chronic prostatitis- one of the most common diseases among men of mature age. Inflammation of the prostate gland significantly reduces the 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 his attending 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 non-bacterial 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 is distinguished 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 division into bacterial and non-bacterial chronic prostatitis is not accidental. Various causes of the disease determine the tactics of treatment 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 gland is free of bacteria. Prostate infection 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 the gram-positive flora (staphylococci, streptococci) are quite rare. In some cases, the growth of two or more microorganisms is noted (mixed infection). Possible infection with pathogenic flora (chlamydia, Trichomonas, gonococcus, 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 on 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 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 sexually transmitted diseases.
All this leads to a decrease in local and general immunity and a natural reproduction of the 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, colliculitis.
Chronic non-bacterial prostatitis
There are several theories about the onset of this form of the disease:
- Chemical inflammation theory. . . Throwing urine into the prostate while urinating leads to urate deposition and the development of inflammation. Urethro-prostatic reflux is facilitated by narrowing of the urethra (stricture) and other developmental abnormalities.
- Immune theory. . . The version is based on autoimmune damage to prostate gland tissues as a result of exposure to bacterial antigens. Hereditary predisposition to this form of pathology is considered.
- Neurogenic theory. . . Violation of 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 deserve 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 the pelvic organs. The microbial factor plays a role only in the initial stages of the development 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 chronic non-bacterial prostatitis (not directly associated with infection by pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis occurs mainly in men between the ages of 25 and 40. With age, the likelihood of developing the disease increases. In old age, inflammation of the prostate gland is often combined with an adenoma, a benign tumor of the prostate.
signschronic prostatitis:
- dull aching pains in the lower abdomen;
- irradiation of pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during intercourse and during bowel movements.
Disorders of urination are very characteristic:
- 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 urinary flow.
The latter 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;
- deterioration of erection;
- reduction of the duration of the relationship;
- premature ejaculation;
- pulling pains in the lower abdomen after ejaculation;
- lack of spontaneous morning erection.
Chronic prostatitis is a leading cause 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 psychoemotional disorders.
Chronic asymptomatic prostatitis occurs without any clinical manifestations. The disease is detected by chance during examination by a urologist. Despite the absence of symptoms, inflammation of the prostate gland can lead to serious complications, erectile dysfunction, and other health problems.
Complications
Launched prostatitis provokes the development of such conditions:
- abscess of the prostate;
- 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 greater the chances of a favorable outcome of the disease.
Diagnostics
The following methods are used to detect chronic prostatitis:
Visit by a urologist
At a personal appointment, 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 evaluates the size and shape of the gland. In case of chronic prostatitis, the organ will be slightly enlarged. The procedure is combined with the collection of prostatic secretions for microbiological examination.
Four-glass sample
The main method that allows you to identify the inflammatory process in the prostate and distinguish it from other diseases. The collection of the material takes place in several stages. In the morning, after 5-6 hours of abstaining from going to the toilet, a man urinates into two jars - for the first (initial) and second (middle) portion of urine. In the first portion, the contents of the urethra are washed out, in the second - the bladder. The third portion of urine is collected after prostate massage and allows you to assess the condition of the prostate gland. The secret of the prostate gland is collected separately for bacteriological culture.
In urinalysis, 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 carrying out a three-glass test, not only the number of leukocytes is evaluated, but also material is taken for bacteriological inoculation. If you suspect chronic prostatitis, the doctor is particularly 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 optimal antibiotic therapy.
The detection of opportunistic bacteria in a titer above 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 takes the secretion secreted for bacteriological examination. The result obtained also allows you 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 a titer greater than 103CFU / ml.
- Detection of opportunistic bacteria in the third portion of urine or in the secretion of the prostate, 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 prostatic secretion.
Ultrasound
Ultrasound examination allows you to assess the size of the organ and identify concomitant pathology. Chronic prostatitis is often combined 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 in a high titer, they are eliminated. Particular attention is paid to correcting the lifestyle and stimulating the body's defenses.
Pharmacological treatment
For the treatment of chronic prostatitis, the following are usedmedicines:
- Antibacterial drugs are selected taking into account the identified pathogen.
- Anti-inflammatory drugs to reduce inflammation and relieve pain.
- Means that facilitate urination (alpha-blockers, which relax the muscles of the urethra and stimulate the outflow of urine).
- Means that increase blood flow in the 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-prostate barrier and accumulate in the tissues of the prostate gland. These conditions are met by means of the fluoroquinolone group. 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 last at least 2 weeks after the preliminary diagnosis.
After receiving the results of bacteriological research and confirmation of 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 exist for a long time successfully 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 penetrate this biological barrier, which significantly reduces the effectiveness of therapy. This problem can be avoided by the use of modern antibiotics, which can not only penetrate the tissue of the prostate gland and accumulate in it, but also pass through biofilms and infect bacteria that are subjected to such serious protection.
Non-drug therapy
Among the non-pharmacological treatments, particular attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate gland, 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 a man of the unpleasant symptoms of chronic prostatitis.
Physiotherapeutic methods of influenza are used in the treatment of chronic prostatitis along with medicinal effects. A good effect can be seen from the use of ultrasound, laser beam, radio waves and electromyostimulation. Shock wave massage of the prostate (UHM) is very popular. Physiotherapy is particularly indicated in the presence of erectile dysfunction as one of the complications of prostatitis.
Particular 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 fruits and vegetables, herbs. Steam cooking is recommended.
Following a diet will speed recovery, strengthen your immune system, and help your body cope with the stress caused by antibiotics while treating a disease.
ethnoscience
Not all men go to the doctor when symptoms of prostatitis appear. Often, men prefer to be treated in folk methods, using the knowledge base of numerous forums, relying on the advice of friends, relatives and neighbors. Neglect of one's own health, refusal of rational antibiotic therapy and other traditional methods of exposure threaten the development of complications and a deterioration in the general condition. Prostatitis not treated in time can cause erectile dysfunction. Is it worth the risk if you can see a doctor in time and fix the problem with minimal leaks?
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-leaved wintergreen;
- garden parsley;
- Perforated of St. John's wort;
- Canadian gold rod;
- licorice root;
- echinacea.
Individually or in combination, these components stimulate blood flow in the pelvic organs, eliminate congestion and stimulate the immune system.
Herbal remedies will not rid the body of pathogenic bacteria, but they will help remove the symptoms of the disease.
In combination with antibacterial drugs and prostate massage, herbal remedies significantly improve the general condition and accelerate recovery.
Prophylaxis
The following will help reduce the risk of developing chronic prostatitis:advice:
- Hypothermia of the whole body and genital area, pelvis and lower limbs 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 yourself from sexually transmitted diseases. The best prevention of infection will be to avoid casual sex.
- You should be attentive to your health and cure any diseases of the genital area in 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 (doing sports, fitness, walking).
All men over the age of 30 are advised to undergo regular examinations by a urologist (at least once a year). If any unpleasant symptoms occur, you should see your doctor as soon as possible.
FAQ
Can chronic prostatitis be treated?
Contrary to popular belief, chronic prostatitis can be successfully treated. If you follow all the recommendations of the doctor, 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 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 must undergo treatment. Otherwise, there is a risk of infection, and the effectiveness of therapy is reduced due to relapses of the disease.
Is it possible to have sex with chronic prostatitis?
Yes, if the general conditions allow 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 function of the prostate is preserved and its secret is fully developed. Before conceiving a child, it is recommended to undergo 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 developmental abnormalities and termination of pregnancy.
How does chronic prostatitis affect potency?
Chronic inflammation of the prostate gland threatens the development of erectile dysfunction. With such a pathology, a decrease in libido is noted, the frequency and strength of erection decreases, orgasms become painful. In advanced cases, sexual activity becomes impossible.
Can chronic prostatitis be cured without antibiotics?
Antibiotic therapy is considered to be one of the key 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?
It will not be possible to eliminate chronic prostatitis with traditional medicine alone. To achieve the optimal effect, complex treatment is carried out using antibiotics, herbal preparations, anti-inflammatory drugs and physiotherapy methods.