Chronic prostatitis is one of the most common diseases among mature men. Inflammation of the prostate gland significantly reduces the quality of life, becoming a cause of psychosomatic and sexual disorders. The lack of sufficient information 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 his doctor.
Prostatitis is an inflammatory-degenerative lesion of the prostate gland.
Classification
The American National Institutes of Health (NIH USA) has developed and proposed the following classification of chronic prostatitis:
- chronic bacterial prostatitis;
- chronic nonbacterial prostatitis (with and without signs of inflammation);
- chronic asymptomatic prostatitis.
Modern andrologists adhere to this classification in the diagnosis and treatment of inflammatory diseases of the prostate. Acute prostatitis stands out 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 separation of bacterial and nonbacterial chronic prostatitis is not accidental. Different causes of the disease determine the tactics of treatment and greatly affect the outcome of the disease.
Chronic bacterial prostatitis
Chronic bacterial prostatitis occurs in 10-15% of patients. The immediate reason for the development of the disease is the penetration of pathogenic and opportunistic flora into the prostate. By definition, the prostate gland does not contain bacteria. Infection of the prostate is possible through the urethra, as well as hematogenous and lymphogenic. The following microorganisms are most often found during the examination:
- Escherichia coli (up to 95%);
- Proteus;
- Klebsiella;
- pseudomonas.
Representatives of the gram-positive flora (staphylococci, streptococci) are quite rare. In some cases, there is growth of two or more microorganisms (mixed infection). Possible infection with pathogenic flora (chlamydia, Trichomonas, gonococci and others).
Most of the microorganisms found during the study 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, growth and reproduction of opportunistic flora occurs, which leads to inflammation of the prostate tissue and the appearance of all the symptoms of the disease.
Risk factors for the development of chronic bacterial prostatitis:
- non-observance 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 the natural reproduction of opportunistic flora in the prostate. It is possible that the infection penetrates the urethra in inflammatory diseases of the genital tract. The likelihood of developing prostatitis increases with existing urethritis, cystitis, coliculitis.
Chronic nonbacterial prostatitis
There are several theories about the appearance of this form of the disease:
- Theory of chemical inflammation. . . Throwing urine into the prostate during urination leads to urate deposition and the development of inflammation. Urethro-prostate reflux is facilitated by narrowing of the urethra (stricture) and other developmental abnormalities.
- Immune theory. . . The version is based on autoimmune damage to prostate tissue as a result of exposure to bacterial antigens. The hereditary predisposition to this form of pathology is considered.
- Neurogenic theory. . . Disruption of the innervation in the pelvic area provokes blood stagnation in the organs and leads to the development of prostatitis.
In the development of nonbacterial prostatitis, the following risk factors also deserve special attention:
- prolonged sedentary work;
- sedentary way of life;
- bad habits;
- stress and emotional overload;
- prolonged sexual abstinence.
These risk factors provoke the development of congestion in the prostate, lead to disruption of microcirculation in the pelvic organs. The microbial factor plays a role only in the initial stages of the disease. In the future, its importance decreases 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 nonbacterial chronic prostatitis (not directly related to infection with pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis occurs mainly in men aged 25-40 years. With age, the likelihood of developing the disease increases. In old age, inflammation of the prostate gland is often combined with adenoma - a benign tumor of the prostate.
Signs of chronic prostatitis:
- dull pain in the lower abdomen;
- irradiation of pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during intercourse and during defecation.
Disorders of urination are very typical:
- frequent urination;
- excretion of urine in small portions;
- feeling of incomplete emptying of the bladder;
- the appearance or intensification of pain when urinating;
- slow and intermittent flow of urine.
The latter symptom is characteristic of prostate adenoma, which often occurs against the background of chronic prostatitis.
In the long course of the disease there are disorders in the sexual sphere:
- decreased libido;
- worsening of erection;
- reducing the duration of sexual intercourse;
- premature ejaculation;
- pulling pain in the lower abdomen after ejaculation;
- lack of spontaneous morning erection.
Chronic prostatitis is one of the leading 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.
Chronic asymptomatic prostatitis occurs without any clinical manifestations. The disease is discovered accidentally during an examination by a urologist. Despite the lack of symptoms, inflammation of the prostate gland can lead to serious complications, erectile dysfunction and other health problems.
Complications
Initiated 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 is started, the better 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 meeting, 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 prostate secretion for microbiological examination.
Sample of four cups
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 done in several stages. In the morning, after 5-6 hours of abstinence from going to the toilet, a man urinates in two jars - for the first (initial) and for the second (middle) 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 the prostate massage and allows you to assess the condition of the prostate gland. The secretion of the prostate gland is collected separately for bacteriological culture.
In the analysis of urine, two parameters are evaluated: the number of leukocytes and erythrocytes. In prostate diseases, the number of white blood cells increases in the third portion of urine. Usually their number does not exceed 10 in the field of view.
Microbiological research
When performing a test with three glasses, not only the number of leukocytes is assessed, but also material for bacteriological inoculation is taken. If you suspect chronic prostatitis, the doctor is especially interested in the third portion of urine. Based on the results of the study, the doctor can identify the cause of the disease and choose the optimal antibiotic therapy.
The identification of opportunistic bacteria in a titer above 10 has diagnostic value.3CFU / ml or detection of uniquely pathogenic microorganisms in any quantity.
Bacteriological culture of prostate secretion
Bacteriological inoculation of prostate fluid makes it possible to assess the nature of the process (infectious or not) and to determine the type of pathogen.
Before taking the third portion of urine during prostate massage, the doctor takes the secreted secretion for bacteriological examination. The obtained result also allows to determine the diagnosis and treatment tactics.
Diagnostic criteria for chronic bacterial prostatitis:
- Detection of opportunistic microorganisms in the third portion of urine or prostate secretion in a titer above 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. Often, chronic prostatitis is combined with prostate adenoma - a benign tumor.
Principles of treatment
The goal of chronic prostatitis therapy 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 the correction of lifestyle and stimulation of the body's defenses.
Medication treatment
The following drugs are used to treat chronic prostatitis:
- Antibacterial drugs are selected taking into account the identified pathogen.
- Anti-inflammatory drugs to reduce inflammation and relieve pain.
- Agents that facilitate urination (alpha-blockers that 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 identified pathogen. When choosing a drug should take into account its ability to penetrate the blood-brain barrier and accumulate in the tissues of the prostate gland. These conditions are met by means from 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 bacteriological examination 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 cause of the disease, but also to prevent the recurrence of prostatitis.
Unfortunately, antibiotic therapy is not always effective. Many microorganisms successfully exist for a long time in the secretion of the prostate 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 cross this biological barrier, which significantly reduces the effectiveness of therapy. This problem can be avoided by using modern antibiotics, which can not only penetrate and heat the prostate tissue, but also pass through biofilms and infect bacteria that are under such severe 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 gland, removes congestion and facilitates the secretion. 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 methods of exposure are used in the treatment of chronic prostatitis together with medicinal effects. Good effect is seen from the use of ultrasound, laser beam, radio waves and electromyostimulation. Shock wave prostate 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, 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 the immune system and help the body cope with the stress caused by antibiotics while treating the disease.
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 numerous 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. Untreated prostatitis can cause erectile dysfunction. Is it worth the risk if you can visit a doctor on 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 effectiveness of many herbs in the treatment of chronic prostatitis. Experts recommend herbal preparations based on the following ingredients:
- pumpkin oil;
- winter green round-leaved;
- garden parsley;
- St. John's wort perforatum;
- Canadian gold bar;
- licorice root;
- echinacea.
Individually or in combination, these components stimulate blood flow to the pelvic organs, remove congestion and stimulate the immune system.
Phytopreparations 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 medicines significantly improve the general condition and speed up recovery.
Prevention
The following recommendations will help reduce the risk of developing chronic prostatitis:
- Hypothermia of the whole body and 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 reject casual sex.
- You need to take care of your health and treat all diseases in the genital area in time.
- It will not be superfluous to follow a diet (give up spicy, fried and fatty foods), as well as to keep your body in good shape (sports, fitness, walking).
All men over the age of 30 are advised to have regular check-ups with a urologist (at least once a year). If you have 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 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 dangerous in a partner?
Sexually transmitted infections are often the cause of chronic prostatitis. If a pathogen is identified, both partners should be treated. Otherwise there is a risk of infection and the effectiveness of therapy is reduced due to recurrence of the disease.
Is it possible to have sex with chronic prostatitis?
Yes, if the general condition allows 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 secretion is fully developed. Before conceiving a child, it is recommended that you 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 the development and termination of pregnancy.
How does chronic prostatitis affect potency?
Chronic inflammation of the prostate gland threatens the development of erectile dysfunction. In such 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 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 deal with the disease without antibiotics.
Can chronic prostatitis be cured with folk remedies?
Getting rid of chronic prostatitis only with traditional medicine will not work. To achieve the optimal effect, a complex treatment is carried out with the use of antibiotics, herbal preparations, anti-inflammatory drugs and physiotherapeutic methods.