chronic prostatitis- one of the most common diseases among men of mature age. Inflammation of the prostate gland significantly reduces the quality of life, becoming the cause of psychosomatic and sexual disorders. Lack of sufficient knowledge about the nature of this disease makes the treatment of chronic prostatitis a difficult task that requires a lot of patience on the part of both the patient and their treating physician.
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Classification
The American National Institute of Health (NIH USA) developed and proposed the followingclassificationchronic prostatitis:
- chronic bacterial prostatitis;
- non-bacterial chronic prostatitis (with and without signs of inflammation);
- Asymptomatic chronic prostatitis.
Modern andrologists adhere to this classification in the diagnosis and treatment of inflammatory diseases of the prostate. Acute prostatitis stands out separately. Knowing to which category the identified pathology belongs, the doctor will be able to choose the optimal therapy 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. Various causes of the disease determine the treatment tactics and greatly 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 is free of bacteria. Infection of the prostate is possible through the urethra, as well as by hematogenous and lymphogenic routes. During the examination, the following microorganisms are most often detected:
- Escherichia coli (up to 95%);
- Proteus;
- klebsiella;
- pseudomonas.
Representatives of the gram-positive flora (staphylococci, streptococci) are quite rare. In some cases, the growth of two or more organisms is noted (mixed infection). Possible infection with pathogenic flora (chlamydia, Trichomonas, gonococcus, etc. ).
Most of the microorganisms detected during the examination are representatives of the normal microflora. Under normal conditions, they do not harm the body and exist peacefully on the mucous membranes of the urinary system and digestive tract. Under certain conditions, the 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 factor'sdevelopment 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 reproduction of the opportunistic flora in the prostate. It is not excluded that the infection can enter through the urethra in case of inflammatory diseases of the genital tract. The likelihood of developing prostatitis increases with existing urethritis, cystitis, and colliculitis.
Chronic nonbacterial prostatitis
There are several theories about the appearance of this form of the disease:
- Theory of chemical inflammation. . . Dumping urine into the prostate during urination leads to urate deposition and the development of inflammation. Urethro-prostatic reflux is facilitated by narrowing of the urethra (stricture) and other developmental abnormalities.
- immune theory. . . The version is based on autoimmune damage to the tissues of the prostate gland as a result of exposure to bacterial antigens. Hereditary predisposition to this form of pathology is considered.
- Neurogenic theory. . . Violation of innervation in the pelvic region causes stagnation of blood in the organs and leads to the development of prostatitis.
In the development of nonbacterial prostatitis, the following also deserve special attention.risk factor's:
- prolonged sedentary work;
- sedentary lifestyle;
- bad habits;
- stress and emotional overload;
- prolonged sexual abstinence
These risk factors provoke the development of congestion in the prostate, lead to a violation of microcirculation in the pelvic organs. The microbial factor plays a role only in the initial stages of the development of the disease. In the future, their importance diminishes and autoimmune processes and trophic disorders in the tissues of the prostate gland come to the fore.
According to statistics, 85-90% of men have chronic non-bacterial prostatitis (not directly associated with infection by pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis occurs mainly in men ages 25 to 40. With age, the probability of developing the disease increases. In old age, inflammation of the prostate is often combined with an adenoma, a benign tumor of the prostate.
Signschronic prostatitis:
- dull pains in the lower abdomen;
- irradiation of pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during sexual intercourse and during bowel movements.
Urination disorders are very characteristic:
- frequent urination;
- urine excretion in small portions;
- feeling of incomplete emptying of the bladder;
- the appearance or intensification of pain when urinating;
- Slow and intermittent stream of urine.
The last symptom is characteristic of prostate adenoma, which often occurs against the background of chronic prostatitis.
With a long course of the disease, there are disorders in the sexual sphere:
- decreased libido;
- impaired erection;
- reduction in the duration of sexual intercourse;
- premature ejaculation;
- pulling pains in the lower abdomen after ejaculation;
- lack of spontaneous morning erection.
Chronic prostatitis is one of the main causes of erectile dysfunction, in which a man is unable to achieve and maintain an erection sufficient for a full sexual intercourse. Such a condition significantly disrupts the course of life, can cause depression and other psycho-emotional disorders.
Chronic asymptomatic prostatitis occurs without any clinical manifestations. The disease is detected by chance during examination by a urologist. Despite the absence of symptoms, inflammation of the prostate gland can lead to serious complications, erectile dysfunction, and other health problems.
Complications
Released prostatitis provokes the development of such conditions:
- prostate abscess;
- cystitis and pyelonephritis (inflammation of the bladder and kidneys);
- vesiculitis (inflammation of the seminal vesicles);
- erectile dysfunction;
- sterility.
The earlier the disease is detected and treatment is started, the more likely there is a favorable outcome of the disease.
Diagnosis
The following methods are used to detect chronic prostatitis:
Examination by a urologist
In a personal appointment, the doctor focuses on the patient's complaints. The external genitalia are examined and a digital rectal exam of the prostate is performed. On palpation, the doctor evaluates the size and shape of the gland. In the case of chronic prostatitis, the organ will be slightly enlarged. The procedure is combined with the collection of prostate secretions for microbiological examination.
Sample of four glasses
The main method that allows you to identify the inflammatory process in the prostate and distinguish it from other diseases. The collection of material is carried out in several stages. In the morning, after 5-6 hours of abstaining from going to the toilet, a man urinates into two jars, for the first (initial) and for the second (middle) portion of urine. In the first part, the contents of the urethra are washed, in the second - the bladder. The third portion of urine is collected after prostate massage and allows you to assess the state of the prostate gland. The secret of the prostate is collected separately for bacteriological culture.
Two parameters are assessed in the urinalysis: the number of leukocytes and the number of erythrocytes. With prostate disease, the white blood cell count increases in one third of the urine. Normally, their number does not exceed 10 in the field of view.
Microbiological examination
When performing a three-vessel test, not only is the amount of leukocytes assessed, but material is also taken for bacteriological inoculation. If you suspect chronic prostatitis, the doctor is especially interested in the third portion of urine. Based on the results of the examination, the doctor can identify the causative agent of the disease and select the optimal antibiotic therapy.
Detection of opportunistic bacteria in a titer of more than 10 has diagnostic value.3CFU / ml or unequivocal detection of pathogenic microorganisms in any quantity.
Bacteriological culture of prostate secretion
Before taking the third portion of urine during a prostate massage, the doctor takes the secreted discharge for a bacteriological examination. The obtained result also allows you to determine the diagnostic and treatment tactics.
Diagnostic criteria for chronic bacterial prostatitis:
- Identification of opportunistic microorganisms in the third portion of urine or prostate secretion in a titer greater than 103CFU / ml.
- Detection of opportunistic bacteria in the third portion of urine or prostate secretion, the number of which is significantly (10 times) higher than in the second portion of urine.
- Identification of pathogenic microorganisms in the third portion of urine or prostate secretion.
Ultrasound
Ultrasound examination allows you to assess the size of the organ and identify concomitant pathology. Chronic prostatitis is often combined with prostate adenoma, a benign tumor.
Treatment principles
The goal of therapy for chronic prostatitis is to eliminate the inflammatory process, activate blood flow, and improve organ nutrition. When pathogenic or opportunistic microorganisms are detected at a high titer, they are killed. Particular attention is paid to correcting the lifestyle and stimulating the body's defenses.
Pharmacotherapy
For the treatment of chronic prostatitis, the following are usedmedicines:
- Antibacterial drugs are selected taking into account the identified pathogen.
- Anti-inflammatory drugs to reduce inflammation and relieve pain.
- Means that facilitate urination (alpha blockers, which relax the muscles of the urethra and stimulate urine output).
- Means that increase blood flow in the pelvic organs.
The choice of antibiotic will depend on the identified pathogen. When choosing a drug, one should take into account its ability to penetrate the hematoprostatic barrier and accumulate in the tissues of the prostate gland. These conditions are fulfilled by means of the group of fluoroquinolones. Macrolides and tetracyclines are also used to treat chronic prostatitis.
According to the recommendations of the European Association of Urology, the course of antibacterial therapy should be at least 2 weeks after the preliminary diagnosis.
Upon receipt of the results of the bacteriological investigation and confirmation of the bacterial nature of the disease, the 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 exist successfully 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 with a complex polysaccharide structure. Most antibacterial drugs cannot penetrate this biological barrier, significantly reducing the effectiveness of therapy. This problem can be avoided by using modern antibiotics, which can not only penetrate the tissue of the prostate gland and accumulate in it, but also pass through biofilms and infect bacteria that are under such severe protection.
Non-drug therapy
Among non-pharmacological treatments, special attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate gland, removes congestion, and facilitates the excretion of secretions. The combination of massage and long-term use of antibacterial drugs is the main way to relieve a man from the unpleasant symptoms of chronic prostatitis.
Physiotherapeutic influence methods are used in the treatment of chronic prostatitis in conjunction with medicinal effects. A good effect is observed with the use of ultrasound, laser beam, radio waves and electromyostimulation. Shock wave massage of the prostate (UHM) is very popular. Physiotherapy is especially indicated in the presence of erectile dysfunction as one of the complications of prostatitis.
Special attention is paid to diet in the treatment of prostatitis. The following foods should be excluded from the diet:
- alcohol;
- spicy, spicy food;
- fried and fatty foods (including fatty meats and fish).
Salt intake is limited to 5g per day. Priority is given to fresh vegetables and fruits, herbs. Steam cooking is recommended.
Eating a diet will speed recovery, strengthen your immune system, and help your body cope with the stress caused by antibiotics while treating illness.
ethnoscience
Not all men go to the doctor when symptoms of prostatitis appear. Men often prefer to be treated by popular methods, using the knowledge base of numerous forums, relying on the advice of friends, family and neighbors. Neglect of one's health, refusal of rational antibiotic therapy and other traditional methods of exposure threatens the development of complications and the deterioration of the general condition. Prostatitis that is not cured 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 losses?
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 treating chronic prostatitis. Experts recommend herbal preparations based on the following ingredients:
- pumpkin seed oil;
- round-leaved wintergreen;
- garden parsley;
- St. John's wort perforatum;
- Canadian goldenrod;
- licorice root;
- echinacea
Individually or in combination, these components stimulate blood flow in the pelvic organs, remove congestion, and boost the immune system.
Herbal remedies will not eliminate pathogenic bacteria from the body, but they will help eliminate the symptoms of the disease.
In combination with antibacterial drugs and prostate massage, herbal remedies significantly improve the general condition and accelerate recovery.
Prophylaxis
The following will help reduce the risk of developing chronic prostatitis:recommendations:
- Hypothermia of the whole body and the genital area, pelvis and lower extremities should not be allowed. In the cold season, it is worth wearing thermal underwear.
- It is necessary to follow the rules of intimate hygiene and use condoms to protect against STIs. The best prevention of infection will be to avoid casual sex.
- You should be attentive to your health and treat any diseases of the genital area in time.
- It will not be superfluous to follow a diet (abandon spicy, fried and fatty foods), as well as keep your body in good shape (playing sports, being fit, walking).
All men over the age of 30 are advised to undergo periodic examinations by a urologist (at least once a year). If you experience any unpleasant symptoms, you should see your doctor as soon as possible.
Frequently asked questions
Can chronic prostatitis be cured?
Contrary to popular belief, chronic prostatitis can be treated successfully. If you follow all the recommendations of the doctor, you can get rid of the unpleasant symptoms of prostatitis and significantly improve the 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 couple dangerous for a woman?
Sexually transmitted infections are often the cause of chronic prostatitis. If a pathogen is identified, both partners should undergo treatment. Otherwise, there is a risk of infection, and the effectiveness of therapy is reduced due to relapses of the disease.
Is it possible to have sex with chronic prostatitis?
Yes, if the general condition allows it 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 its secret is fully developed. Before conceiving a child, it is recommended to undergo an examination and treatment by a urologist. The infection that caused the development of prostatitis is easily transmitted to a woman. Intrauterine infection of the fetus can cause abnormalities in development and termination of pregnancy.
How does chronic prostatitis affect potency?
Chronic inflammation of the prostate threatens the development of erectile dysfunction. With such a pathology, a decrease in libido is observed, the frequency and strength of erection decrease, orgasms become painful. In advanced cases, sexual activity becomes impossible.
Can chronic prostatitis be cured without antibiotics?
Antibiotic therapy is considered one of the key treatments for chronic prostatitis. In most cases, it is impossible to cope with the disease without antibiotics.
Can chronic prostatitis be cured with home remedies?
It will not be possible to get rid of chronic prostatitis only with traditional medicine. To achieve the optimal effect, complex treatment with antibiotics, herbal preparations, anti-inflammatory drugs and physiotherapy methods is carried out.