chronic prostatitis- one of the most common diseases among men of mature age. Prostate inflammation significantly reduces quality of life, becoming the cause of psychosomatic and sexual disorders. The 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 from both the patient and the treating physician.
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Classification
The American National Institute of Health (NIH USA) has developed and proposed the followingclassificationchronic prostatitis:
- chronic bacterial prostatitis;
- chronic nonbacterial 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 physician will be able to choose the ideal therapeutic regimen and obtain significant success in the treatment of the disease.
Causes and risk factors
The division into bacterial and nonbacterial chronic 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 of bacteria. Infection of the prostate is possible through the urethra, as well as hematogenous and lymphogenic. 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 observed (mixed infection). Possible infection with pathogenic flora (chlamydia, Trichomonas, gonococci, 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 in the mucous membranes of the urinary system and digestive tract. Under certain conditions, 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 STI.
All this leads to a decrease in local and general immunity and a natural reproduction of 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, colculitis.
Chronic nonbacterial prostatitis
There are several theories about the occurrence of this form of the disease:
- Theory of chemical inflammation. . . Pouring urine into the prostate during urination leads to urate deposition and the development of inflammation. Urethroprostatic reflux is facilitated by narrowing of the urethra (stenosis) and other developmental abnormalities.
- immunological theory. . . The version is based on autoimmune damage to prostate tissues as a result of exposure to bacterial antigens. Hereditary predisposition to this form of pathology is considered.
- neurogenic theory. . . Violation of the 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 deserves 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 in the prostate, lead to a violation of microcirculation in Organs pelvic organs. The microbial factor plays a role only in the early stages of disease development. In the future, its importance diminishes and autoimmune processes and trophic disorders in prostate tissues come to the fore.
According to statistics, 85-90% of men have chronic nonbacterial prostatitis (not directly associated with infection by pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis mainly occurs in men aged between 25 and 40 years. With age, the likelihood of developing the disease increases. In old age, inflammation of the prostate is often combined with an adenoma - a benign prostate tumor.
Signalschronic prostatitis:
- dull pains in the lower abdomen;
- radiating pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during intercourse and during bowel movements.
Urination disorders are very characteristic:
- frequent urination;
- urine excretion in small portions;
- sensation of incomplete emptying of the bladder;
- the appearance or intensification of pain when urinating;
- slow, 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;
- erection deterioration;
- 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 cannot achieve and maintain an erection sufficient for full sexual 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 manifestations. The disease is detected incidentally during examination by a urologist. Despite the absence of symptoms, prostate inflammation can lead to serious complications, erectile dysfunction, and other health problems.
complications
Cast 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;
- infertility.
The earlier the disease is detected and treatment started, the greater the chances of a favorable outcome of the disease.
Diagnosis
The following methods are used to detect chronic prostatitis:
Examination by a urologist
In a personal consultation, the doctor focuses on the patient's complaints. The external genitalia 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 secretions from the prostate 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 vials - for the first (initial) and for the second (half) portion of urine. In the first portion, the contents of the urethra are washed, in the second - the bladder. The third portion of urine is collected after prostate massage and allows to assess the condition of the prostate. The prostate secret is collected separately for bacteriological culture.
In the analysis of urine, two parameters are evaluated: the number of leukocytes and the number of erythrocytes. With prostate disease, the white blood cell count increases in the third portion of the urine. Usually, 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 evaluated, but material for bacteriological inoculation is also taken. If you suspect chronic prostatitis, your doctor is especially interested in the third portion of your urine. Based on the test results, the doctor can identify the causative agent of the disease and select the optimal antibiotic therapy.
Detection of opportunistic bacteria at a titer of more than 10 is of diagnostic value.3CFU/ml or detection of pathogenic microorganisms unequivocally in any quantity.
Bacteriological culture of prostatic secretion
Before withdrawing the third portion of urine during a prostate massage, the doctor removes the secreted secretion for bacteriological examination. The result obtained also makes it possible to determine the diagnosis and treatment tactics.
Diagnostic criteria for chronic bacterial prostatitis:
- Identification of opportunistic microorganisms in the third portion of urine or prostatic secretion in titers above 103CFU/ml.
- Detection of opportunistic bacteria in the third piece of urine or prostatic secretion, the number of which is significantly (10 times) greater than in the second piece of urine.
- Identification of pathogenic microorganisms in the third portion of the urine or prostatic secretion.
ultrasound
The ultrasound examination allows to assess the size of the organ and identify concomitant pathology. Often, chronic prostatitis is combined with prostate adenoma - a benign tumor.
treatment principles
The purpose 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 in high titer, they are eliminated. Particular attention is paid to lifestyle correction and stimulation of the body's defenses.
drug treatment
For the treatment of chronic prostatitis, the following are usedmedicines:
- Antibacterial drugs are selected taking into account the identified pathogen.
- Anti-inflammatory medications to reduce inflammation and relieve pain.
- Means that facilitate urination (alpha-blockers, which relax the muscles of the urethra and encourage the output of urine).
- Means that increase blood flow in Organs 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 blood-prostatic barrier and accumulate in prostate tissues. These conditions are satisfied 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.
After receiving 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 disease-causing agent, but also to prevent the recurrence of prostatitis.
Unfortunately, antibiotic therapy is not always effective. Many microorganisms successfully exist in the prostate secretion for a long time and acquire antibiotic resistance. Bacteria form special biofilms and form colonies of microorganisms covered with a complex polysaccharide structure. Most antibacterial drugs cannot penetrate this biological barrier, which significantly reduces the effectiveness of the therapy. This problem can be avoided with the use of modern antibiotics, which can not only penetrate and accumulate in prostate tissue, but also pass through biofilms and infect bacteria that are under such serious protection.
non-drug therapy
Among non-drug treatments, special attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate, eliminates congestion, and facilitates the excretion of secretions. The combination of massage and prolonged use of antibacterial drugs is the main way to relieve a man of the unpleasant symptoms of chronic prostatitis.
Physiotherapeutic methods of influence are used in the treatment of chronic prostatitis along with medicinal effects. A good effect is seen with the use of ultrasound, laser beam, radio waves and electromyostimulation. Prostate shock wave massage (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 and 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 will speed recovery, strengthen your immune system, and help your body deal with the stress caused by antibiotics while treating an 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 various 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 not cured in time can cause erectile dysfunction. Is it worth the risk if you can see a doctor right away 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 effectiveness of many herbs in the treatment of chronic prostatitis. Experts recommend herbal preparations based on the following ingredients:
- Pumpkin seed oil;
- round-leaf wintergreen;
- garden parsley;
- St. John's wort perforatum;
- Canadian gold rod;
- Licorice root;
- echinacea.
Individually or in combination, these components stimulate blood flow in Organs pelvic organs, clear congestion and boost the immune system.
Herbal remedies will not rid the body of pathogenic bacteria, but they will help to remove 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 your risk of developing chronic prostatitis:recommendations:
- Hypothermia of the entire body and of 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 pay attention to your health and treat any disease of the genital area on time.
- It will not be superfluous to follow a diet (give up spicy, fried and fatty foods), as well as keep your body in good shape (playing sports, fitness, hiking).
All men over the age of 30 are advised to have regular examinations by a urologist (at least once a year). If you experience any unpleasant symptoms, you should consult your doctor as soon as possible.
Common questions
Can chronic prostatitis be cured?
Contrary to popular belief, chronic prostatitis can be successfully treated. If you follow all the doctor's recommendations, 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 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 the 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 prostate function 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 prostatitis to develop 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, 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 main treatments for chronic prostatitis. In most cases, it is impossible to deal 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 antibiotics, herbal preparations, anti-inflammatories and physiotherapy methods.