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 to see a doctor for and what to do to avoid getting sick.
What is prostatitis
Prostatitis is inflammation of the prostate or prostate gland, it is one of the most common "male" diseases. Prostatitis is very different, it can appear due to and without infection, 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 have 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 increase. Men under 50 make up 65. 2% of the patients. According to various sources, the overall prevalence of the disease in men is 13. 2 to 35% (Lummus W. F. , 2001; Meares E. M. , 1990). According to other data, 8 to 35% of men between the ages of 20 and 40 have inflammation of the prostate. In older men, the real picture is "masked" by the appearance of benign prostatic hyperplasia (prostate adenoma), since their symptoms are largely the same. Up to 65% of patients with adenoma are operated on for undetected prostatitis. (Nickel JC et al. , 2007). Given that inflammatory diseases of the genital organs 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 comprises several syndromes with different clinical courses. 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 that only accounts for 5% of cases. It is a consequence of urinary tract infection that develops against the background of predisposing factors (impaired urine outflow, suppressed immunity). Chronic bacterial prostatitis occurs in 5% of cases.
II category: Chronic bacterial prostatitis. . . It is also a rare disease that is considered a recurrent urinary tract infection with the main focus in the prostate.
III Category: Chronic Prostatitis / Chronic Pelvic Pain Syndrome. . . Previously, this disease was known as chronic abacterial prostatitis and accounts for up to 95% of all diagnosed prostatitis (Habermacher GM, 2006). Chronic pain syndrome combines pathologies characterized by urological pain without urinary tract infection. Urethritis, cancer, narrowing of the urethra and neurological damage to the bladder are not included. Divided into categories IIIa and IIIb: with signs of inflammation and no signs of inflammation. These signs are determined by the laboratory, mainly by the presence of leukocytes in urine or prostate secretions.
IV category: Asymptomatic inflammatory prostatitis. . . It is an incidental finding when examining a patient. It is most commonly diagnosed when testing men for infertility or an elevated PSA marker in the blood. We do not look at this type of disease in detail because scientists have not yet developed a unified view of this form (Nickel JC, 2011).
Symptoms of prostatitis
Symptoms of acute prostatitis
The disease begins acutely, there is pain in the perineum, body temperature rises. The urge to urinate is frequent (at least 5-7 per night), and urination becomes painful and difficult. The urine comes out intermittently, there is no feeling of satisfaction from urinating. There may be blood in the last parts of the urine. The pain is worse when you have a bowel movement. This is a serious illness that urgently needs help.
Complications of acute prostatitis are:
- acute urinary retention;
- Abscess of the prostate (formation of a purulent focus);
- Paraprostatitis (inflammation of the tissue around the gland, which can be caused by a breakthrough abscess);
- Phlebitis of the paraprostatic venous plexus (inflammation of the surrounding veins).
Chronic prostatitis symptoms
All types of chronic prostatitis (both bacterial and chronic pelvic pain syndrome) are similar. The picture of the disease is very different. Below is a list of symptoms that vary in severity.
- Pain:
- Pain or discomfort in any of the characteristic areas (groin, maxillary region, testicles, penis, lower back, abdomen, rectum);
- Painful urination or increased pain when urinating;
- Pain during or after ejaculation;
- increased sensitivity of muscles in the perineum;
- Neuropathic pain;
- Pain due to intestinal irritation.
- Urinary Symptoms:
- Lower urinary tract symptoms (LUTS) related to emptying (urge to empty the bladder, incontinence, urge to urinate, nocturnal urge to urinate, pain when urinating);
- LUTS related to obstruction (weak urine pressure, intermittent current, need for pressure);
- Burning in the urethra;
- recurring urinary tract infections.
- Sexual dysfunction:
- erectile disorder;
- Violation of ejaculation (premature or delayed ejaculation, blood in semen);
- decreased libido.
- Psychosocial symptoms:
- Fear;
- Depression;
- cognitive and behavioral disorders;
- decreased quality of life.
Men with chronic pelvic pain syndrome are more likely to have manifestations of mental stress and sexual dysfunction (A. Mehik, 2001).
If symptoms of prostatitis and chronic pelvic pain syndrome appear, you need to see a urologist or andrologist. If symptoms of acute prostatitis are severe, 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 with no predisposing factors can resist infection and inflammation. The onset of the disease is facilitated by a decrease in immunity, a violation of the outflow of secretions from the prostate, an inadequate sexual regime, difficulty in the outflow of urine and a deterioration in blood flow to the pelvic organs. Other risk factors are cold climates, alcohol abuse, and a sedentary lifestyle.
Acute prostatitis is bacterial inflammation. The most common pathogens are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter and a few others. The disease develops when the infection enters the gland through urine, an ascending infection, lymph from the rectum, or blood from other sources of infection. The sexual transmission of pathogens plays an important role.
Risk factors for acute bacterial prostatitis:
- Phimosis;
- Urinary tract infection;
- acute inflammation of the epididymis (inflammation of the epididymis);
- unprotected anal intercourse;
- Urinary catheterization;
- Operations performed through the urethra;
- Prostate biopsy;
- Violation of the secretion and excretion of prostate juice.
The risk factors and pathogens of chronic bacterial prostatitis are similar to those of acute. The causative agents of genital infections are of particular importance: Trichomonas, Chlamydia, Ureaplasma, Mycoplasma.
Chronic pelvic pain syndrome is not currently considered a homogeneous disease, and doctors find it difficult to pinpoint the main cause. Biopsy revealed inflammatory changes in the prostate in only one third of these patients. It is believed that the main role in its development is played by immune, neurological and endocrine disorders.
Among the causes of the syndrome considered by scientists:
- Infections
- Autoimmune diseases;
- chemical inflammation from ingress of urine;
- Immune system disorders;
- Throwing urine into the prostate ducts;
- Pain in the muscles of the pelvic floor due to their pathological tension;
- Pinching of nerves;
- psychological stress.
Diagnosis of prostatitis
diagnosisacute prostatitisis based on:
- Complaints;
- physical examination;
- Urine tests, which should include bacteriological culture to identify the pathogen.
In uncomplicated cases, imaging of the prostate is usually not required. Transrectal ultrasound (ultrasound) or computed tomography (CT) of the pelvis is done if urinary retention is severe and a prostate abscess is suspected. PSA tests are also not recommended, as in acute illness the level is always increased. Prostate biopsy is contraindicated due to pain and high risk of complications.
To facilitate diagnosischronic prostatitisDoctors use several specialized questionnaires that detail the medical history, changes in quality of life, and symptoms. During the exam, the doctor palpates the abdomen, performs a digital exam of the prostate (through the rectum) and assesses the condition of the pelvic muscles. In most cases, the diagnosis is made on the basis of a medical examination, as well as a bacteriological and clinical examination of urine or semen. Criteria for the diagnosis of chronic bacterial prostatitis are a history of recurrent urinary tract infections and a ten-fold increase in the bacterial level in prostate secretions, semen culture or urinalysis after prostate massage (Budía A; 2006).
If the analysis of the secretion of the prostate and urine does not provide enough information in the presence of symptoms of chronic prostatitis, the following additional studies are carried out:
- 2-glass sample (urinalysis to determine the site of infection);
- 4-glass sample;
- Urine flow rate;
- Determination of residual urine;
- cytological analysis of urine.
In differential diagnosis (to exclude prostate stones, abscesses, cancer), the following tests are also used:
- Sowing a smear from the urethra;
- Screening for sexually transmitted diseases;
- Analysis for PSA;
- Uroflowmetry;
- Cystoscopy;
- Prostate biopsy;
- retrograde urethrography;
- Ultrasound of the kidneys;
- Magnetic resonance imaging, computed tomography.
Treatment of prostatitis
Treatment of bacterial prostatitis
Ideally, antibiotic therapy should be based on bacteriological data. However, it usually starts before results are available, provided the most common pathogens are gut 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 and tetracycline groups. After specifying the pathogen, the antibiotic can be replaced.
Complicated acute bacterial prostatitis sometimes requires surgical treatment. In the case of an abscess, the operation is performed through the rectum or urethra. In the case of acute urinary retention, a cathystomy is performed when it is impossible to pass the catheter through the urethra. A cystostomy is performed and the catheter is inserted through the abdominal wall above the pubic bone.
Additional treatment for acute prostatitis includes pain relief, fever, drinking plenty of fluids, stool softeners. Alpha blockers are also used to improve the flow of urine. Patients should avoid sexual intercourse for a week after treatment for acute prostatitis.
Chronic prostatitis / treatment of chronic pelvic pain syndrome
As we have already pointed out, the cause of this syndrome is very difficult to identify. Hence the difficulty in choosing therapy. Usually the doctor begins treatment with the appointment of 1-2 drugs, which can be changed in the event of insufficient effectiveness. The European guidelines for the treatment of chronic pelvic pain offer the following drugs and treatments:
- Alpha blockers relax the bladder and prostate, and greatly relieve symptoms.
- Antibiotics can also be prescribed as empirical experience has shown that they can be effective.
- Anti-inflammatory agents improve quality of life and relieve pain.
- 5-alpha reductase inhibitors relieve the symptoms of prostatitis.
- Muscle relaxants work in a similar way to alpha blockers.
- Phytotherapy. The bioflavonoid quercetin and various other drugs relieve pain through anti-inflammatory and antioxidant properties.
In chronic pelvic pain syndrome, placebo helps relieve symptoms by 30% (D. A. Shoskes, 1999)
Drug free treatment: :
- Prostate massage. It is carried out with a finger through the rectum, courses are recommended 1-3 times a week for 3-4 weeks.
- Physical 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 when other methods have failed. This method of treatment is rarely used.
- Psychological treatment. The deterioration in the quality of life and the difficult attitude of the patient to the situation require the intervention of a psychologist.
prevention
As a warningacute prostatitisTimely treatment of urological diseases is necessary to remember a safe sex life and avoid genital infections. Partial prevention should be carried out by doctors, without prescribing unnecessary invasive procedures (biopsies, cystoscopy) and radically curing urinary tract infections.
The main points of prevention of chronic prostatitis:
- Personal hygiene. To prevent infections, the genital areas should be kept clean.
- Physical activity. When you sit for long periods of time, the blood in the pelvic area stagnates, which can contribute to inflammation of the prostate. You have to get up and move around at every opportunity. Stretching and aerobics make a good effect. Physical activity, among other things, reduces anxiety, which is often associated with prostatitis.
- Normal sexual activity according to 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 drinks, 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.
- Maintain a healthy weight.
- Stress control. To do this, you can talk to a specialist (psychotherapist) and learn how to relax.
- Safe sex against infections.
- Avoid hypothermia.
- Consult a doctor in good time if dangerous symptoms occur: painful urination, frequent urge, discomfort in the lower abdomen and perineum.