Chronic prostatitis- one of the most common diseases in middle-aged men. Inflammation of the prostate 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 his attending physician.
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Classification
The United States National Institute of Health (NIH USA) has developed and proposed the followingclassificationchronic prostatitis:
- chronic bacterial prostatitis;
- Chronic non-bacterial 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 differs separately. Knowing which category the identified pathology belongs to, the doctor will be able to choose the optimal treatment regimen and achieve significant success in the treatment of the disease.
Causes and risk factors
The division into chronic bacterial and non-bacterial prostatitis is not accidental. Various causes of the disease determine treatment tactics and largely 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 from bacteria. Infection of the prostate is possible through the urethra, as well as through the hematogenous and lymphogenous pathways. During the examination, the following microorganisms are most often detected:
- Escherichia coli (up to 95%);
- Proteus;
- klebsiella;
- pseudomonas.
Representatives of gram-positive flora (staphylococci, streptococci) are quite rare. In some cases, the growth of two or more microorganisms is noted (mixed infection). Possible infection by pathogenic flora (chlamydia, Trichomonas, gonococcus, etc. ).
Most of the microorganisms detected during the examination are representatives of 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 factorsdevelopment 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 cases of inflammatory diseases of the genital tract. The likelihood 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:
- Theory of chemical inflammation. . . Throwing urine into the prostate during urination leads to deposition of urate and the development of inflammation. Urethro-prostatic reflux is facilitated by the narrowing of the urethra (narrowing) and other developmental abnormalities.
- Immune theory. . . The version is based on autoimmune damage to prostate tissue following 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 non-bacterial prostatitis, the following also deserve special attention.risk factors:
- long sedentary work;
- sedentary lifestyle;
- bad habits;
- stress and emotional overload;
- prolonged sexual abstinence.
These risk factors provoke the development of congestion of the prostate, lead to a violation of microcirculation in the pelvic organs. The microbial factor plays a role only in the early stages of disease development. In the future, its importance decreases, and autoimmune processes and trophic disorders in the tissues of the prostate are highlighted.
According to statistics, 85-90% of men have chronic non-bacterial prostatitis (not directly associated with infection with pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis mainly occurs in men between the ages of 25 and 40. With age, the likelihood of developing the disease increases. In old age, inflammation of the prostate is often associated with adenoma - a benign tumor of the prostate.
Panelschronic prostatitis:
- dull, aching pains in the lower abdomen;
- irradiation of pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during intercourse and during bowel movements.
Urination disorders are very characteristic:
- frequent urination;
- excretion of urine in small portions;
- feeling of incomplete emptying of the bladder;
- onset or intensification of pain when urinating;
- slow, intermittent urine stream.
The latter 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;
- deterioration of erection;
- reduction in the duration of sexual intercourse;
- premature ejaculation;
- pulling pains in the lower abdomen after ejaculation;
- absence of spontaneous morning erection.
Chronic prostatitis is one of the main causes of erectile dysfunction, in which a man cannot achieve and maintain an erection sufficient for full intercourse. Such a condition significantly disrupts the course of life, can cause depression and other psycho-emotional disorders.
Asymptomatic chronic prostatitis occurs without any clinical manifestation. The disease is detected by chance during an examination by a urologist. Despite the absence of symptoms, inflammation of the prostate can lead to serious complications, erectile dysfunction, and other health problems.
Complications
Launched prostatitis provokes the development of such conditions:
- abscess of the prostate;
- cystitis and pyelonephritis (inflammation of the bladder and kidneys);
- vesiculitis (inflammation of the seminal vesicles);
- erectile dysfunction;
- infertility.
The earlier the disease is detected and treatment started, the greater the chances of a favorable course of the disease.
Diagnostic
The following methods are used to detect chronic prostatitis:
Examination by a urologist
During a personal appointment, the doctor focuses on the patient's complaints. The external genitals are examined and a digital rectal examination of the prostate is performed. On palpation, the doctor assesses 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 prostatic 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 takes place in several stages. In the morning, after 5-6 hours of abstaining from going to the toilet, a man urinates in two pots - for the first (initial) and for the second (average) 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 the prostate massage and is used to assess the condition of the prostate. The secret of the prostate is collected separately for bacteriological culture.
In urine analysis, two parameters are evaluated: the number of leukocytes and erythrocytes. With prostate disease, the number of white blood cells increases in the third part of the urine. Normally, their number does not exceed 10 in the field of view.
Microbiological examination
When performing a three-glass test, not only the number of leukocytes is assessed, but material is also taken for bacteriological inoculation. If you suspect chronic prostatitis, the doctor is particularly 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 at a titer greater than 10 has diagnostic value.3CFU / ml or unambiguous detection of pathogenic microorganisms in any quantity.
Bacteriological culture of prostatic secretion
Before taking the third portion of urine during a prostate massage, the doctor takes the secretion secreted for bacteriological examination. The obtained result also helps to determine the diagnosis and treatment tactics.
Diagnostic criteria for chronic bacterial prostatitis:
- Identification of opportunistic microorganisms in the third portion of urinary or prostatic secretions at a titer greater than 103CFU / ml.
- Detection of opportunistic bacteria in the third portion of urine or prostatic 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 urinary or prostatic secretions.
Ultrasound
Ultrasound examination allows you to assess the size of the organ and identify concomitant pathology. Often, chronic prostatitis is associated with an adenoma of the prostate - 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 pathogenic or opportunistic microorganisms are detected at a high titre, they are eliminated. Particular attention is paid to correcting the lifestyle and stimulating the body's defenses.
Medical treatment
For the treatment of chronic prostatitis the following are usedmedications:
- 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 the flow of urine).
- Means that increase blood flow to the pelvic organs.
The choice of antibiotic will depend on the pathogen identified. When choosing a drug, one should take into account its ability to penetrate the hematoprostatic barrier and accumulate in the tissues of the prostate. 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 duration of antibacterial therapy should be at least 2 weeks after the preliminary diagnosis.
Upon receipt of the results of bacteriological research and confirmation of 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 exist successfully in the secretion of the prostate for a long time and acquire resistance to antibiotics. Bacteria form special biofilms and form colonies of microorganisms covered with a complex polysaccharide structure. Most antibacterial drugs are unable to penetrate this biological barrier, which greatly reduces the effectiveness of therapy. This problem can be avoided with the use of modern antibiotics, which can not only penetrate and accumulate in the prostate tissue, but also pass through biofilms and infect bacteria that are under such serious protection.
Non-drug therapy
Among the non-drug treatments, special attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate, clears congestion, and facilitates the excretion of secretions. The main way to relieve a man from the unpleasant symptoms of chronic prostatitis is the combination of massage and long-term use of antibacterial drugs.
Influencing physiotherapeutic methods are used in the treatment of chronic prostatitis with medicinal effects. The use of ultrasound, laser beam, radio waves and electromyostimulation gives a good effect. Prostate shock wave massage (UHM) is very popular. Physiotherapy is particularly indicated in the presence of erectile dysfunction as one of the complications of prostatitis.
Particular attention is paid to diet in the treatment of prostatitis. The following foods should be excluded from the diet:
- alcohol;
- spicy and spicy food;
- fried and fatty foods (including fatty meats and fish).
Salt intake is limited to 5 g per day. Priority is given to fresh vegetables and fruits, aromatic herbs. Steaming is recommended.
Eating a diet will speed up 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. Often men prefer to be treated with folk methods, 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 traditional methods of exposure threaten the development of complications and 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 fix the problem with minimal waste?
Of course, among the methods of traditional medicine there are some aspects that deserve special attention. Modern urology recognizes the effectiveness of many herbs in the treatment of chronic prostatitis. Experts recommend herbal preparations made from the following ingredients:
- pumpkin seed oil;
- round-leaved wintergreen;
- parsley from the garden;
- St. John's Wort;
- Canadian goldenrod;
- Licorice root;
- echinacea.
Individually or in combination, these components stimulate blood circulation in the pelvic organs, clear congestion and stimulate the immune system.
Herbal remedies will not rid the body of pathogenic bacteria, but will help eliminate the symptoms of the disease.
In combination with antibacterial drugs and prostate massage, herbal remedies significantly improve the general condition and speed up recovery.
Prophylaxis
The following will help reduce the risk of developing chronic prostatitis:recommendations:
- Hypothermia of the whole body and genital area, pelvis and lower limbs should not be allowed. In the cold season, it is worth wearing thermal underwear.
- It is necessary to respect the rules of intimate hygiene and to use condoms to protect against STIs. The best prevention of infection will be to avoid casual sex.
- You need to pay attention to your health and treat all diseases of the genital area in time.
- It will not be superfluous to follow a diet (give up spicy, fried and fatty foods), as well as keep your body in shape (play sports, do fitness, walk).
All men over 30 are advised to undergo regular examinations by a urologist (at least once a year). If you experience any unpleasant symptoms, you should see your doctor as soon as possible.
Faq
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 partner 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 treatment 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 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 developmental abnormalities 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, there is a decrease in libido, the frequency and strength of erections decrease, orgasms become painful. In advanced cases, sexual activity becomes impossible.
Can we cure chronic prostatitis 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 folk remedies?
It will not be possible to get rid of chronic prostatitis with traditional medicine alone. To achieve the optimal effect, complex treatment is carried out with the help of antibiotics, herbal preparations, anti-inflammatory drugs and physiotherapy methods.