Chronic prostatitis- one of the most common diseases in men of mature age. Inflammation of the prostate significantly reduces the quality of life, becoming a 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 doctor.
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Classification
The American National Institutes of Health (NIH USA) developed and proposed the followingclassificationchronic 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. Knowing which category the identified pathology belongs to, the doctor will be able to choose the optimal treatment regimen and achieve significant success in treating the disease.
Causes and risk factors
The division into 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 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. The following microorganisms are most often detected during the examination:
- 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) has been reported. 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 damage the organism and exist peacefully on the mucous membrane 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 the 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 the natural reproduction of opportunistic flora in the prostate. It is possible that the infection may enter through the urethra in the case of 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 origin of this form of the disease:
- Theory of chemical inflammation. . . Excretion of urine in the prostate during urination leads to the deposition of urate and the development of inflammation. Urethro-prostatic reflux is facilitated by narrowing of the urethra (stricture) and other developmental abnormalities.
- Immunity theory. . . The version is based on autoimmune damage to prostate tissue as a result of exposure to bacterial antigens. Hereditary predisposition to this form of pathology is considered.
- Neurogenic theory. . . Injury to the innervation in the pelvic region causes blood stagnation in the organs and leads to the development of prostatitis.
The following deserve special attention in the development of nonbacterial prostatitis.risk factors:
- 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 microcirculation in the pelvic organs. Microbial factor plays a role only in the initial stages of disease development. In the future, its importance decreases, and autoimmune processes and trophic disorders in prostate tissues come to the fore.
According to statistics, 85-90% of men have nonbacterial chronic prostatitis (which is not directly related to infection by pathogenic or opportunistic bacteria).
Symptoms
Chronic prostatitis occurs mainly in men aged 25-40 years. The probability of developing the disease increases with age. In old age, inflammation of the prostate is often combined with adenoma - a benign tumor of the prostate.
Signschronic prostatitis:
- dull pain in the lower abdomen;
- radiation pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during intercourse and during bowel movements.
Urinary disorders are very characteristic:
- frequent urination;
- excretion of urine in small portions;
- feeling of incomplete bladder emptying;
- 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 background of chronic prostatitis.
With a long course of the disease, sexual disorders occur:
- decreased libido;
- worsening of erection;
- reduction in the duration of intercourse;
- premature ejaculation;
- pulling pains 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 complete sexual intercourse. This 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 absence of symptoms, inflammation of the prostate can lead to serious complications, erectile dysfunction and other health problems.
Complications
Initiated prostatitis causes 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 sooner the disease is detected and treatment is started, the greater the chances of a favorable outcome of the disease.
Diagnosis
The following methods are used to detect chronic prostatitis:
Examination by a urologist
During the personal examination, 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 secretions for microbiological examination.
Four glass pattern
The main method that allows you to identify the inflammatory process in the prostate and distinguish it from other diseases. Collection of materials takes place in several stages. In the morning, after 5-6 hours of abstinence from going to the toilet, the man urinates in two jars - for the first (initial) and second (middle) portion of urine. In the first part, the contents of the urethra are washed out, in the second - the bladder. The third part of the urine is collected after the prostate massage and enables the assessment of the condition of the prostate. The secretion of the prostate is specially collected for bacteriological culture.
In the analysis of urine, two parameters are assessed: the number of leukocytes and erythrocytes. In prostate disease, 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 examination
When performing the test of three glasses, not only the number of leukocytes is estimated, but also the 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 examination, the doctor can identify the cause of the disease and select the optimal antibiotic therapy.
Detection of opportunistic bacteria in a titer greater than 10 is of diagnostic value.3CFU / ml or detection of unambiguously pathogenic microorganisms in any quantity.
Bacteriological culture of prostate secretion
Before taking the third portion of urine during the prostate massage, the doctor takes the secreted secretion 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 part of urine or prostate secretions in titers 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 secretions.
Ultrasound
Ultrasound examination allows you to estimate the size of the organ and identify concomitant pathologies. Often, chronic prostatitis is combined with prostate adenoma - a benign tumor.
Principles of treatment
The goal of treatment of chronic prostatitis is to eliminate the inflammatory process, activate the blood flow and improve the nutrition of the organs. When pathogenic or opportunistic microorganisms are detected in high titers, they are eliminated. Special attention is paid to the correction of lifestyle and stimulation of the body's defenses.
Drug treatment
The following are used to treat chronic prostatitismedicines:
- Antibacterial drugs are selected taking into account the identified pathogen.
- Anti-inflammatory drugs that reduce inflammation and relieve pain.
- Means that facilitate urination (alpha-blockers, which relax the muscles of the urethra and stimulate the outflow of urine).
- Agents that increase blood flow in the pelvic organs.
The choice of antibiotic depends on the identified pathogen. When choosing a drug, its ability to penetrate the hematoprostatic barrier and accumulate in prostate tissues should be taken into account. These conditions are met by agents from the fluoroquinolone group. Macrolides and tetracyclines are also used to treat chronic prostatitis.
According to the recommendations of the European Association of Urologists, 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, the 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 in prostate secretion for a long time and acquire resistance to antibiotics. Bacteria form special biofilms and form colonies of microorganisms covered with a complex polysaccharide structure. Most antibacterial drugs are not able to break through this biological barrier, which significantly reduces the effectiveness of therapy. This problem can be avoided by using modern antibiotics, which can not only penetrate the prostate tissue and accumulate in it, but also pass through biofilms and infect bacteria that are under such serious protection.
Drug-free therapy
Among non-drug treatments, special attention is paid to prostate massage. The procedure stimulates blood flow to the prostate, removes blockages and facilitates the secretion of secretions. 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.
In the treatment of chronic prostatitis, in addition to the healing effect, physiotherapeutic methods of action are also used. A good effect is seen with the use of ultrasound, laser beam, radio waves, electromyostimulation. Shockwave 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 foods;
- 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. Steam cooking is recommended.
Diet will speed up your recovery, strengthen your immune system and help your body cope with the stress caused by antibiotics during the treatment of the disease.
ethnoscience
Not all men go to the doctor when they have symptoms of prostatitis. Often men prefer to treat themselves with folk methods, using the knowledge base from numerous forums, relying on the advice of friends, relatives and neighbors. Neglecting one's own health, refusing rational antibiotic therapy and other traditional methods of exposure threatens the development of complications and deterioration of the general condition. Prostatitis that is not cured in time can cause erectile dysfunction. Is it worth the risk if you consult 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 treating chronic prostatitis. Experts recommend herbal preparations based on the following ingredients:
- pumpkin seed oil;
- evergreen round leaves;
- garden primrose;
- St. John's wort perforatum;
- Canadian gold bar;
- 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 will help eliminate the symptoms of the disease.
Combined with antibacterial drugs and prostate massage, herbal remedies significantly improve the general condition and speed up recovery.
Prophylaxis
The following will help reduce the risk of developing 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 way to prevent infection is to avoid casual sex.
- You should take care of your health and treat all diseases of the genital area on 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 (playing sports, fitness, walking).
All men over the age of 30 are advised to see a urologist regularly (at least once a year). If you experience 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 recommendations of your doctor, 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 in a partner dangerous for a woman?
Sexually transmitted infections are often the cause of chronic prostatitis. If a pathogen is detected, both partners must undergo treatment. Otherwise, there is a risk of infection, and the effectiveness of therapy is reduced due to relapse 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 prostate function is preserved and its secretion is fully developed. An examination and treatment by a urologist is recommended before conceiving a child. 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 threatens the development of erectile dysfunction. With such pathology there is a decrease in libido, the frequency and strength of erections are reduced, 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 cope with the disease without antibiotics.
Can chronic prostatitis be cured by folk remedies?
Traditional medicine alone will not be able to get rid of chronic prostatitis. In order to achieve the optimal effect, complex treatment with antibiotics, herbal preparations, anti-inflammatory drugs and physiotherapeutic methods is carried out.