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 should see a doctor for and what to do to avoid getting sick.
What is prostatitis
Prostatitis is an inflammation of the prostate or prostate, it is one of the most common "male" diseases. Prostatitis is very different, it can occur by infection and without it, with insufficient and excess sexual activity, and so on. This article will help you understand the basic nuances of the disease.
About 10% of men have symptoms of chronic prostatitis, but only about 60% of them seek medical help (Nickel JC et al. , 2001).
Prostatitis affects men of all age groups and its prevalence continues to grow. Men under 50 represent 65. 2% of patients, according to various sources, the prevalence of the disease among men as a whole is 13, 2-35% (Lummus W. F. , 2001; Meares E. M. , 1990). According to other data, 8 to 35% of men aged 20-40 years suffer from inflammation of the prostate. Among older men, the real picture is "masked" by the incidence of benign prostatic hyperplasia (adenoma of the prostate), since its symptoms are basically the same. Up to 65% of patients with adenoma are operated on with unrecognized prostatitis. (Nickel JC et al. , 2007). Given that inflammatory diseases of Organs genitals are a common cause of male infertility, scientists speak of a threat to the nation's reproductive health.
What is prostatitis
The simple division into acute and chronic is not enough to characterize prostatitis, the disease includes several syndromes with a different clinical course. Consider which forms of the disease are isolated according to the modern classification (Krieger JN et. Al, 1999).
Category I: Acute bacterial prostatitis. . . A relatively rare species, responsible for only 5% of cases. It is a consequence of urinary tract infection, which develops in the context 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 considered a recurrent urinary tract infection with a primary focus on the prostate.
Category III: chronic prostatitis / chronic pelvic pain syndrome. . . Previously, this disease was called chronic abacterial prostatitis and is responsible 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. It 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 urine or prostate secretions.
Category IV: asymptomatic inflammatory prostatitis. . . It is an accidental finding when examining a patient. It is most often diagnosed when examining men for infertility or a high level of the PSA marker in the blood. We do not consider this type of disease in detail, since scientists have not yet developed a unified view in this way (Nickel JC, 2011).
Symptoms of prostatitis
Symptoms of acute prostatitis
The disease starts acutely, there is pain in the perineum, the body temperature increases. The urge to urinate is frequent (at least 5-7 a night), urination becomes painful, difficult. The urine comes out in intermittent portions, there is no feeling of satisfaction when urinating. Blood can be found in the last portions of the urine. The pain is worse with bowel movements. This is a serious illness that requires urgent help.
Complications of acute prostatitis are:
- acute urinary retention;
- abscess of the prostate (formation of a purulent focus);
- paraprostatitis (inflammation of the tissue around the gland, can be caused by a penetrating abscess);
- paraprostatic venous plexus phlebitis (inflammation in the surrounding veins).
Symptoms of chronic prostatitis
All types of chronic prostatitis (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, supra-groin, testicles, penis, lower back, abdomen, rectum);
- pain when urinating or increased pain when urinating;
- pain during or after ejaculation;
- increased sensitivity of the perineum muscles;
- neuropathic pain;
- pain due to intestinal irritation.
- Urinary symptoms:
- lower urinary tract symptoms (LUTS) associated with emptying (desire to empty the bladder, incontinence, desire to urinate, nighttime desire, pain when urinating);
- LUTS associated with obstruction (weak urine pressure, intermittent stream, need to push);
- burning sensation in the urethra;
- recurrent urinary tract infections.
- Sexual dysfunctions:
- erectile dysfunction;
- violation of ejaculation (premature or delayed ejaculation, blood in the semen);
- decreased libido.
- Psychosocial symptoms:
- anxiety;
- depression;
- cognitive and behavioral disabilities;
- decreased quality of life.
Men with chronic pelvic pain syndrome are more likely to experience manifestations of psychological stress and sexual dysfunction (A. Mehik, 2001).
If symptoms of prostatitis and chronic pelvic pain syndrome appear, consult a urologist or andrologist. In the case of severe symptoms of acute prostatitis, you should seek emergency care to avoid 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 a decrease in immunity, violation of the flow of secretions from the prostate, inadequate sexual regimen, difficulty in the flow of urine and deterioration of blood circulation in Organs pelvic organs. Other risk factors include cold climates, alcohol abuse and a sedentary lifestyle.
Acute prostatitis is a bacterial inflammation, its most common pathogens are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter and some others. The disease develops when the infection enters the gland with the release of urine, by an ascending infection, by the lymph of the rectum or by the blood of other foci of infection. The 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 secretion and excretion of prostatic juice.
The risk factors and agents that cause chronic bacterial prostatitis are similar to those of acute prostatitis. Of particular importance are the agents that cause genital infections: Trichomonas, chlamydia, ureaplasma, mycoplasma.
Chronic pelvic pain syndrome is currently not considered a homogeneous disease; doctors have a hard time naming its main cause. Only in a third of these patients did the biopsy reveal inflammatory changes in the prostate. The main role in its development is believed to be played by immunological, neurological and endocrine disorders.
Among the causes of the syndrome considered by scientists:
- infections
- autoimmune disorders;
- chemical inflammation due to the entry of urine;
- disorders of the immune system;
- throwing urine into the prostatic ducts;
- pain in the pelvic floor muscles due to its pathological tension;
- nerve compression;
- Psychological stress.
Diagnosis of prostatitis
Diagnosisacute prostatitisis placed based on:
- claims;
- medical exam;
- urine tests, which should include bacteriological culture to identify the pathogen.
In uncomplicated cases, an image of the prostate is usually not necessary. Transrectal ultrasound (ultrasound) or computed tomography (CT) of the pelvis is performed if urinary retention is severe and if an abscess in the prostate is suspected. The PSA test is also not recommended, as in an acute illness your level will increase in any case. Prostate biopsy is contraindicated due to pain and the 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, performs a digital examination of the prostate (through the rectum), evaluates the condition of the pelvic muscles. In most cases, the diagnosis is made on the basis of medical examination and bacteriological and clinical examination of urine or semen. The criteria for the diagnosis of chronic bacterial prostatitis are a history of recurrent urinary tract infections and a tenfold increase in bacterial levels in prostate secretions, semen culture or urinalysis after prostate massage (Budía A; 2006).
If analysis of prostate and urine secretion does not provide sufficient information in the presence of symptoms of chronic prostatitis, the following additional studies are performed:
- Sample of 2 glasses (urine test to determine the location of the infection);
- Sample of 4 glasses;
- urine flow rate;
- determination of residual urine;
- cytological analysis of urine.
In differential diagnosis (to exclude prostate stones, abscess, cancer), the following tests are also used:
- sow a smear from the urethra;
- screening for sexually transmitted diseases;
- PSA analysis;
- urofluxometry;
- cystoscopy;
- prostate biopsy;
- retrograde urethrography;
- Ultrasound of the kidneys;
- magnetic resonance, 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 European guidelines for the treatment of urological infections, the drugs of choice in the treatment of acute and chronic bacterial prostatitis are antibiotics from the groups of fluoroquinolones, macrolides and tetracyclines. After specifying the pathogen, the antibiotic can be replaced.
Complicated acute bacterial prostatitis sometimes requires surgical treatment. In the case of an abscess, surgery is performed through the rectum or the urethra. In the case of acute urinary retention, when it is impossible to pass the catheter through the urethra, a cystostomy is performed, the catheter is inserted through the abdominal wall above the pubis.
Additional treatment for acute prostatitis includes relieving pain, fever, drinking a lot of fluids and softening stools. Alpha blockers are also used to improve urinary flow. After treatment for acute prostatitis, patients should abstain from sexual intercourse for a week.
Treatment for chronic prostatitis / chronic pelvic pain syndrome
As we have pointed out, the cause of this syndrome is very difficult to identify. Hence the difficulties with the selection of therapy. Usually, the doctor starts treatment with the indication 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 medications and treatments:
- Alpha blockers relax the bladder and prostate, significantly relieving symptoms.
- Antibiotics can also be prescribed because empirical experience has shown that they can be effective.
- Anti-inflammatories improve the quality of life and relieve pain.
- 5-alpha reductase inhibitors relieve symptoms of prostatitis.
- Muscle relaxants have an effect similar to alpha blockers.
- Phytotherapy. The bioflavonoid quercetin and several other drugs relieve pain through anti-inflammatory and antioxidant properties.
In chronic pelvic pain syndrome, placebo helps to relieve symptoms by 30% (D. A. Shoskes, 1999)
Drug-free treatment:
- Prostate massage. It is carried out with the 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 and even its removal if other methods fail. This method of treatment is rarely used.
- Psychological treatment. The deterioration in the quality of life and the patients' difficult attitude towards the situation require the intervention of a psychologist.
Prevention
For warningacute prostatitisthe timely treatment of any urological disease is necessary, remembering a safe sex life and avoiding genital infections. Partial prevention should be performed by doctors without prescribing unnecessary invasive procedures (biopsies, cystoscopy) and radically curing urinary tract infections.
The main points of prevention of chronic prostatitis:
- Personal hygiene. To prevent infections, intimate areas must be kept clean.
- Physical activity. When sitting for a long time, the blood in the pelvic area becomes stagnant, which can contribute to inflammation of the prostate. You need to get up and move at every opportunity. Aerobic and stretching exercises have 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 eliminate bacteria from the urinary tract.
- Diet. It is recommended to limit the use of foods that irritate the prostate: coffee, tea, soft drinks, spices, pickles, preserves, fried foods and alcohol. The proportion 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 to relax.
- Safe sex to prevent infections.
- Avoiding hypothermia.
- Timely visit to the doctor when dangerous symptoms appear: pain when urinating, frequent cracking, discomfort in the lower abdomen and perineum.