple stones, prostate resection is used.
Transurethral resection is also effective for bacterial prostatitis. Thus, it is possible to reduce the risk of relapse.
Folk remedies
Treatment of prostatitis with folk remedies is unlikely to be effective on its own, but in combination with medical and physiotherapeutic methods it may be applicable. These include: beekeeping products, decoctions of plants and seeds, tinctures of garlic, ginger, beaver stem, fresh vegetables, pumpkin seeds.
In acute cases of the course of the disease, you should consult a doctor and in no case should you self-medicate! In case of rupture of a purulent abscess, a fatal outcome is possible.
Candles for prostatitis
Treatment of prostatitis with rectal suppositories is much more effective than tablets, only because the rectum is much closer to the prostate, which means that the medicine will work faster.
The composition of drugs for the treatment of prostatitis can be completely different, they are prescribed to solve a specific problem.
- Antibacterial agents are particularly effective for prostatitis caused by chlamydia.
- Painkillers are used for symptomatic treatment, they relieve pain well.
- Immunostimulants improve blood circulation, relieve swelling and are used in complex therapy.
- Phytopreparations have a mild effect. They, like candles in bee products, are used as an addition to the main treatment.
- Ichthyol-based compounds promote blood flow in the intestinal mucosa area, which accelerates the mitigation of inflammatory processes and slightly improves immunity.
- Enzyme-based products prevent the formation of scar tissue. It is recommended to be taken as part of complex therapy with antibiotics, anti-inflammatory and analgesic drugs.
Auxiliary drugs
For the symptomatic treatment of prostatitis in men, such as relieving pain during urination, you can also take antispasmodics that relax smooth muscles and thus quickly relieve pain.
Dietary supplements for blood thinning and anti-inflammatory based on bee products, pumpkin seed oil, palm fruit extracts contribute to general recovery.
Diet and lifestyle
For the treatment of prostatitis, a correct, balanced diet and a healthy lifestyle are very important. Food should not contain spicy, fried, salty, pickled foods. In the acute form, alcohol is strictly prohibited.
Food should contain enough fiber to prevent constipation. The protein content should be reduced. It is desirable to supplement the diet with herbs, ginger, pumpkin seeds.
Non-drug treatment
Drug-free therapy methods allow you to act directly on the prostate, increase the concentration of drugs in its tissues, help eliminate congestion.
Microwave hyperthermia is performed using a rectal probe that is inserted into the patient's anus. In the device, you can set the required temperature for a particular type of exposure. To increase the concentration of the drug in the prostate, heating to 38-40°C is required. To get an antibacterial effect - 40-45 ° C.
Today, non-drug treatment focuses on laser therapy. The possibilities of this technique are wide. Under the influence of a laser, the following processes occur in the prostate gland:
- activation of redox reactions;
- improves blood microcirculation;
- new capillaries are formed;
- pathogenic microflora is suppressed;
- the process of cell division is activated, which contributes to tissue regeneration.
During the research period of the effects of laser therapy on prostate patients, a side effect, but positive for treatment purposes, was observed. In those who completed the course, potency increased, erectile dysfunction was eliminated, and vitality was restored. To achieve this result, it is necessary to use a beam with a certain wavelength. In general, low-intensity laser radiation is used to treat chronic prostatitis.
Patients, on their own initiative, can undergo a course of laser therapy, if not prescribed by the attending physician.
Surgical treatment of chronic prostatitis
Chronic prostatitis does not pose a threat to the patient's life, but it can significantly reduce its quality. The most serious complication of this disease is the formation of stones in the tissue of the gland. To free it from prostoliths, transurethral resection is used.
The surgery is performed under TRUS control.
If complications such as prostate sclerosis occur, transurethral electrosurgery is performed. If sclerosis of the bladder neck is observed in combination with this pathology, a partial resection of the prostate is performed.
With blockage of the seminal and excretory ducts, endoscopic operations are indicated to eliminate violations of the permeability of the secret. For this purpose, an incision is made in the seminal vesicles and excretory ducts. With an abscess, complete removal of the gland is possible.
Consequences of untreated prostatitis
Even if the symptoms of prostatitis do not appear for a long time, it is necessary to regularly undergo examination by a urologist. Unhealed prostatitis can be accompanied by the formation of calcifications, which must then be removed together with the gland. Experts are sure that there are no other ways to remove or disperse stones.
In addition, pathogenic microorganisms can migrate to neighboring organs, causing inflammation. Running prostatitis can cause the development of prostate adenoma and cancer.
Prediction and prevention
Acute prostatitis is a disease that has a marked tendency to become chronic. Even with adequate treatment in time, more than half of patients end up with chronic prostatitis. Recovery is not always achieved, however, with correct and consistent therapy and following the doctor's recommendations, it is possible to eliminate unpleasant symptoms and achieve a long-term stable remission in a chronic process.
Prevention is the elimination of risk factors. It is necessary to avoid hypothermia, alternate sedentary work and periods of physical activity, eat regularly and fully. Laxatives should be used for constipation. One of the preventive measures is the normalization of sexual life, since excessive sexual activity and sexual abstinence are risk factors in the development of prostatitis. If symptoms of a urological or sexually transmitted disease appear, you should consult a doctor in a timely manner.