Chronic prostatitis- one of the most common diseases in men in adulthood. Inflammation of the prostate gland significantly reduces the quality of life, becoming the cause of psychosomatic and sexual disorders. 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 physician.
The American National Institutes of Health (NIH USA) developed and proposed the followingDistributionchronic 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 therapy regimen and achieve considerable success in treating the disease.
Causes and risk factors
The division into chronic bacterial and non-bacterial prostate is not accidental. Different causes of the disease determine the tactics of treatment and greatly 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. 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%);
Representatives of gram-positive flora (staphylococci, streptococci) are quite rare. In some cases the growth of two or more microorganisms is observed (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 in the mucosa of the urinary system and in the digestive tract. Under certain conditions, the 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;
- 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. The possibility of infection entering through the urethra in case of inflammatory diseases of the genital tract is not excluded. The possibility of developing prostatitis increases with existing urethritis, cystitis, coliculitis.
Chronic non-bacterial prostatitis
There are several theories for the occurrence of this form of the disease:
- Theory of chemical inflammation. . . Dropping urine into the prostate during urination leads to urate deposition and the development of inflammation. Urethro-prostatic reflux is facilitated by urethral stricture (stricture) and other developmental abnormalities.
- Immune theory. . . The version is based on autoimmune damage to prostate gland tissue as a result of exposure to bacterial antigens. Hereditary predisposition to this form of pathology is considered.
- Neurogenic theory. . . Violation of the innervation in the pelvic region provokes blood stagnation in the organs and leads to the development of prostatitis.
In the development of non-bacterial prostatitis, special attention deserves the following.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 disease development. In the future, its importance diminishes, and autoimmune processes and trophic disorders in the prostate gland tissues come to the fore.
According to statistics, 85-90% of men have chronic non-bacterial prostatitis (not directly related to infection with pathogenic or opportunistic bacteria).
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 gland is often combined with an adenoma - a benign prostate tumor.
- dull aching pain in the lower abdomen;
- radiation pain in the groin, scrotum, perineum, lower back, sacrum;
- increased discomfort during sexual intercourse and during bowel movements.
Urinary disorders 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 flow of urine.
The latter symptom is characteristic of prostate adenoma, which often appears against the background of chronic prostatitis.
With a long course of the disease, there are disorders in the sexual sphere:
- decreased sexual desire;
- worsening of erection;
- reducing the duration of sexual intercourse;
- premature ejaculation;
- withdrawal pain in the lower abdomen after ejaculation;
- lack of spontaneous erection in the morning.
Chronic prostatitis is one of the leading causes of erectile dysfunction, in which a man can not reach and maintain an erection sufficient for a full sexual intercourse. Such a condition significantly disrupts the flow of life, can cause depression and other psycho-emotional disorders.
Chronic asymptomatic prostatitis occurs without any clinical manifestation. The disease is discovered accidentally 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.
Initiated prostatitis provokes the development of such conditions:
- prostate abscess;
- cystitis and pyelonephritis (inflammation of the bladder and kidneys);
- vesiculitis (inflammation of the seminal vesicles);
- erectile dysfunction;
The sooner the disease is detected and treatment is started, the greater the chances of a favorable outcome of the disease.
The following methods are used to detect chronic prostatitis:
Examination by a urologist
In 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 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.
Sample with four glasses
The main method that allows you to identify the inflammatory process in the prostate and distinguish it from other diseases. The collection of material is done in several stages. In the morning, after 5-6 hours of abstinence from going to the toilet, a man urinates in two jars - for the first (initial) part and for the second (secondary) part 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 gland. The secretion of the prostate gland 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 number of white blood cells in the third part of the urine increases. Normally, their number does not exceed 10 in the field of view.
When performing a three-cup test, not only the leukocyte count is assessed, but also the material for bacteriological inoculation is taken. If you suspect chronic prostate, the doctor is particularly interested in the third part of the urine. Based on the results of the examination, the doctor can identify the causative agent of the disease and choose the optimal antibiotic therapy.
Detection of opportunistic bacteria at a titer of more than 10 is of diagnostic value.3CFU / ml or detection of pathogenic microorganisms unequivocally in any quantity.
Bacteriological culture of prostate secretion
Before taking the third part of the urine during 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 secretion at a titer above 103CFU / ml.
- Detection of opportunistic bacteria in the third part of urine or prostate secretion, the number of which is significantly (10 times) higher than in the second part of urine.
- Identification of pathogenic microorganisms in the third part of urine or prostate secretion.
Ultrasound examination allows you to assess the size of the organ and identify the accompanying pathology. Often, chronic prostatitis is 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 circulation and improve organ nutrition. When pathogenic or opportunistic microorganisms are detected at a high titer, they are eliminated. Special attention is paid to lifestyle correction and stimulating the body's defenses.
The following are used to treat chronic prostatitismedicaments:
- Antibacterial drugs are selected taking into account the identified pathogen.
- Anti-inflammatory medications to reduce inflammation and relieve pain.
- Means that facilitate urination (alpha-blockers, which relax the urethral muscles and stimulate urine output).
- Means that increase blood flow to the 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 tissues of the prostate gland should be taken into account. 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 Society 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 confirmation of the bacterial nature of the disease, treatment lasts up to 4-6 weeks. This approach allows you to not only get rid of the causative agent of the disease, but also prevent the recurrence of prostatitis.
Unfortunately, antibiotic therapy is not always effective. Many microorganisms exist successfully in prostate secretion for a long time and gain resistance to antibiotics. Bacteria form distinct biofilms and form colonies of microorganisms covered with a complex polysaccharide structure. Most antibacterial drugs are not able to penetrate this biological barrier, which significantly reduces the effectiveness of therapy. This problem can be avoided with the use of modern antibiotics, which can not only penetrate the prostate gland tissue and accumulate in it, but also go through biofilms and infect bacteria that are under such serious protection.
Among drug-free treatments special attention is paid to prostate massage. The procedure stimulates the blood supply to the prostate gland, eliminates congestion 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.
Physiotherapeutic methods of influence are used in the treatment of chronic prostatitis along with medicinal effects. A good effect is seen from the use of ultrasound, laser beam, radio waves and electromyostimulation. Prostate shock wave (UHM) massage is very popular. Physiotherapy is particularly 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:
- spicy, spicy food;
- fried and fatty foods (including fatty meats and fish).
Salt consumption is limited to 5 g per day. Preference is given to fresh vegetables and fruits, herbs. Steam cooking is recommended.
Eating a diet will speed up healing, strengthen your immune system, and help your body cope with the stress caused by antibiotics when treating an illness.
Not all men go to the doctor when prostate symptoms appear. Often, men prefer to be treated with popular methods, using the knowledge base from numerous forums, relying on the advice of friends, relatives and neighbors. Neglecting one's health, refusing rational therapy with antibiotics and other traditional methods of exposure threatens the development of complications and a worsening of the general condition. Untreated prostate in time can cause erectile dysfunction. Is it worth the risk if you can go to the doctor on time and solve the problem with minimal loss?
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;
- winter with round leaves;
- garden parsley;
- St. John's wort perforatum;
- Canadian flori;
- licorice root;
Individually or in combination, these ingredients stimulate blood flow to the pelvic organs, eliminate congestion and stimulate the immune system.
Herbal remedies will not save the body from pathogenic bacteria, but will help relieve the symptoms of the disease.
In combination with antibacterial drugs and prostate massage, herbal medicines significantly improve the overall condition and speed up healing.
The following will help reduce the risk of developing chronic prostatitis:recommendation:
- 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 follow the rules of intimate hygiene and use condoms to protect against STIs. The best prevention of infection will be to avoid casual sex.
- You need to be mindful of your health and treat any diseases of the genital area in a timely manner.
- It will not be superfluous to follow a diet (get rid of 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 undergo regular examinations by a urologist (at least once a year). If you have any unpleasant symptoms, you should consult your doctor as soon as possible.
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 your quality of life.
Could chronic prostatitis be asymptomatic?
Yes, this variant of the disease is detected only after examination by a urologist.
Is chronic partner prostatitis dangerous for a woman?
Sexually transmitted infections are often the cause of chronic prostatitis. If a pathogen is identified, both partners should undergo treatment. Otherwise, there is a risk of infection and the effectiveness of therapy is reduced due to relapse.
Is it possible to have sex with a chronic prostate?
Yes, if the general condition allows and there are no problems in the sexual sphere (erectile dysfunction).
Is it possible to give birth to a child with chronic prostatitis?
Yes, if prostate function is preserved and its secretion 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 sexual desire is observed, the frequency and strength of the erection is 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 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?
It will not be possible to get rid of chronic prostatitis only with traditional medicine. To achieve the optimal effect, complex treatment is performed using antibiotics, herbal preparations, anti-inflammatory drugs and physiotherapy methods.