Symptoms and treatment of chronic prostatitis
Chronic prostatitis - This is a prolonged inflammation of the prostate gland, leading to a violation of the morphology and functioning of the prostate. It manifests itself as a prostatic triad: pain in the pelvic and genital areas, urinary disorders, sexual disorders. Diagnosis includes palpation of the gland, examination of prostate secretion, ultrasound, uroflowmetry, urethroscopy, puncture biopsy of the prostate gland. Comprehensive medication, physiotherapy, prostate massage, posterior urethral instillation are indicated. Surgical intervention is advisable for complicated forms of chronic prostatitis.
Chronic prostatitis is the most common male disease: about 50% of men suffer from some form of inflammation of the prostate. Chronic prostatitis often affects men aged 20 to 40 years, who are in the period of the greatest sexual, reproductive and labor activity. In this regard, the identification and treatment of chronic prostatitis acquires in modern andrology not only a medical, but also a socially significant aspect.
The etiology and pathogenesis of bacterial chronic prostatitis are associated with infection in the prostate gland in the following ways: ascending (through the urethra), descending (when throwing infected urine from the bladder), hematogenous or lymphogenous. Often uropathogens are Escherichia coli, Klebsiella, Proteus, Staphylococcus aureus, Enterococcus, Corynebacterium, fungal, parasitic and viral pathogens. Along with non-specific flora, pathogens of specific urethritis (chlamydia, mycoplasmas, gonococci, trichomonads, gardnerella) can take part in the development of chronic prostatitis.
However, for the development of chronic prostatitis, it is important not so much the presence and activity of microorganisms as the condition of the pelvic organs and blood circulation in them, the presence of concomitant diseases, and the level of protective mechanisms. Therefore, the emergence of chronic prostatitis can contribute to a number of factors. First of all, these are urological diseases - pyelonephritis, cystitis, urethritis, urethral stricture, untreated acute prostatitis, orchitis, epididymitis, etc.
A microbial etiological agent can enter the prostate from distant foci of infection, for example, in the presence of sinusitis, tonsillitis, caries, chronic bronchitis, pneumonia, pyoderma, etc. Local and general hypothermia, overheating, stay in a humid environment, fatigue, malnutrition are predisposed to chronicity , rare urination, etc.
Non-bacterial chronic prostatitis is usually associated with congestive (stagnant) phenomena in the prostate gland due to stasis of venous circulation in the pelvic organs and impaired drainage of the prostate acini. Local congestion leads to overflow of the vessels of the prostate with blood, edema, its incomplete emptying from the secret, violation of the barrier, secretory, motor, contractile function of the gland.
Stagnant changes are usually caused by behavioral factors: prolonged sexual deprivation, the practice of interrupted or prolonged sexual intercourse, excessive sexual activity, physical inactivity, chronic intoxication, occupational hazards (vibration). The development of non-bacterial inflammation is predisposed by the pathology of the pelvic organs and nerve structures that innervate them (for example, spinal cord injuries), prostate adenoma, hemorrhoids, constipation, androgen deficiency, and other causes.
According to the modern classification of prostatitis, developed in 1995, there are three categories of the disease:
- I. Acute prostatitis.
- II. Chronic prostatitis of bacterial origin.
- III. Inflammation of non-bacterial origin / pelvic pain syndrome is a symptom complex that is not associated with obvious signs of infection and lasts 3 months or more.
- III A. Chronic process with the presence of an inflammatory component (detection of prostate secretion of leukocytes and pathogens),
- III B. Chronic pathology with the absence of an inflammatory component (white blood cells and pathogens in the secretion of the prostate).
- IV. Asymptomatic chronic prostatitis (lack of complaints in the detection of leukocytes in prostatic secretion).
In the presence of an infectious component, they speak of bacterial (infectious) chronic prostatitis, in the absence of microbial pathogens - non-bacterial (non-infectious). It is believed that in 90-95% of all cases, non-bacterial inflammation occurs and only in 10-5% - bacterial inflammation.
Symptoms of Chronic Prostatitis
The disease is manifested by local and general symptoms. Local manifestations include the prostatic triad, characterized by pain, dysuria and impaired sexual function. The pains are constant aching in nature, localized in the perineum, genitals, above the pubis, in the groin. The pain syndrome intensifies at the beginning and end of urination, while pain radiates to the glans penis, scrotum, sacrum, and rectum.
Pain can increase after intercourse or due to prolonged abstinence, weaken or intensify after orgasm, become more intense immediately at the time of ejaculation. The intensity of the pain syndrome varies from discomfort to severe manifestations that disturb sleep and performance. Pain with limited localization in the sacrum is often regarded as osteochondrosis or radiculitis, in connection with which the patient can be treated on his own for a long time without resorting to the help of a doctor.
Urination is frequent and painful. At the same time, difficulty in the onset of mictus, weakening or intermittent urine stream, a feeling of incomplete emptying of the bladder, frequent nightly urges, burning in the urethra may be noted. In urine, the presence of floating threads can be detected. After defecation or physical activity from the urethra, discharge (prostatorea) appears, due to a decrease in prostate tone. Itching, a feeling of cold or excessive sweating in the perineum, local changes in the color of the skin associated with stagnation of blood circulation may be noted.
Chronic prostatitis is accompanied by severe violations of sexual function. The phenomena of dyspotency can be expressed in worsening, painful erection, prolonged and frequent nightly erections, difficulty or early ejaculation, loss of sexual desire (decreased libido), blurred orgasms, hemospermia, infertility. Sexual disorders are always difficult for a man to experience, leading to psycho-emotional disorders, up to neurosis and depression, further impairing sexual function.
Exacerbations are accompanied by a slight increase in body temperature and a deterioration in well-being. The general condition is characterized by increased irritability, lethargy, anxiety, fatigue, loss of appetite, sleep disturbance, decreased ability to work, and creative and physical activity. In almost a quarter of patients, there are no symptoms of the disease for a long time, which leads to late treatment by the andrologist.
Symptoms, diagnosis, treatment of chronic prostatitis
The first signs of prostatitis in men can occur at a young age, and if high-quality medical care is not provided, the disease can go into a latent (latent) form and proceed with minor symptoms: discomfort during urination and sexual intercourse, pain in the perineum and lower back. If you do not pay attention to these symptoms, chronic prostatitis progresses, the treatment of which is more complicated and longer.
An experienced urologist will tell you what chronic prostatitis means and how dangerous it can be. Even a single inflammation without effective treatment can result in the transition of the disease to a severe recurrent form.
The causative agent of prostatitis are microbial agents: Pseudomonas aeruginosa, staphylococcus, Escherichia coli. But the causes of chronic prostatitis can be associated with the following predisposing factors:
- decreased immunity,
- genitourinary injuries
- drinking alcohol and too spicy food,
- pelvic congestion,
- smoking, chronic intoxication of the body with destructive substances,
- sedentary lifestyle,
- the presence of foci of chronic infection,
- sexually transmitted diseases.
The prolonged influence of one or more predisposing factors leads to the fact that chronic prostatitis in men progresses. The disease occurs at any age, quite often young men suffer, who have a history of sexually transmitted diseases, other infectious processes of the prostate and urinary organs.
Men have a tendency to procrastinate with recourse to specialists. Often the initiator of a urologist consultation is the wife. If the husband has chronic prostatitis, it is necessary to immediately begin treatment. Otherwise, you can start the course of the disease, which will turn into a severe chronic form and begin to give complications.
Diagnosing chronic prostatitis can not only in older people. Young and middle-aged people are also affected. At risk are those who lead a sedentary lifestyle, adhere to sexual abstinence or experience physical activity in the perineum. That is, the likelihood of chronic prostatitis in drivers and athletes is much higher than in all others.
Among all diseases of the male reproductive system, chronic prostatitis takes first place in prevalence, followed by cancer and benign prostatic hyperplasia of BPH (prostate adenoma). Approximately one in three men experiences inflammation of the prostate, and every fifth of them suffers from a chronic form of the disease.
I. A. Izmakin, chief urologist at the Euromedica Clinic, talks about pathology and how it appears:
In most cases, the cause of chronic prostatitis is a past illness of the genitourinary system caused by infections. A little less often, it is caused by inflammatory processes associated with a change in the hormonal background of a man.
Signs of the disease
Signs of chronic prostatitis in men during remission are almost completely absent. A minor pain syndrome is permanent, but the discomfort is moderate. After hypothermia, prolonged abstinence, chronic prostatitis may worsen, the signs of which increase depending on the condition of the man.
Each time with an exacerbation, characteristic symptoms of chronic prostatitis in men appear:
- heaviness and pain in the perineum,
- signs of intoxication,
- violation of urination
- irradiation of pain in the penis or anus,
- the prostate during palpation is asymmetric and painful,
- chills, weakness, fever.
It is characteristic that the pain intensifies at the beginning and end of urination. Unpleasant sensations are usually given to the area of the rectum, sacrum and penis. The pain syndrome appears after intimate contact, it is especially acute during sperm excretion. Urination during remission can be painless, but it is usually quicker. At the same time, it becomes difficult to start mixing.
The stream of urine becomes intermittent, there is a feeling of incomplete emptying of the bladder. In the morning there is a burning sensation in the urethra. In morning urine there are often filiform formations. This means that the inflammatory process has a chronic course.
Impact on Sexual Ability
Male problems with potency often arise against the background of a protracted course of the inflammatory process that disrupts the functionality of the prostate, reduces libido, and can even cause infertility. With such complications, chronic prostatitis occurs - the causes of erectile dysfunction are often often associated with a sluggish infectious and inflammatory process. Until the causative agents of the disease are destroyed, the action of predisposing factors is eliminated, the potency will not be restored.
Diagnosis of chronic prostatitis
Complex diagnostics will help to determine the course and causes of chronic prostatitis in men. First of all, experts prescribe a rectal examination of the prostate gland. During the procedure, the specialist determines the clarity of the contours and boundaries of the organ, the degree of pain. In the future, to identify specific functional and structural changes, an ultrasound scan is performed.
Ultrasound of the prostate gland (TRUS) is a safe, informative method of visualizing the main structures of the prostate and adjacent urogenital organs. Studies are carried out both through the abdominal wall, and transrectally - through the rectum. If it is difficult to urinate, the specialist additionally examines the bladder and determines the residual urine.
Ultrasound diagnosis allows you to choose the most effective treatment for chronic prostatitis in men, as well as evaluate the effectiveness of the methods already used. The absence of radiation load on the body allows the use of ultrasound as often as required by a specific clinical situation.
Prostate secretion and urethroscopy
The secretion of the prostate is taken after urination and massage of the gland. The study of biomaterial allows you to identify pathogenic microflora, to determine the level of leukocytes and the number of lecithin grains. The method makes it possible to classify the nature of the pathological process, to understand how to treat a man and what drugs to use. Diagnosis is not accompanied by painful sensations, it is easily perceived by a man.
In case of violation of the urethra, the appearance of blood in the urine and erectile dysfunction, it is recommended to perform urethroscopy. This procedure allows you to evaluate the urethra and to carry out certain therapeutic measures using endoscopic equipment.
Additional research methods
Additional diagnostic methods are used to clarify the clinical picture, determine the exact causes of the inflammatory process. Chronic prostatitis must be differentiated from neurogenic bladder and other similar diseases that have similar symptoms. Specialists prescribe electromyography, urodynamic diagnostic methods. They allow a qualitative differentiation of chronic inflammation from other diseases.
Chronic prostatitis often leads to hyperplastic processes, proliferation of glandular tissues, growth of adenoma and malignant neoplasms.To exclude the cancer process, it is necessary to conduct PSA diagnostics. The method involves determining the level of prostate-specific antigen, with an increase in which it is possible to suspect the growth of malignant cells. To clarify the nature of the identified formations, it is necessary to conduct a biopsy of the prostate gland followed by morphological study of the given material.
Chronic prostatitis significantly reduces the quality of life of men. The long course of the inflammatory process in one way or another violates the reproductive function, weakens the libido and threatens various infectious complications. The most unpleasant consequences of the disease are impotence and reproductive disorders. Constant inflammation changes the tissues of the prostate gland, contributes to their proliferation, hormonal abnormalities, the early appearance of menopause and the growth of adenoma.
The chronic course of the disease can lead to urinary incontinence, the formation of stones and cysts in the prostate. As the disease develops, prostate sclerosis forms. This pathological condition is the final stage of inflammation of the prostate. The body accumulates collagen with the formation of dense tissues. The urethra narrows, there are problems with potency. Such changes are characteristic of benign prostatic hyperplasia, which at any time can lead to malignant cell growth and the formation of cancerous tumors.
Chronic inflammation of the prostate is not easy to cure. But recovery is possible or the transition of pathology into a prolonged stage of remission. The effectiveness of medical procedures depends on the timeliness of seeking medical help.
A man must strictly follow the recommendations of the attending physician, avoid the effects of predisposing factors: hypothermia, scrotal injury, sexually transmitted diseases, the effect of stress. It is important to remember that even a banal viral infection can cause an exacerbation of the disease with the appearance of intense pain and disruption of the urinary system.
Bacterial prostatitis is treated with antibiotics. They are prescribed for several weeks. Nonsteroidal anti-inflammatory drugs are used to increase the comfort of a patient’s life, to combat the main acute symptoms. Adrenergic blockers are effective for restoring urodynamics, regular outflow of prostate secretion and relieving muscle tension of the gland. Paraprostatic blockade in combination with acupuncture effectively cope even with intense pain.
If a man feels anxiety against the background of a chronic inflammatory process, sedatives or tranquilizers can be used. But such drugs should be prescribed by qualified specialists who are familiar with a specific clinical case.
From physiotherapy, drug electrophoresis, ultrasound treatment, magnetotherapy are used. Acupuncture is also used in combination with analgesic blockade. In addition, it is recommended to use therapeutic sitting baths, enemas and special instillations in the urethra. Dropwise administration of drugs helps well in chronic inflammatory processes.
The technique ensures that a large amount of the agent enters directly into the pathological focus. For a long time, a high concentration of the drug remains. This allows you to effectively cope with a sluggish infectious process. The drug must be kept for 30-40 minutes, limiting urination.
With the ineffectiveness or impossibility of using conservative techniques and physiotherapy, surgical treatment is necessary. It is mainly required to remove urethral strictures. In case of sclerosis of the prostate, transurethral resection is performed using endoscopic technique. The method is used if the patient has severe concomitant diseases of the internal organs that do not allow for classical prostatectomy.
With recurrent phimosis against a background of a chronic infectious process, it is recommended to carry out therapeutic circumcision of the foreskin. The operation is performed according to indications and only in the conditions of the urological department.
The prognosis of the disease is determined by the timeliness and effectiveness of the prescribed treatment, the duration of treatment of the inflammatory process, the age of the man and the presence of certain concomitant disorders. Subject to medical prescriptions, the implementation of preventive measures, including the normalization of intimate activity and the prevention of sexually transmitted diseases, it is possible to reduce the number of relapses per year and put the disease in a state of prolonged remission.
Types of Chronic Prostatitis
Universal is considered a classification developed in the USA, according to which Several types of chronic prostatitis are distinguished:
- Acute bacterial (with relapse).
- Chronic bacterial.
- Chronic aseptic (abacterial) prostatitis, which is divided into 2 subspecies: the syndrome of chronic pelvic pain of an inflammatory or non-inflammatory nature (prostatodynia).
- Asymptomatic flowing (latent) chronic prostatitis.
Constructive and the most complete is the classification of chronic prostatitis, proposed by Tiktinsky O. L., which is shown in table 1.
Table 1. Types of chronic prostatitis
|Type of triggering factors||Type of chronic prostatitis|
|Etiological (depending on the cause of prostatitis)||Infectious prostatitis (bacteria, fungi, viruses, tuberculosis, trichomoniasis)|
|Congestive prostatitis (stagnation caused by physical inactivity, sexual abstinence)|
|Pathogenetic (depending on the pathogen penetration into the prostate)||Hematogenous prostatitis (movement of the infection with blood flow from other organs)|
|Lymphogenic prostatitis (pathogen movement with lymphatic flow in case of proctitis, thrombophlebitis, hemorrhoids)|
|Contact prostatitis (movement of infection from other organs along the urethra in the descending and ascending ways)|
The development of chronic prostatitis goes through several stages:
- Exudative. Pain in the groin, lower abdomen, with ejaculation and erection are characteristic
- Alternative. Discomfort intensifies, pains begin to radiate (spread) to the sacrum. Urination and erection are normal,
- Proliferative. The pressure of a stream of urine is weakening, urges are becoming more frequent. With the proliferative form of prostatitis, an erection becomes intense, but the orgasm either does not occur or is blurry,
- Cicatricial (sclerosis of the prostate). The feeling of heaviness in the lower abdomen, frequent urination, ejaculation is almost absent.
These symptoms of chronic prostatitis in men do not always appear in a strict order. The degree of their severity depends on the characteristics of the body.
Chronic bacterial prostatitis
Bacteria cause inflammation of the prostate in 6-10% of cases. The bacterial form of chronic prostatitis is usually triggered by non-specific infections (E. coli, Staphylococcus aureus, hemolytic streptococcus) penetrating the prostate from other organs or the external environment. Inflammation caused by this type of bacteria develops slowly with erased symptoms, so chronic infectious prostatitis often worsens, already being started. Sometimes inflammation is manifested by mild itching, burning and even pain in the urethra, urination disorder.
Active development of infection is indicated lower abdominal pain and fever. These are the first signs that the defeat of other pelvic organs has begun. The formation of abscesses is possible.
Modern methods of treating bacterial prostatitis suggest taking antibioticsactive against the pathogen detected during diagnosis. As aids are prescribed antispasmodics, painkillers of class NSAIDs (diclofenac), diuretics.
First-line antibacterial drugs are:
- Fluoroquinolones (“Levofloxacin”, “Ciprofloxacin”, “Pefloxacin”, “Nolicin”), which create the highest concentration of the active substance in the tissues of the prostate. Effective against chlamydia (in this case, the therapy is enhanced with tetracycline antibiotics (Doxycycline)), gram-negative bacteria, ureaplasma.
- Penicillins with clavuanoic acid (Amoxiclav).
- Cephalosporins (Cefotaxime, Ceftriaxone).
Second-line antibiotics are macrolides (Azithromycin). Sulfonamides (Biseptol) may also be included in the scheme. It is impossible to quickly cure chronic prostatitis. Depending on the nature of the inflammation, therapy takes from 2 to 12 weeks.. If within 2 weeks there is no positive dynamics, then the drug changes.
The unsatisfactory result from antibiotic therapy for chronic prostatitis is due to the following reasons:
- Short course
- Low concentration of active substance,
- The formation in the lumens of the ducts, acini of the prostate (cluster-shaped sacs that make up the glandular tissue of the prostate gland) colonies of resistant bacteria.
Antibiotics are administered not only orally, but also by the intraprostatic and endolymphatic route (injections into the lymph vessel or lymph node).
Fungal (mycotic) prostatitis is a separate subspecies of the chronic form of the disease. Pathogens penetrate both with unprotected sexual contact, and with lymph flow from other organs. Symptoms of prostate tissue damage are often lubricated, so inflammation becomes chronic.
Signs of chronic prostatitis of fungal origin during exacerbation:
- Enlarged lymph nodes in the groin.
- Drawing pain in lower abdomen.
- White plaque and curdled lumps on the head of the penis, itching, rashes.
- Frequent urination with pain.
- Decreased libido, erectile dysfunction.
With normal immunity, fungal colonies do not reproduce more than a safe norm. The risk of developing candida prostatitis is increased in diabetics, men with positive HIV status, as well as those suffering from systemic diseases.
Chronic pelvic pain, involving the coccyx and perineum, is a sign of abacterial prostatitis (the prevalence is 80-90%, including prostatodynia 20-30%) Other manifestations may not be at all. When diagnosing pathogenic microorganisms, it is not found either in prostate juice, or in urine, or in ejaculate. With the inflammatory nature of pelvic pain in the above biological fluids, the number of leukocytes increases.
In addition to pain, with chronic abacterial prostatitis, symptoms such as blood in the ejaculate, discomfort during ejaculation and defecation, difficulty urinating are periodically observed. In some men, libido decreases markedly, erectile function worsens, general weakness and muscle pain occur.
Chronic calculous prostatitis
The chronic calculous form of prostatitis is also abacterial. Stones (prostatolitis) in the prostate are formed due to stagnation of the secret. They consist of products of inflammatory reactions, salts, necrotic masses. Pathology usually develops on the background of congestive (congestive) chronic prostatitis, urolithiasis (stones can migrate from the kidneys and bladder) metabolic disorders, adenomas.
Signs of chronic prostatitis with calcifications:
- Impaired urination.
- Pain in the groin, tailbone.
- Blood in semen.
- Erection worse.
To dissolve stones, special preparations (Trilon B) are injected into the prostate and rectal massage is performed. If conservative methods do not work, then resort to surgery. A neglected form of chronic calculous prostatitis can lead to an abscess of the gland or organ atrophy.
In chronic latent prostatitis, there are no signs. The only thing that is found in the diagnosis is leukocytosis of prostate secretion and a likely increase in PSA levels.
Asymptomatic prostatitis is detected by accident: during a routine examination or when contacting for another reason.
The consequences of chronic prostatitis
By itself chronic prostatitis is not dangerous for a man’s life. Its consequences can be threatening if you do not seek medical help on time. Complications most often develop in young patients.
In chronic prostatitis, the protective function of the gland is impaired, the amount of zinc and lysozyme necessary for its normal functioning is reduced. As a result, the organ becomes a source of permanent infection.. Pathogens often migrate to the testicles, rectum, causing epididymitis, paraproctitis. When the infection moves along the ascending paths, the development of pyelonephritis, renal failure.
Since the prostate is actively involved in the formation of ejaculate, its persistent inflammation can lead to infertility. Often, a woman cannot become pregnant, not because of poor partner sperm, but because of defective seminal fluid. Attempts to conceive a child in a natural way for a long time fail (more about the effect of prostatitis on the conception of a child).
A serious complication is scarring of the wall of the bladder, the prostate itself, the urethra. Long-term inflammatory deform tissues, they frown, become non-functional. The likelihood of developing prostate adenoma (BPH) is also high, which can serve as a catalyst for the oncological process.
Diagnosis of chronic prostatitis
At the consultation, the doctor details the patient’s medical history, especially it is important to describe any violations in intimate life. The range of complaints in a man with chronic prostatitis can be extremely wide: from sexual dysfunction to neurosis. ¼ all patients do not notice any symptoms at all, pathology is detected by chance.
Anamnesis is important. Characteristic precursors of various types of chronic prostatitis: for infectious, it is bacterial or gonorrhea urethritis, for non-infectious - hemorrhoids, varicocele, varicose veins in the legs.
Of paramount importance in the diagnosis of chronic prostatitis are palpation of the gland, analysis of its secret (more about sowing prostate secretion). During an exacerbation, the size of the prostate slightly increases, and during periods of remission it returns to normal, only slight swelling is possible. The secret is obtained by rectal massage of the gland. If the inflammatory process is focal in nature, then the consistency of the organ is uneven: sections of retraction, thickening, softening alternate. In such cases, prostatic juice is obtained separately from each lobe.
Changes in the secretion of the gland, which are indicators of chronic prostatitis:
- The shift of acidity towards alkalization,
- Increased lysozyme activity,
- Decrease in volume of acid phosphatase.
Highly informative is the luminescent-cytological study of prostatic juice, as well as a test of its crystallization. In healthy men, the juice crystallizes in the form of a fern leaf. Violation of the geometry of the pattern indicates endocrine pathologies, as a result of which a lack of androgens occurs.
In some cases, when diagnosing infectious chronic prostatitis, alimentary provocations are used - the patient intentionally consumes spicy food or alcohol, as a result of which the pathogens of gonorrhea and trichomonas are activated. Sluggish inflammatory processes occur with the introduction of pyrogenal or prednisone.
Among laboratory studies, the most informative is considered a test called a three-glass sample.. The patient urinates first in one glass, then in the second, after which prostate massage is performed. The urine remaining in the bladder is collected in a third glass. She, along with the ejaculate, undergoes bacteriological research. Among the mandatory tests, a smear from the urethra for the presence of STDs is also taken.
Not all conditional pathogens that grew during bacterial seeding are automatically considered pathogens of chronic prostatitis. In microbiocenosis, their presence is a normal variant. Growth titer (concentration) is important. If the indicator exceeds 10 to 4 degrees, then it is considered to be diagnostically significant. Otherwise, the patient is shown dynamic observation, not treatment.
An informative diagnostic method is TRUS or transabdominal ultrasound. By echographic signs, you can determine the duration and severity of inflammation.
The main echoes of chronic prostatitis:
- The volume of the gland increases to 20 cm 3 or more,
- Sclerotic and fibrotic tissue transformations,
Urine flow rate and the presence of obstructive changes in the ureter make it possible to track uroflowmetry. To differentiate chronic prostatitis from cancer and hyperplasia if necessary, a biopsy of the gland.
PSA levels in chronic prostatitis during remission are normal or slightly elevated. Against the background of an active inflammatory process, it can rise to 8-10 ng / ml.
Diagnosis of non-bacterial chronic prostatitis is somewhat more complicated. It is necessary to carry out a number of tests to exclude the bacterial form of inflammation, pathologies of other pelvic organs. Microscopy of urine and ejaculate shows an excess of leukocyte levels, but ultrasound, cystoscopy, CT scan do not reveal concomitant diseases.
Symptoms of the disease
Signs of chronic prostatitis can be very different. Most often, the patient complains of:
- Decreased performance.
- Increased irritability.
- Sleep disturbance.
- I’m losing my appetite.
- Increased sweating.
Candidate of medical sciences, urologist Guk Andrey Valerievich answers questions about symptoms:
Among local symptoms:
- Urination disorder. The patient feels frequent urges, pain at the beginning and end of urination.
- Aching pain that can give in the groin, sacrum, scrotum, pubic bone or rectum.
- Pain during sex.
- Discharge during tension of the pelvic muscles.
Unlike the acute phase, in a chronic disease, sexual dysfunction often occurs. This is due to the fact that congestive and inflammatory processes are also affecting the nerve endings, which ensure the transmission of impulses to the brain. As a result, erectile dysfunction is possible, which weakens or ejaculation (premature ejaculation), sensations during an orgasm become dull. Such symptoms of chronic prostatitis in men lead to fear of intimacy, irritability, and as a result, sexual neurosis develops.
It is not easy to treat chronic prostatitis. How long it takes to take the medicine depends on the degree of pathology and the duration of the disease. It is important to remember that if the symptoms of the disease have disappeared, this does not mean a final cure. The severe effects of chronic prostatitis include scarring of the gland. This process can go to the urethra.
General Therapies for Chronic Prostatitis
In addition to specific methods of treating various types of chronic prostatitis, there are general methods used for all types of inflammation.
An effective way of healing the prostate is massage. It has a direct effect on the tissues of the gland, improves blood circulation and lymph flow, removes products of inflammatory reactions. With exacerbation, prostate massage is not performed.
Physiotherapeutic methods are an integral part in the complex treatment of chronic prostatitis. Among them are the following:
- Transrectal, transurethral microwave hyperthermia. When tissues are heated to 40˚, bacterial growth stops, immunity is activated at the cellular level. At 45 обез anesthetic effect is achieved by blocking the sensitivity of nerve endings.
- Laser therapy (low energy).
- Ultrasonic phonophoresis (for summing up the prostate medication).
- Balneotherapy, microclysters with hydrogen sulfide, mineral waters (effective in cicatricial processes).
The choice of physiotherapy methods depends on the phase of chronic prostatitis, the degree of emptying of the glandular lobules, and the activity of inflammation.
Some physiotherapeutic procedures can be carried out at home using special portable devices. For instance:
- Ereton (electrical pulses, magnetic field, vibration),
- Mavit (magnetic, thermal, vibration exposure),
- “Yarovit” (photo-vacuum effect). The device "Yarovit" is also used for erectile dysfunction: a member is placed in a transparent flask in which a vacuum is periodically created. Thus, blood circulation is stimulated in the cavernous bodies of the penis and in the entire inguinal region.
- "Shuposhi" (4 modes of massage effect on bioactive points). Effective in chronic pelvic pain syndrome.
Impact on the prostate is performed both transrectally and superficially (special manipulators are included in the package). During exacerbation, it is impossible to use hardware physiotherapy.
Exercise is the most effective way to maintain the functional state of the gland tissue with chronic prostatitis. The Kegel system, static and dynamic squats, walking on the buttocks, bringing legs with effort (gymnastics according to Bubnovsky) - all these techniques help strengthen the muscular skeleton of the pelvis, stimulate blood circulation in the prostate gland. Some men prefer yoga asanas, jogging.
If you don’t have time to visit the gym, you can buy inexpensive home sports equipment: a mini-stepper, stacked dumbbells, rubber bands, and fitball.
Often in case of complications of chronic prostatitis surgical treatment is the only adequate solution to the problem. The following methods are used to eliminate the consequences and eliminate the provoking pathological factors:
- Removal of the prostate (prostatectomy) is performed only if there is a suspicion of oncology or intraoperative complication in the form of an outflow of pus,
- Partial resection of the prostate with hyperplasia,
- Endoscopic drainage of cysts and abscesses,
- Resection of the seed tubercle. The operation is performed with its sclerotherapy, which is the cause of a weak orgasm, painful ejaculation, a small amount of sperm,
- Circumcisio (circumcision): removal of the foreskin due to the accumulation of infections caused by phimosis (too narrow foreskin that does not expose the head).
If chronic prostatitis is complicated by adenoma, then in 70% of cases the symptoms are erasedpatient seeks help too late. Doctors have to operate the prostate in the stage of exacerbation of inflammation, which significantly worsens the prognosis. Surgical intervention (except for prostatectomy) does not guarantee a complete cure for chronic prostatitis. The sooner the patient goes to the clinic, the more favorable the outcome: prolonged remission, the absence of white blood cells and bacteria in biological fluids.
Every man can suspect prostatitis. There are home methods for diagnosing this ailment. So, all the symptoms indicate the presence of chronic prostatitis. Also, there is a home research method. A man must empty himself into three different transparent containers. If the urine in the first and third dishes will be different in color, then there is cause for concern. Clouded urine is also considered abnormal. In the case of the presence of a turbid liquid in two containers, there is a possibility of the presence of prostatitis. If turbid urine is found in only one vessel, there is some kind of inflammatory process.
To maintain the normal functioning of the prostate in chronic prostatitis, it is very important to follow preventive measures. To begin with, a man should carefully monitor his intimate hygiene. This is the only way to prevent bacteria from entering the genitourinary system from the outside. Chronic prostatitis involves the periodic occurrence of relapses. And here it is important to consult a doctor in a timely manner. So, the manifestations of the disease will not be acute, without violating the usual rhythm of a man’s life.
To avoid stagnant processes in the prostate, the regularity of sexual relations is important. Also, do not lead an excessively active sex life. Experts define the concept of regularity of sex as 2-4 times a week. This is the best option for restoring the male body, improving sperm quality and prostate secretion. Regular, but moderate physical activity will also avoid relapses of stagnant processes.
It is important to prevent the development of constipation. Therefore, a balanced diet for chronic prostatitis is the main condition. So, the diet of young people should consist of such products:
- Lean meats
- Green pea,
- Vegetable soups, light meat broths,
- Gray bread
- Dried fruits.
A microelement such as zinc plays an important role in the prevention of chronic prostatitis. In this regard, doctors recommend that men consume more seafood, pumpkin seeds, beef, nuts. A sufficient amount of zinc is also found in chicken eggs. But, to use this product is allowed no more than one egg per day. Speaking of drinks, it is useful to drink fruit drinks, dried fruit compotes, purified non-carbonated water.
In the case of chronic prostatitis, it is important to completely exclude from the diet food that irritates the prostate gland. These include alcohol, a large amount of salt and spicy, smoked meats, animal fat, offal, canned food, marinades, vinegar, radishes, radishes, spices, spices, seasonings, mushrooms and mushroom broths, sorrel, spinach, strong tea and coffee, large amount of sweets, pastries, chocolate. Various synthetic food additives are also harmful - dyes, emulsifiers, stabilizers.
Urologists, andrologists recommend regular examination, physiotherapy. Periodic preventive courses of physiotherapy will help not only to avoid the re-development of chronic prostatitis, but also completely cure the disease. Taking multivitamin complexes and immunomodulators will strengthen the immune system. It is important to exclude stressful situations, overheating, hypothermia, a sedentary lifestyle, bad habits. In general, chronic prostatitis is treatable, it’s quite simple to adhere to all the recommendations of a qualified specialist.
Diagnosis of the disease
When contacting a doctor, he will take an interest in the patient’s symptoms. Particular attention is paid to the frequency and nature of pain, impaired urination, sexual dysfunction. But due to the fact that chronic prostatitis can occur without any manifestations, certain studies are necessary:
- Clinical and bacterial analysis of urine, which determines the number of leukocytes and the presence of pathogenic microorganisms.
- An analysis of the secret that bacteria may contain.
- Mucosal scraping, in which the number of leukocytes, the presence of macrophages and amyloid bodies are determined.
- Transurethral ultrasound makes it possible to identify the echoes of chronic prostatitis and determine the condition of the prostate.
On the issues of diagnosis and treatment, listen to the report of the specialists of the FSBI “Research Institute of Urology” of the Ministry of Health of the Russian Federation:
To make the treatment with pills more effective, the doctor may recommend physiotherapy (electrophoresis, phonophoresis, laser therapy, mud treatment) and transrectal hyperthermia, which is carried out taking into account existing changes in prostate tissue and associated diseases. When exposed to a temperature of 40 degrees, cellular immunity is activated. When exposed to a temperature of 45 degrees, inhibition of nerve endings occurs, which helps to relieve pain. The use of laser therapy has a biostimulating effect.
In the absence of contraindications, the patient is given a prostate massage. Often patients are prescribed a course of psychotherapy and special exercises that can strengthen the muscles of the perineum.
Often, chronic prostatitis does not give symptoms, and patients seek medical help even when there have been serious changes in the prostate gland and the medicines for chronic prostatitis are already powerless. In addition, such complications can pose a threat to the health of the patient. An example of a complication is sclerosis of the prostate gland.
Due to the fact that such complications are often detected in young men, doctors use minimally invasive surgery. Indications for its use are: phimosis, involuntary excretion of urine or, conversely, its delay, prostate abscess, a significant enlargement of the gland in size, urethral block or bleeding. There are types of surgical intervention that are indicated for chronic inflammation:
- Circumcision - is used when the patient has phimosis. During the operation, the foreskin is dissected.
- Prostatectomy is a radical operation during which the prostate is completely removed. It is carried out in case of suspicion of the presence of a malignant tumor.
- Resection of the prostate is a partial removal of the gland, in case of its sclerotic change.
- Elimination of adhesions.
- Drainage of a cyst or abscess. It is produced by endoscopy. For drainage, a special tube with a camera at the end is used. Such a device is introduced into the lumen of the urethra and makes it possible to control the progress of the operation.
- In the case of complaints of various disorders of a sexual nature (orgasm, painful ejaculation, etc.), the patient undergoes an incision in the vas deferens.
The result of surgery will depend on the timeliness of the diagnosis. In cases where there is prostate adenoma, the manifestations of chronic prostatitis can be lubricated. This is observed in 70% of cases. 25% of men learn about the development of chronic prostatitis during an examination for adenoma. And only 5% of patients - during a routine examination.
The condition for the operation is the lack of effect in the conservative treatment of the disease. Therefore, the operation is needed to prevent complications and improve the quality of life.
However, it should be borne in mind that even after surgery, the return of prostatitis is possible.This happens in almost half of the operated. Contraindication to any operation is:
- Pathology of the liver.
- Respiratory system diseases.
- Mental disorders.
- Heart diseases.
Dietary supplements and folk methods
Folk remedies for chronic prostatitis are used only as an auxiliary and rehabilitation therapy. Among herbal preparations, extracts containing pigeum, sabal palm, pumpkin seed oil (Prostamol Uno, candles and Vitaprost tablets) have proven themselves well.
- Grushanka round-leaved. Brew a tablespoon of dry raw materials with a glass of boiling water, leave for 3 hours. Drink 50 ml three times a day before meals in a course of 3-4 weeks,
- Parsley root. Place a tablespoon of crushed raw materials in a thermos, pour 100 ml of boiling water, leave for 8 hours. Strain, take a tablespoon before meals 4 times a day,
- Young Aspen Bark. Place in a thermos a tablespoon of dry raw materials, 250 ml of boiling water, leave for 8 hours. To drink in the morning
- Red root. Fill 50 g of raw material with 500 ml of vodka (or alcohol), insist 3 weeks. Take a teaspoon before meals three times a day.
Other herbs for CP: parsley, celery, celandine, horsetail, thyme. In some cases, horseradish treatment is effective: pour 100 g of fresh root with a liter of boiling wine (dry red), leave for a day, boil again, strain. Drink half a cup before meals.
With chronic prostatitis, anti-inflammatory properties will be beneficial. honey, propolis, decoction on bee subpestilence. Bee products treatment is suitable only for men who are not prone to allergies. There are positive reviews about beaver tincture. Get rid of congestive processes in the pelvic area contribute to tinctures for ginseng and eleutherococcus.
In some cases, treatment is used to eliminate the consequences of prolonged use of antibiotics and prostate tissue repair homeopathy: “Conium”, “Aurum muriaticum”.
Diet for chronic prostatitis plays an important role: food and drinks can both provoke an exacerbation and prolong remission. The use of alcohol, fatty, fried foods, sweets, spinach, pickles, sorrel, coffee and tea should be minimized.. Useful lean meat, fatty fish, quail eggs. Fermented milk products and vegetables are required.
Diet control is a mandatory measure for chronic prostatitis. If you often make mistakes in the diet, then relapse can not be avoided.
Enough for the prevention of chronic prostatitis follow a few recommendations:
- Avoid frequent constipation and empty the bladder in a timely manner. These measures will help to avoid the accumulation and reproduction of pyogenic microflora.
- Do not abuse the containment of ejaculation to prolong sexual intercourse.
- Ensure regular emptying of the ducts of the prostate, for which it is necessary: having sex (or masturbation), physical exercise, periodic exercise during sedentary work.
- Protect and maintain hygiene during sexual intercourse.
- Balance the diet: more fiber and lean meat, fewer refined foods, alcohol, sweets.
To prevent prostatitis, it is useful to use pumpkin seeds or dietary supplements with zinc and selenium.
Exacerbations of chronic prostatitis always arise against a background of provoking factors:
- The abuse of spicy, sweet, fatty foods, coffee and alcohol (more about the effect of alcohol on prostatitis),
- Urinary retention and ejaculation,
- Frequent constipation
- Infectious diseases,
- Unprotected sex with an unstable partner (microflora conflict is possible even in the absence of STDs),
- Physical overload and lack of physical activity,
- Prolonged abstinence,
As for the bath or sauna in chronic inflammation of the prostate, then in remission, their visit is theoretically not contraindicated - infrequent warming with moderate temperatures accelerates metabolic processes and blood flow. In some men, too much heat (like a hot bath) can cause swelling of the gland and bouts of pain.
George, 33 years old: “I recommend everyone with chronic prostatitis to periodically undergo a massage course. A very useful thing. The doctor also prescribed Lycoprofit and advised cycling. I did everything, the symptoms disappeared in a month.
Sergey, 41 years old: “I tried a lot of different schemes, nothing helped, until Sextafag was prescribed. This is a bacteriophage that suppresses conditionally pathogenic microflora. Chronic prostatitis is treated for a long time, not all can withstand antibiotics, and this drug kills those pathogens that remain. I don’t remember pain for 3 years. ”
Artem, 35 years old: “I have congestive prostatitis. I tried a lot of things, but it really became better only from SmartProst.
Chronic prostatitis for men is like a sword of Damocles. Another attack can begin at any time and drag on for a long time. This situation negatively affects both the nervous and financial condition (the average price for a course of treatment of chronic prostatitis is from 20 thousand rubles). Long-term remission will ensure only compliance with all the doctor’s prescriptions and a healthy lifestyle. Antibiotics are not a panacea; most effectively, only your own immunity can cope with the disease.
Forecast and Prevention
The prognosis is determined by the timeliness and adequacy of treatment, the age of the patient, the presence of concomitant pathologies. Prevention of the disease requires compliance with sexual hygiene, timely treatment of urogenital and extragenital infections, normalization of the regularity of sexual life, sufficient physical activity, prevention of constipation, timely emptying of the bladder. To exclude relapses, dynamic examinations of an andrologist (urologist), preventive courses of physiotherapy, multivitamins, immunomodulators, the elimination of hypothermia, overheating, stress, bad habits are necessary.