Chronic prostatitis- one of the most common diseases in men of mature age. Inflammation of the prostate significantly reduces the quality of life and becomes the cause of psychosomatic and sexual disorders. The lack of adequate knowledge of 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 the attending physician.
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classification
The American National Institute of Health (NIH USA) developed and proposed:classificationchronic prostatitis:
- chronic bacterial prostatitis;
- chronic non-bacterial prostatitis (with and without signs of inflammation);
- chronic asymptomatic prostatitis.
Modern andrologists adhere to this classification when diagnosing and treating inflammatory diseases of the prostate. Acute prostatitis is noted separately. Knowing what category the identified pathology belongs to, the doctor can choose the optimal regimen of therapy and achieve significant success in the treatment of the disease.
Causes and Risk Factors
The division into bacterial and non-bacterial chronic prostatitis is no coincidence. Different causes of the disease determine the treatment tactics and largely influence 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. The prostate is by definition free of bacteria. Infection of the prostate is possible via the urethra as well as hematogenous and lymphogenous. The following microorganisms are most often detected 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, the growth of two or more microorganisms is detected (mixed infection). Possible infection with pathogenic flora (chlamydia, trichomonas, gonococci, 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 tract and digestive tract. Under certain conditions, a 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 STIs.
All this leads to a decrease in local and general immunity and a natural reproduction of opportunistic flora in the prostate. It cannot be ruled out that the infection can occur via the urethra in inflammatory diseases of the genital tract. The likelihood of developing prostatitis increases with the existing urethritis, cystitis, colliculitis.
Chronic non-bacterial prostatitis
There are several theories about the occurrence of this form of the disease:
- Chemical inflammation theory. . . Throwing urine into the prostate while urinating leads to the deposition of urate and the development of inflammation. Urethro-prostatic reflux is facilitated by a narrowing of the urethra (stricture) and other developmental abnormalities.
- Immune theory. . . The version is based on autoimmune damage to the tissue of the prostate as a result of exposure to bacterial antigens. Hereditary predisposition to this form of pathology is taken into account.
- Neurogenic Theory. . . Violation of the innervation in the pelvic area leads to congestion 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 only plays a role in the initial stages of the development of the disease. In the future, its importance will decrease, and autoimmune processes and trophic diseases in the tissues of the prostate will come to the fore.
According to statistics, 85-90% of men have non-bacterial chronic prostatitis (which is not directly related to infection with pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis occurs mainly in men between the ages of 25 and 40. The likelihood of developing the disease increases with age. In old age, inflammation of the prostate is often combined with an adenoma - a benign tumor of the prostate.
signchronic prostatitis:
- dull pain in the lower abdomen;
- Irradiation of pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during intercourse and defecation.
Urination disorders are very characteristic:
- frequent urination;
- Urine output in small portions;
- Feeling of incomplete emptying of the bladder;
- the appearance or worsening of painful urination;
- sluggish and intermittent stream of urine.
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 in erection;
- Shortening the duration of sexual intercourse;
- premature ejaculation;
- drawing 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 psycho-emotional disorders.
Chronic asymptomatic prostatitis occurs without clinical manifestations. The disease is discovered accidentally during an examination by a urologist. Despite the lack of symptoms, inflammation of the prostate can lead to serious complications, erectile dysfunction, and other health problems.
Complications
The initiated 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 recognized and treatment is started, the greater the chances of a favorable course of the disease.
diagnosis
The following methods are used to identify chronic prostatitis:
Examination by a urologist
In a personal appointment, the doctor concentrates on the patient's complaints. The external genitals will be examined and a digital rectal exam of the prostate will be done. When palpating, the doctor assesses the size and shape of the gland. With chronic prostatitis, the organ is slightly enlarged. The procedure is combined with the removal of prostate secretions for a 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 material collection takes place in several stages. In the morning, after 5-6 hours of not using the toilet, a man urinates in two glasses - for the first (initial) and for the second (middle) portion of urine. In the first part the urethral contents are washed off, 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. The secret of the prostate is collected separately for bacteriological culture.
The urinalysis evaluates two parameters: the number of leukocytes and erythrocytes. If you have prostate disease, the number of white blood cells in the third portion of urine increases. Usually their number does not exceed 10 in the field of view.
Microbiological examination
In a three-glass test, in addition to the leukocyte count, material for bacteriological vaccination is also taken. If chronic prostatitis is suspected, 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 greater than 10 is of diagnostic value.3CFU / ml or detection of clearly pathogenic microorganisms in any amount.
Bacteriological culture of prostate secretion
Before taking the third portion of urine during a prostate massage, the doctor takes the secretion for a 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 part of the urine or prostate secretion if the titer is greater than 103CFU / ml.
- Detection of opportunistic bacteria in the third urine or prostate secretion, the number of which is significantly (10 times) higher than in the second urine portion.
- Identification of pathogenic microorganisms in the third part of the urine or prostate secretion.
Ultrasonic
Ultrasound examination allows you to assess the size of the organ and identify an accompanying pathology. Often, chronic prostatitis is combined with prostate adenoma - a benign tumor.
Treatment principles
The aim of therapy for chronic prostatitis is to eliminate the inflammatory process, activate blood circulation and improve organ nutrition. If pathogenic or opportunistic microorganisms are detected in a high titer, they are eliminated. Special attention is paid to the correction of the lifestyle and the stimulation of the body's own defenses.
Medication
To treat chronic prostatitis, the following are usedMedication:
- Antibacterial drugs are selected taking into account the identified pathogen.
- Anti-inflammatory drugs to reduce inflammation and relieve pain.
- Means that make urination easier (alpha blockers that relax the muscles of the urethra and stimulate the flow of urine).
- Agents that increase blood flow in the pelvic organs.
The choice of antibiotic depends on the pathogen identified. When choosing a drug, one should consider its ability to penetrate the hematoprostatic barrier and accumulate in the tissues of the prostate. These conditions are met by agents 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.
After receiving the results of bacteriological research and confirming the bacterial nature of the disease, treatment lasts up to 4-6 weeks. This approach makes it possible not only to get rid of the causative agent of the disease, but also to prevent prostatitis from recurring.
Unfortunately, antibiotic therapy is not always effective. Many microorganisms exist successfully in the secretion of the prostate for a long time and acquire resistance to antibiotics. Bacteria form special biofilms and form colonies of microorganisms that are covered with a complex polysaccharide structure. Most antibacterial drugs cannot penetrate this biological barrier, which significantly reduces the effectiveness of therapy. This problem can be avoided by using modern antibiotics, which not only penetrate the tissue of the prostate and accumulate in it, but also penetrate biofilms and thus infect strongly protected bacteria.
Non-drug therapy
Among the non-drug treatments, particular attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate, eliminates congestion and facilitates the elimination of secretions. The combination of massage and long-term use of antibacterial drugs is the main way of relieving a man from the unpleasant symptoms of chronic prostatitis.
In the treatment of chronic prostatitis, in addition to medicinal effects, physiotherapeutic influencing methods are also used. A good effect is shown when using 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 when treating prostatitis. The following foods should be excluded from the diet:
- Alcohol;
- spicy, spicy food;
- fried and fatty foods (including fatty meat and fish).
Salt consumption is limited to 5 g per day. Fresh vegetables and fruits, herbs, have priority. Steaming is recommended.
Dieting speeds recovery, strengthens your immune system, and helps your body manage the stress caused by antibiotics while treating an illness.
Ethnosciences
Not all men see a doctor when they experience symptoms of prostatitis. Often times, men prefer to be treated with folk methods, using the knowledge base from numerous forums and relying on the advice of friends, relatives and neighbors. Neglect of one's own health, refusal to rational antibiotic therapy and other traditional methods of exposure threatens the development of complications and deterioration in the general condition. Prostatitis that is not cured in time can lead to erectile dysfunction. Is it worth the risk if you can consult a doctor in a timely manner 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;
- round-leaved wintergreen;
- Garden parsley;
- St. John's Wort Perforatum;
- canadian goldenrod;
- Licorice root;
- Echinacea.
Individually or in combination, these components stimulate the blood flow to the pelvic organs, remove congestion and stimulate the immune system.
Herbal remedies will not rid the body of pathogenic bacteria, but will help get rid of 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 chronic prostatitis:recommendations:
- 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 adhere to the rules of intimate hygiene and use condoms to protect against STIs. The best prevention against infection is to avoid casual sex.
- You should take care of your health and treat any genital diseases in good time.
- It will not be superfluous to follow a diet (avoid spicy, fried and fatty food) and keep your body in shape (exercise, fitness, hiking).
All men over 30 years of age are advised to have a urologist examined regularly (at least once a year). If you experience any uncomfortable symptoms, you should see your doctor as soon as possible.
FAQ
Can Chronic Prostatitis Be Cured?
Contrary to popular belief, chronic prostatitis can be treated successfully. 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 determined only after an 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 be treated. Otherwise, there is a risk of infection and the effectiveness of therapy will be reduced by relapses of the disease.
Is Sex Possible With Chronic Prostatitis?
Yes, if the general condition permits and there are no problems in the sexual area (erectile dysfunction).
Is it possible to father 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 that you be examined and treated by a urologist. The infection that caused prostatitis to develop can easily be passed on to a woman. Intrauterine infection of the fetus can cause developmental disorders and termination of pregnancy.
How does chronic prostatitis affect potency?
Chronic inflammation of the prostate 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 most important treatments for chronic prostatitis. In most cases, the disease cannot be managed without antibiotics.
Can folk remedies cure chronic prostatitis?
It will not be possible to get rid of chronic prostatitis with traditional medicine alone. To achieve the optimal effect, complex treatment with antibiotics, herbal preparations, anti-inflammatory drugs and physiotherapy methods is carried out.