According to statistics, about 40% of men with symptoms of prostatitis do not seek medical help. At the same time, the consequences of the disease, including the risk of male infertility, are very serious. Find out what symptoms you need to see a doctor and what to do to avoid getting sick.
What is prostatitis?
Prostatitis is an inflammation of the prostate or prostate, it is one of the most common "male" diseases. Prostatitis is very different, it can occur due to infection and without it, with insufficient sexual activity and with excess and so on. This article will help you understand the basic nuances of the disease.
About 10% of men show symptoms of chronic prostatitis, but only about 60% of them seek medical help (Nickel JC et al. , 2001).
Prostatitis affects men of all ages and its prevalence continues to rise. Men under the age of 50 make up 65. 2% of patients, according to various sources, the prevalence of the disease among men as a whole is 13, 2-35% (Lummus W. F. , 2001; Meares E. M. , 1990). According to other data, 8 to 35% of men aged 20-40 suffer from prostate inflammation. Among the elderly, the real picture is "hidden" by the appearance of benign prostatic hyperplasia (prostate adenoma), as their symptoms are largely the same. Up to 65% of patients with adenoma are treated with unrecognized prostatitis. (Nickel JC et al. , 2007). Since inflammatory diseases of the genitals are a common cause of male infertility, scientists speak of a threat to the nation's reproductive health.
What is prostatitis?
A simple division into acute and chronic is not enough to characterize prostatitis, the disease includes several syndromes with different clinical course. Consider which forms of the disease are isolated according to the modern classification (Krieger JN et al. , 1999).
Category I: Acute bacterial prostatitis. . . A relatively rare species, representing only 5% of cases. It is a consequence of urinary tract infection, it develops in the context of predisposing factors (reduced urine flow, suppressed immunity). In 5% of cases, it turns into chronic bacterial prostatitis.
Category II: Chronic bacterial prostatitis. . . It is also a rare disease that is considered a recurrent infection of the urinary system with a primary focus on the prostate.
Category III: Chronic prostatitis / chronic pelvic pain syndrome. . . Previously, this disease was called chronic bacterial prostatitis and accounts for up to 95% of all diagnosed prostatitis (Habermacher GM, 2006). Chronic pain syndrome combines pathologies characterized by urological pain in the absence of urinary tract infection. It does not include urethritis, cancers, urethral stricture, neurological damage to the bladder. It is divided into categories IIIa and IIIb: with signs of inflammation and without signs of inflammation. These signs are determined by the laboratory, mainly by the presence of leukocytes in the urine or in the prostate secretions.
Category IV: Asymptomatic inflammatory prostatitis. . . It is a random finding when examining a patient. It is most often diagnosed when examining men for infertility or an elevated level of PSA in the blood. We do not examine this type of disease in detail, as scientists have not yet developed a single view of this form (Nickel JC, 2011).
Symptoms of prostatitis
Symptoms of acute prostatitis
The disease begins intensely, there is pain in the perineum, body temperature rises. The urge to urinate is frequent (at least 5-7 per night), urination becomes painful, difficult. Urine comes in intermittent portions, there is no sense of satisfaction from urination. Blood can be found in the last parts of the urine. The pain is worse with bowel movements. It is a serious illness that requires urgent help.
Complications of acute prostatitis are:
- acute urinary retention
- prostate abscess (formation of purulent focus)
- paraprostatitis (inflammation of the tissue around the gland, can be caused by an abscess extract).
- varicose veins of the paraprostatic venous plexus (inflammation of the surrounding veins).
Chronic symptoms of prostatitis
All types of chronic prostatitis (bacterial and chronic pelvic pain syndrome) are similar. The picture of the disease is very variable, below is a list of symptoms that may be of varying severity.
- Pain:
- pain or discomfort in one of the characteristic areas (groin, hypergrain, testicles, penis, lower back, abdomen, rectum).
- pain when urinating or increased pain when urinating
- pain during or after ejaculation
- increased sensitivity of the muscles in the perineum.
- neuropathic pain;
- pain due to intestinal irritation.
- Urine symptoms:
- Lower urinary tract symptoms (LUTS) associated with bowel movements (urge to empty the bladder, incontinence, urge to urinate, nocturnal urination, pain when urinating)
- LUTS associated with obstruction (weak urine pressure, intermittent flow, need to push).
- burning sensation in the urethra
- recurrent urinary tract infections.
- Sexual dysfunction:
- erectile dysfunction
- violation of ejaculation (premature or delayed ejaculation, blood in semen)
- decreased libido.
- Psychosocial symptoms:
- worry;
- depression;
- cognitive and behavioral impairment
- reduced quality of life
Men with chronic pelvic pain syndrome are more likely to have manifestations of psychological stress and sexual dysfunction (A. Mehik, 2001).
If you experience symptoms of prostatitis and chronic pelvic pain syndrome, you should see a urologist or andrologist. In case of severe symptoms of acute prostatitis, you should seek emergency help to avoid urinary retention and other complications.
Causes of prostatitis
Inflammation of the prostate develops under the influence of many factors. A healthy gland in the absence of predisposing factors has the ability to resist infection and inflammation. The onset of the disease is facilitated by reduced immunity, violation of the outflow of secretions from the prostate, insufficient sexual shape, difficulty in the outflow of urine and deterioration of blood circulation to the pelvic organs. Other risk factors include cold weather, alcohol abuse and a sedentary lifestyle.
Acute prostatitis is a bacterial inflammation, the most common pathogens are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter and some others. The disease develops when the infection enters the gland through urine, with an ascending infection, through the lymph from the rectum or with blood from other foci of infection. Sexual transmission of pathogens plays an important role.
Risk factors for acute bacterial prostatitis:
- phimosis;
- urinary tract infections?
- acute epididymitis (inflammation of the epididymis).
- unprotected anal intercourse
- bladder catheterization
- urethral surgeries.
- prostate biopsy
- violation of the secretion and excretion of prostatic juice.
The risk factors and causative agents of chronic bacterial prostatitis are similar to those for acute. Of particular importance are the causative agents of genital infections: Trichomonas, chlamydia, ureaplasma, mycoplasma.
Chronic pelvic pain syndrome is not currently considered a homogeneous disease; doctors find it difficult to determine its main cause. In only one-third of these patients did the biopsy reveal inflammatory changes in the prostate. It is believed that the primary role in its development is played by immune, neurological and endocrine disorders.
Among the causes of the syndrome that scientists are examining:
- infections
- autoimmune disorders;
- chemical inflammation due to urine entry.
- disorders of the immune system
- pouring urine into the prostate ducts.
- pain in the muscles of the pelvic floor due to their pathological intensity.
- nerve entrapment.
- psychological stress.
Diagnoses of prostatitis
Diagnosisacute prostatitisis based on:
- complaints
- Medical examination;
- urine tests, which must include a bacteriological culture to identify the pathogen.
In simple cases, prostate imaging is usually not required. Transverse ultrasound (ultrasound) or computed tomography (CT) of the pelvis is done if urinary retention is severe and if a prostate abscess is suspected. The PSA test is also not recommended, as in an acute illness its level will increase in any case. Prostate biopsy is contraindicated due to pain and high risk of complications.
To facilitate diagnosischronic prostatitisDoctors use various special questionnaires that identify the history of the disease, changes in quality of life and describe in detail the symptoms. During the examination, the doctor palpates the abdomen, performs a digital examination of the prostate (through the rectum), assesses the condition of the pelvic muscles. In most cases, the diagnosis is made on the basis of a medical examination and a bacteriological and clinical examination of urine or semen. The criteria for diagnosing chronic bacterial prostatitis is a history of recurrent urinary tract infections and a tenfold increase in bacterial levels in prostate secretions, sperm culture or urination after prostate massage (Budía A, 2006).
If the analysis of prostate and urine secretion does not provide enough information in the presence of symptoms of chronic prostatitis, the following additional studies are performed:
- Sample of 2 glasses (urine analysis to determine the location of the infection).
- Sample of 4 glasses.
- urine flow rate
- determination of urine residues
- cytological analysis of urine.
In differential diagnosis (to rule out prostate stones, abscess, cancer), the following tests are also used:
- sowing a coating from the urethra.
- screening for sexually transmitted diseases;
- analysis for PSA?
- uroflometry?
- cystoscopy
- prostate biopsy
- retrograde urethrography
- Kidney ultrasound
- magnetic resonance imaging, computed tomography.
Treatment of prostatitis
Treatment of bacterial prostatitis
Ideally, antibiotic treatment should be based on bacteriological data. But it usually starts before the results are obtained, assuming that the most common pathogens are intestinal bacteria. According to the European guidelines for the treatment of urological infections, the drugs of choice for the treatment of acute and chronic bacterial prostatitis are antibiotics of the fluoroquinolone, macrolide, tetracycline groups. Once the pathogen has been identified, the antibiotic can be replaced.
Complicated acute bacterial prostatitis sometimes requires surgical treatment. In case of an abscess, the surgery is performed through the rectum or through the urethra. In the case of acute urinary retention, when it is impossible for the catheter to pass through the urethra, a cystostomy is performed, the catheter is inserted through the abdominal wall over the pubic area.
Additional treatment for acute prostatitis includes pain relief, fever, fluid intake, stool softeners. Alpha blockers are also used to improve urine flow. After treatment for acute prostatitis, patients should abstain from sexual intercourse for a week.
Treatment of chronic prostatitis / chronic pelvic pain syndrome
As we point out, the cause of this syndrome is very difficult to identify. Hence the difficulties with the choice of treatment. Usually, the doctor starts the treatment by prescribing 1-2 drugs, which can be changed if the effectiveness is insufficient. European guidelines for the management of chronic pelvic pain offer the following medications and treatments:
- Alpha inhibitors relax the bladder and prostate, significantly relieving symptoms.
- Antibiotics can also be prescribed because empirical experience has shown that they can be effective.
- Anti-inflammatory elements improve the quality of life and relieve pain.
- 5-alpha reductase inhibitors relieve the symptoms of prostatitis.
- Muscle relaxants have a similar effect to alpha blockers.
- Phytotherapy. The bioflavonoid quercetin and many other drugs relieve pain through its anti-inflammatory and antioxidant properties.
In chronic pelvic pain syndrome, placebo helps to relieve symptoms by 30% (D. A. Shoskes, 1999)
Drug-free treatment:
- Prostate massage. Performed with the finger through the rectum, courses are recommended 1-3 times a week for 3-4 weeks.
- Natural methods:
- electromagnetic therapy?
- microwave thermotherapy
- extracorporeal shock wave therapy.
- Surgical treatment includes endoscopic incision of the bladder neck, transurethral resection of the prostate and even its removal if other methods have failed. This method of treatment is rarely used.
- Psychological treatment. The deterioration of the quality of life and the difficult attitude of the patients towards the situation require the intervention of a psychologist.
Prevention
For warningacute prostatitisrequires timely treatment of any urological diseases, remember a safe sex life and avoiding genital infections. Partial prevention should be done by doctors without prescribing unnecessary invasive surgeries (biopsies, cystoscopy) and radical treatment of urinary tract infections.
The main points of prevention of chronic prostatitis:
- Personal hygiene. To prevent infections, the affected areas should be kept clean.
- Physical activity. When sitting for a long time, the blood in the pelvic area stops, which can contribute to inflammation of the prostate. You have to get up and move at every opportunity. Stretching, aerobic exercise give a good result. Among other things, physical activity reduces the stress often associated with prostatitis.
- Normal sexual activity depending on age.
- Liquid. You need to drink enough to flush bacteria out of your urinary tract.
- Diet. It is recommended to limit the use of foods that irritate the prostate: coffee, tea, carbonated beverages, spices, pickles, canned foods, fried foods and alcohol. The proportion of fruits and vegetables in the diet should be increased. These recommendations are also important in treating the disease.
- Maintaining a healthy weight.
- Pressure control. To do this, you can talk to a specialist (psychotherapist), learn how to relax.
- Safe sex to prevent infections.
- Avoid hypothermia.
- Timely visit to the doctor when dangerous symptoms appear: painful urination, frequent pushing, discomfort in the lower abdomen and perineum.