Chronic prostatitis is one of the most common diseases among mature men. Inflammation of the prostate significantly reduces quality of life, becoming the 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 the patient and his doctor.
Prostatitis is a degenerative inflammatory lesion of the prostate.
Classification
The American National Institute of Health (NIH USA) developed and proposed the following classification of chronic 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 stands out separately. Knowing to which category the identified pathology belongs, the doctor will be able to choose the ideal therapy regimen and obtain 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 in 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 exam, the following microorganisms are detected more frequently:
- 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 (mixed infection) is observed. Possible infection with pathogenic flora (chlamydia, Trichomonas, gonococcus and others).
Most of the microorganisms detected during the examination are representative 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, the growth and reproduction of conditionally pathogenic flora occurs, which leads to inflammation of the prostate tissues and the appearance of all 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 STDs.
All of this leads to decreased local and general immunity and the natural reproduction of opportunistic prostate flora. It is not excluded that the infection can enter the urethra in inflammatory diseases of the genital tract. The likelihood of developing prostatitis increases with existing urethritis, cystitis and 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 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 the tissues of the prostate, due to exposure to bacterial antigens. Hereditary predisposition to this form of pathology is considered.
- Neurogenic theory. . . The violation of innervation in the pelvic region causes blood to stagnate in the organs and leads to the development of prostatitis.
In the development of non-bacterial prostatitis, the following risk factors also deserve special attention:
- long sedentary work;
- sedentary lifestyle;
- bad habits;
- stress and emotional overload;
- prolonged sexual abstinence.
These risk factors cause the development of congestion in the prostate, leading to a violation of the microcirculation in Organs pelvic organs. The microbial factor plays a role only in the early stages of the development of the disease. In the future, its importance will diminish, and autoimmune processes and trophic disorders in prostate tissues will gain prominence.
According to statistics, 85-90% of men have chronic non-bacterial prostatitis (not directly related to infection by 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 is often associated with an adenoma - a benign prostate tumor.
Signs of chronic prostatitis:
- uncomfortable pain in the lower abdomen;
- irradiation of pain in the groin area, 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;
- sensation of incomplete emptying of the bladder;
- the appearance or intensification of pain when urinating;
- slow and intermittent stream of urine.
The latter symptom is characteristic of prostate adenoma, which often occurs in the context of chronic prostatitis.
With a long course of the disease, disorders in the sexual sphere arise:
- 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 the man is unable to achieve and maintain an erection sufficient for a complete sexual relationship. This 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 by chance during a urologist's examination. Despite the absence of symptoms, inflammation of the prostate can lead to serious complications, erectile dysfunction and other health problems.
Complications
Prostatitis initiated causes the following conditions to develop:
- prostate abscess;
- cystitis and pyelonephritis (inflammation of the bladder and kidneys);
- vesiculitis (inflammation of the seminal vesicles);
- erectile dysfunction;
- infertility.
The sooner the disease is detected and the 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 urologist
In a personal consultation, the doctor focuses on the patient's complaints. The external genitals are examined and a digital rectal examination of the prostate is performed. Upon 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.
Four glass sample
The main method that allows you to identify the inflammatory process of the prostate and distinguish it from other diseases. The collection of the material occurs in several stages. In the morning, after 5-6 hours without going to the bathroom, a man urinates in two pots - for the first (initial) and for the second (middle) portion of the urine. In the first part, the contents of the urethra are washed, in the second - the bladder. The third part of the urine is collected after the prostate massage and allows you 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 erythrocytes. With prostate disease, the white blood cell count increases in the third portion 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 evaluated, but also the material is taken for bacteriological inoculation. If you suspect chronic prostatitis, the doctor is especially 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 ideal antibiotic therapy.
The identification of opportunistic bacteria in a titer of more than 10 has diagnostic value.3CFU / ml or detection of unequivocally pathogenic microorganisms in any quantity.
Bacteriological culture of prostate secretion
The bacteriological seeding of the prostatic fluid allows to evaluate the nature of the process (infectious or not) and to determine the type of pathogen.
Before removing the third portion of urine during prostate massage, the doctor collects the secretion secreted for bacteriological examination. The result obtained 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 above 103CFU / ml.
- Detection of opportunistic bacteria in the third portion of urine or prostate secretion, the number of which is significantly (10 times) greater than in the second portion of urine.
- Identification of pathogenic microorganisms in the third portion of urine or prostate secretion.
Ultrasound
The ultrasound exam allows to evaluate the size of the organ and to identify concomitant pathologies. Chronic prostatitis is often associated with prostate adenoma - a benign tumor.
Principles of treatment
The goal 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 at a high titer, they are eliminated. Special attention is paid to correcting the lifestyle and stimulating the body's defenses.
Drug treatment
The following drugs are used to treat chronic prostatitis:
- Antibacterial drugs are selected taking into account the pathogen identified.
- Anti-inflammatories to reduce inflammation and relieve pain.
- Means that facilitate urination (alpha blockers, which relax the muscles of the urethra and stimulate the urine to escape).
- It means that it increases the blood flow in Organs pelvic organs.
The choice of antibiotic will depend on the pathogen identified. When choosing a drug, its ability to penetrate the hematoprostatic barrier and accumulate in the prostate tissues must be taken into account. These conditions are met through 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 must be at least 2 weeks after the preliminary diagnosis is established.
After receiving the results of the bacteriological research and confirming the bacterial nature of the disease, the 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 have successfully existed in the prostate secret for a long time and acquire resistance to antibiotics. The bacteria form special biofilms and form colonies of microorganisms covered by 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 the prostate tissue and warm up, but also pass through biofilms and infect bacteria that are under such serious protection.
Non-drug therapy
Among non-medicated treatments, special attention is given 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 long-term use of antibacterial drugs is the main way to relieve men 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 observed with 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 and spicy food;
- fried and fatty foods (including fatty fish and meat).
Salt consumption is limited to 5 g per day. Priority is given to fresh fruits and vegetables, herbs. Steam cooking is recommended.
Eating a diet will speed up recovery, strengthen immunity and help the 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 popular methods, using the knowledge base of various forums, with the advice of friends, relatives and neighbors. Neglect of one's own health, the rejection of rational antibiotic therapy and other traditional methods of exposure threaten the development of complications and the deterioration of the general condition. Prostatitis not cured in time can cause erectile dysfunction. Is it worth taking the risk if you can see a doctor at the right 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 treating chronic prostatitis. Experts recommend herbal preparations based on the following ingredients:
- Pumpkin seed oil;
- wintergreen with round leaves;
- garden parsley;
- St. John's wort perforatum;
- Canadian Goldenrod;
- Licorice root;
- echinacea.
Individually or in combination, these components stimulate blood flow in Organs pelvic organs, eliminate congestion and stimulate the immune system.
Phytopreparations do not rid the body of pathogenic bacteria, but they do help to remove the symptoms of the disease.
In combination with antibacterial drugs and prostate massage, herbal remedies significantly improve general condition and speed recovery.
Prevention
The following recommendations will help to reduce the risk of developing chronic prostatitis:
- Hypothermia throughout the 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 a condom to protect against STIs. The best prevention of infection will be the rejection of casual sex.
- You must be aware of your health and treat all diseases of the genital region at the right time.
- It will not be superfluous to follow a diet (giving up spicy, fried and fatty foods), as well as keeping your body in good shape (playing sports, fitness, walking).
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 the quality of life.
Can chronic prostatitis be asymptomatic?
Yes, this variant of the disease is only detected after examination by a urologist.
Is chronic prostatitis in a partner dangerous for women?
Sexually transmitted infections are often the cause of chronic prostatitis. If a pathogen is identified, both partners must undergo treatment. Otherwise, there is a risk of infection and the effectiveness of the therapy is reduced due to recurrences 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 prostate function is preserved and its secret fully developed. Before conceiving a child, it is recommended to have an urologist examined and treated. The infection that caused prostatitis to develop is easily transmitted to women. 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 this pathology, there is a decrease in libido, the frequency and strength of the 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 cope with the disease without antibiotics.
Can chronic prostatitis be cured with folk remedies?
Getting rid of chronic prostatitis with traditional medicine alone will not work. To achieve the ideal effect, a complex treatment is carried out with antibiotics, herbal preparations, anti-inflammatory drugs and physiotherapy methods.