According to statistics, about 40% of men with symptoms of prostatitis do not seek medical help. At the same time, the consequences of the disease, including the risk of male infertility, are very serious. Find out what symptoms you need to see a doctor for and what to do to avoid getting sick.
What is prostatitis
Prostatitis is an inflammation of the prostate gland or prostate, it is one of the most common "male" diseases. Prostatitis is very different, it can occur due to infection and without it, with insufficient sexual activity and excess, etc. Thisarticle will help you understand the basic nuances of the disease.
About 10% of men experience symptoms of chronic prostatitis, but only about 60% seek medical help (Nickel JC et al. , 2001).
Prostatitis affects men of all ages and its prevalence continues to grow. Men under 50 make up 65. 2% of patients, according to various sources, the prevalence of the disease among men is generally 13, 2-35% (Lummus W. F. , 2001; Meares E. M. , 1990). According to other data, 8 to 35% of men aged 20-40 suffer from inflammation of the prostate. In older men, the real picture is "masked" by the incidence of benign prostatic hyperplasia (prostate adenoma), as their symptoms are largely the same. Up to 65% of patients with adenoma are operated on for it with unrecognized prostatitis. (NickelJC et al. , 2007) Given that inflammatory diseases of the genital organs are a common cause of male infertility, scientists speak of a threat to the nation's reproductive health.
What is prostatitis
The simple separation of acute and chronic is not enough to characterize prostatitis, the disease includes several syndromes with different clinical course. Consider what forms of the disease are isolated according to the modern classification (Krieger JN et. Al, 1999).
Category I: Acute bacterial prostatitis. . . Relatively rare species, representing only 5% of cases. This is a consequence of a urinary tract infection, it develops against the background of predisposing factors (impaired urine flow, suppressed immunity). In 5% of cases it turns into chronic bacterial prostatitis.
Category II: Chronic bacterial prostatitis. . . It is also a rare disease that is considered a recurrent urinary tract infection with a major focus in the prostate.
Category III: Chronic prostatitis / chronic pelvic pain syndrome. . . Previously, the disease was called chronic abacterial prostatitis and accounted for up to 95% of all diagnosed prostatitis (Habermacher GM, 2006). Chronic pain syndrome combines pathologies characterized by urological pain in the absence of urinary tract infection. Does not include urethritis, cancer, narrowing of the urethra, neurological damage to the bladder. Divided into categories IIIa and IIIb: with signs of inflammation and without signs of inflammation. These signs are determined in the laboratory, mainly by the presence of leukocytes in the urine or prostate secretions.
Category IV: Asymptomatic inflammatory prostatitis. . . This is an accidental finding on examination of a patient. It is most often diagnosed when examining men for infertility or elevated levels of the PSA marker in the blood. We do not look at this type of disease in detail, as scientists have not yet developed a unified view of this form (Nickel JC, 2011).
Symptoms of prostatitis
Symptoms of acute prostatitis
The disease begins acutely, there is pain in the perineum, body temperature rises. The urge to urinate is frequent (at least 5-7 per night), urination becomes painful, difficult. Urine comes out in periodic portions, there is no feeling of satisfaction from urination. Blood can be found in the last portions of urine. The pain is stronger when defecating. This is a serious illness that requires urgent care.
The complications of acute prostatitis are:
- acute urinary retention;
- prostate abscess (formation of a purulent focus);
- paraprostatitis (inflammation of the tissue around the gland, can be caused by a breakthrough of the abscess);
- phlebitis of the paraprostatic venous plexus (inflammation of the surrounding veins).
Symptoms of chronic prostatitis
All types of chronic prostatitis (both bacterial and chronic pelvic pain syndrome) are similar. The picture of the disease is very variable, below is a list of symptoms that may be present with varying severity.
- Pain:
- pain or discomfort in one of the characteristic areas (groin, over-groin, testicles, penis, lower back, abdomen, rectum);
- pain when urinating or increased pain when urinating;
- pain during or after ejaculation;
- increased sensitivity of the muscles in the perineum;
- neuropathic pain;
- pain due to intestinal irritation.
- Urinary symptoms:
- lower urinary tract symptoms (LUTS) associated with emptying (desire to empty the bladder, incontinence, urge to urinate, nocturnal desire, pain when urinating);
- LUTS associated with obstruction (low urine pressure, intermittent flow, need to press);
- burning sensation in the urethra;
- recurrent urinary tract infections.
- Sexual dysfunction:
- erectile dysfunction;
- ejaculation disorder (premature or delayed ejaculation, blood in the semen);
- decreased libido.
- Psychosocial symptoms:
- anxiety;
- depression;
- cognitive and behavioral impairment;
- reduced quality of life.
Men with chronic pelvic pain syndrome are more likely to exhibit psychological stress and sexual dysfunction (A. Mehik, 2001).
If symptoms of prostatitis and chronic pelvic pain syndrome occur, you should see a urologist or andrologist. In case of severe symptoms of acute prostatitis, you should seek emergency help to prevent urinary retention and other complications.
Causes of prostatitis
Inflammation of the prostate develops under the influence of many factors. A healthy gland in the absence of predisposing factors has the potential to resist infection and inflammation. The onset of the disease is facilitated by decreased immunity, impaired secretion from the prostate, inadequate sexual regime, difficulty in passing urine and deterioration of blood circulation in the pelvic organs. Other risk factors include cold climates, alcohol abuse and a sedentary lifestyle.
Acute prostatitis is a bacterial inflammation, and its most common pathogens are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter and some others. The disease develops when the infection enters the gland by throwing urine, through an ascending infection, through the lymph from the rectum, or through blood from other foci of infection. Sexual transmission of pathogens plays an important role.
Risk factors for acute bacterial prostatitis:
- phimosis;
- urinary tract infections;
- acute epididymitis (inflammation of the epididymis);
- unprotected anal intercourse;
- bladder catheterization;
- operations performed through the urethra;
- prostate biopsy;
- violation of the secretion and secretion of prostate juice.
The risk factors and causes of chronic bacterial prostatitis are similar to those of acute. Of particular importance are the causes of genital infections: Trichomonas, chlamydia, ureaplasma, mycoplasma.
At present, chronic pelvic pain syndrome is not considered a homogeneous disease; doctors can hardly pinpoint its root cause. Only in one third of these patients did the biopsy reveal inflammatory changes in the prostate gland. Immune, neurological and endocrine disorders are thought to play a leading role in its development.
Among the causes of the syndrome considered by scientists:
- infections
- autoimmune disorders;
- chemical inflammation due to urine penetration;
- disorders of the immune system;
- throwing urine into the prostate ducts;
- pain in the pelvic floor muscles due to their pathological tension;
- nerve entrapment;
- psychological stress.
Diagnosis of prostatitis
Diagnosisacute prostatitisis based on:
- complaints;
- medical examination;
- urine tests, which should include a bacteriological culture to identify the pathogen.
In uncomplicated cases, imaging of the prostate is usually not necessary. Transrectal ultrasound (ultrasound) or computed tomography (CT) of the pelvis is done if urinary retention is severe and if a prostate abscess is suspected. PSA testing is also not recommended, as in acute disease its level will be increased in any case. Prostate biopsy is contraindicated due to pain and high risk of complications.
To facilitate diagnosischronic prostatitisdoctors use several special questionnaires that specify the history of the disease, changes in quality of life and detail the symptoms. During the examination, the doctor palpates the abdomen, conducts a digital examination of the prostate gland (through the rectum), assesses the condition of the pelvic muscles. In most cases, the diagnosis is made on the basis of a medical examination and bacteriological and clinical examination of urine or semen. The criteria for diagnosing chronic bacterial prostatitis are a history of recurrent urinary tract infections and a tenfold increase in bacterial levels in prostate secretions, sperm culture, or urine analysis after prostate massage (Budía A; 2006).
If the analysis of prostate and urine secretion does not provide sufficient information in the presence of symptoms of chronic prostatitis, the following additional tests are performed:
- Sample of 2 cups (urine analysis to determine the location of the infection);
- 4-glass sample;
- urine flow rate;
- determination of residual urine;
- cytological analysis of urine.
In case of differential diagnosis (to exclude prostate stones, abscess, cancer) the following tests are also used:
- seeding of smear from the urethra;
- screening for sexually transmitted diseases;
- PSA analysis;
- uroflowmetry;
- cystoscopy;
- prostate biopsy;
- retrograde urethrography;
- Ultrasound of the kidneys;
- magnetic resonance imaging, computed tomography.
Treatment of prostatitis
Treatment of bacterial prostatitis
Ideally, antibiotic therapy should be based on bacteriological data. But it usually starts before the results are obtained, assuming that the most common pathogens are intestinal bacteria. According to the European guidelines for the treatment of urological infections, the selected drugs in the treatment of acute and chronic bacterial prostatitis are antibiotics from the fluoroquinolone, macrolide, tetracycline groups. After specifying the pathogen, the antibiotic can be replaced.
Complex acute bacterial prostatitis sometimes requires surgical treatment. In case of an abscess, surgery is performed through the rectum or through the urethra. In case of acute urinary retention, when it is impossible for the catheter to pass through the urethra, a cystostomy is performed, the catheter is inserted through the abdominal wall above the pubis.
Additional treatments for acute prostatitis include pain relief, fever, drinking plenty of fluids, stool softeners. Alpha blockers are also used to improve urine flow. After treatment for acute prostatitis, patients should abstain from sexual intercourse for one week.
Chronic prostatitis / Chronic pelvic pain syndrome
As we have pointed out, the cause of this syndrome is very difficult to identify. Hence the difficulties in choosing therapy. Usually the doctor starts treatment with the appointment of 1-2 drugs, which can be changed if the effectiveness is insufficient. The European guidelines for the treatment of chronic pelvic pain offer the following drugs and treatments:
- Alpha blockers relax the bladder and prostate, significantly relieving symptoms.
- Antibiotics can also be prescribed, as empirical experience has shown that they can be effective.
- Anti-inflammatory drugs improve the quality of life and relieve pain.
- 5-alpha reductase inhibitors relieve the symptoms of prostatitis.
- Muscle relaxants have a similar effect as alpha blockers.
- Phytotherapy. Bioflavonoid quercetin and several other drugs relieve pain through anti-inflammatory and antioxidant properties.
In chronic pelvic pain syndrome, placebo helps relieve symptoms by 30% (D. A. Shoskes, 1999).
Treatment without drugs:
- Prostate massage. Performed with a finger through the rectum, courses are recommended 1-3 times a week for 3-4 weeks.
- Physical methods:
- electromagnetic therapy;
- microwave thermotherapy;
- extracorporeal shock wave therapy.
- Surgical treatment includes endoscopic incision of the bladder neck, transurethral resection of the prostate gland and even its removal if other methods have failed. This method of treatment is rarely used.
- Psychological treatment. The deterioration of the quality of life and the difficult attitude of the patients to the situation require the intervention of a psychologist.
Prevention
For a warningacute prostatitistimely treatment of any urological diseases is necessary, remembering a safe sex life and avoiding genital infections. Partial prophylaxis should be performed by physicians without prescribing unnecessary invasive procedures (biopsies, cystoscopy) and radical treatment of urinary tract infections.
The main points of prevention of chronic prostatitis:
- Personal hygiene. To prevent infections, intimate areas should be kept clean.
- Physical activity. When sitting for a long time, the blood in the pelvic area stagnates, which can contribute to inflammation of the prostate gland. You have to get up and move at every opportunity. Stretching, aerobic exercise give a good effect. Among other things, physical activity reduces the anxiety often associated with prostatitis.
- Normal sexual activity according to age.
- Liquid. You need to drink enough to help flush bacteria out of your urinary tract.
- Diet. It is advisable to limit the use of foods that irritate the prostate gland: coffee, tea, carbonated beverages, spices, pickles, canned food, fried foods and alcohol. The share of fruits and vegetables in the diet should be increased. These recommendations are also important in the treatment of the disease.
- Maintain a healthy weight.
- Stress control. To do this, you can talk to a specialist (psychotherapist), learn how to relax.
- Safe sex to prevent infections.
- Avoid hypothermia.
- Timely visit to the doctor when dangerous symptoms appear: painful urination, frequent urges, discomfort in the lower abdomen and perineum.