According to statistics, about 40% of men with symptoms of prostatitis do not seek medical help. At the same time, the consequences of this disease, including the risk of male infertility, are very serious. Find out what symptoms you should see a doctor and what to do to avoid getting sick.
What is prostatitis
Prostatitis is an inflammation of the prostate gland or prostate, it is one of the most common "male" diseases. Prostatitis is very different, they 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 this disease.
About 10% of men experience symptoms of chronic prostatitis, but only about 60% of them seek medical help (Nickel JC et al. , 2001).
Prostatitis strikes men of all ages, and its prevalence continues to increase. Men under the age of 50 comprise 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, from 8 to 35% of men aged 20-40 years suffer from prostate inflammation. In older men, the actual picture is "masked" by the occurrence of benign prostate hyperplasia (prostate adenoma), because their symptoms are generally the same. Up to 65% of patients with adenomas are operated on for him with undiagnosed prostatitis. (Nickel JC et al. , 2007). Since inflammatory diseases of the genital organs are a common cause of male infertility, scientists are talking about the threat to the nation’s reproductive health.
What is prostatitis
The division of moderate into acute and chronic is not sufficient to characterize prostatitis, the disease encompasses several syndromes with different clinical courses. Consider disease forms isolated according to modern classifications (Krieger JN et. Al. , 1999).
Category I: Acute bacterial prostatitis. . . A relatively rare species, only 5% of cases. This is a consequence of a urinary tract infection, developing against the background of predisposing factors (disturbed urine outflow, suppressed immunity). In 5% of cases, it turns into chronic bacterial prostatitis.
Category II: Chronic bacterial prostatitis. . . It is also a rare disease considered to be a recurrent urinary tract infection with a primary focus on the prostate.
Category III: Chronic prostatitis / chronic pelvic pain syndrome. . . Previously, the disease was called chronic abacterial prostatitis, and accounted for up to 95% of all prostatitis diagnosed (Habermacher GM, 2006). Chronic pain syndrome combines pathology characterized by urological pain in the absence of urinary tract infection. It does not include urethritis, cancer, narrowing of the urethra, neurological damage to the bladder. Divided into categories IIIa and IIIb: with signs of inflammation and without signs of inflammation. These signs are determined by the laboratory, primarily by the presence of leukocytes in the urine or prostate secretions.
Category IV: Asymptomatic inflammatory prostatitis. . . This was an unintentional finding when examining a patient. It is most often diagnosed when examining men for infertility or high levels of PSA markers in the blood. We do not consider this type of disease in detail, as 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 nights), urination becomes painful, difficult. Urine comes out intermittently, there is no sense of satisfaction from urinating. Blood may be present in the last part of the urine. The pain worsens with bowel movements. This is a serious illness that needs immediate help.
Complications of acute prostatitis are:
- acute urinary retention;
- prostate abscess (formation of purulent foci);
- paraprostatitis (inflammation of the tissue around the gland, can be caused by a breakthrough abscess);
- paraprostatic venous plexus phlebitis (inflammation of the surrounding veins).
Symptoms of chronic 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 can appear with varying severity.
- Pain:
- pain or discomfort in one of the characteristic areas (groin, supra-groin, testicles, penis, lower back, abdomen, rectum);
- pain when urinating or pain when urinating;
- pain during or after ejaculation;
- increased muscle sensitivity in the perineum;
- neuropathic pain;
- pain due to intestinal irritation.
- Symptoms of urination:
- lower urinary tract symptoms (LUTS) associated with emptying (urge to empty the bladder, incontinence, desire to urinate, urge at night, pain when urinating);
- LUTS associated with obstruction (poor urinary pressure, intermittent flow, need to push);
- burning sensation in the urethra;
- recurrent urinary tract infections.
- Sexual dysfunction:
- erectile dysfunction;
- ejaculatory violations (premature or delayed ejaculation, blood in semen);
- decreased libido.
- Psychosocial symptoms:
- restlessness;
- depression;
- cognitive and behavioral disorders;
- declining quality of life.
Men with chronic pelvic pain syndrome tend to have manifestations of psychological stress and sexual dysfunction (A. Mehik, 2001).
If symptoms of prostatitis and chronic pelvic pain syndrome appear, you should see a urologist or andrologist. If there are symptoms of severe 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. Healthy glands in the absence of predisposing factors have the potential to resist infection and inflammation. The onset of the disease is facilitated by decreased immunity, violation of the outflow of secretions from the prostate, inadequate sexual regimen, difficulty of urine outflow, and deterioration of blood circulation in the pelvic organs. Other risk factors include cold climates, alcohol abuse, and an inactive lifestyle.
Acute prostatitis is a bacterial inflammation, the most common pathogens are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter and a few others. The disease develops when an infection enters the gland by excreting urine, by ascending infection, through lymph from the rectum, or by blood from another focus of infection. The transmission of sexual pathogens plays an important role.
Risk factors for acute bacterial prostatitis:
- phimosis;
- urinary tract infections;
- acute epididymitis (inflammation of the epididymis);
- unprotected anal intercourse;
- urinary catheterization;
- surgery performed through the urethra;
- prostate biopsy;
- violation of the secretion and excretion of prostate juice.
The risk factors and causative agents of chronic bacterial prostatitis are similar to those of acute disease. Of particular importance are the causative agents of genital infections: Trichomonas, chlamydia, ureaplasma, mycoplasma.
Chronic pelvic pain syndrome is currently not considered a homogeneous disease; doctors find it difficult to name the root cause. In only one -third of these patients, biopsy revealed inflammatory changes in the prostate gland. It is believed that a major role in its development is played by immune, neurological and endocrine disorders.
Among the causes of the syndrome considered by scientists:
- infection
- autoimmune disorders;
- chemical inflammation due to ingestion of urine;
- immune system disorders;
- excreting urine into the prostate duct;
- pain in the pelvic floor muscles due to their pathological tension;
- nerve traps;
- psychological stress.
Diagnosis of prostatitis
Diagnosisacute prostatitisplaced based on:
- complaints;
- health screening;
- urine tests, which should include bacteriological cultures to identify pathogens.
In uncomplicated cases, prostate imaging is usually not required. Transctal ultrasound (ultrasound) or computed tomography (CT) of the pelvis is performed if severe urinary retention and if prostate abscess is suspected. PSA testing is also not recommended, as in acute illness its levels will increase. Prostate biopsy is contraindicated because of the pain and high risk of complications.
To facilitate diagnosischronic prostatitisphysicians use a number of special questionnaires that determine disease history, changes in quality of life, and detail symptoms. During the examination, the doctor performs palpation on the abdomen, performs a digital examination of the prostate gland (through the rectum), assesses the condition of the pelvic muscles. In most cases, the diagnosis is made based on medical examination and bacteriological and clinical examination of urine or semen. Criteria for the diagnosis of chronic bacterial prostatitis are a history of recurrent urinary tract infection and a tenfold increase in bacterial levels on prostate secretions, semen cultures, or urinalysis after prostate massage (Budía A; 2006).
If analysis of prostate secretions and urine does not provide sufficient information in the event of symptoms of chronic prostatitis, the following additional studies are performed:
- 2-glass sample (urinalysis to determine location of infection);
- 4-glass sample;
- urine flow rate;
- determination of residual urine;
- urine cytological analysis.
In the differential diagnosis (to exclude prostate stones, abscesses, cancer), the following tests are also used:
- sow smears from the urethra;
- venereal disease screening;
- analysis for PSA;
- uroflowmetry;
- cystoscopy;
- prostate biopsy;
- retrograde urethography;
- 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. But usually it starts before the results are obtained, assuming that the most common pathogen is intestinal bacteria. According to European guidelines for the treatment of urological infections, the drugs of choice in the treatment of acute and chronic bacterial prostatitis are antibiotics of the fluoroquinolone group, macrolides, tetracyclines. After determining the pathogen, antibiotics can be replaced.
Complicated acute bacterial prostatitis sometimes requires surgical treatment. In the event of an abscess, surgery is performed through the rectum or through the urethra. In case of acute urinary retention, when it is impossible to pass the catheter through the urethra, a cystostomy is performed, the catheter is inserted through the abdominal wall above the pubis.
Additional treatments for acute prostatitis include painkillers, fever, drinking plenty of fluids, stool softeners. Alpha blockers are also used to increase urine flow. After treatment for acute prostatitis, patients should abstain from sexual intercourse for a week.
Treatment of Chronic Prostatitis Syndrome / Chronic Pelvic Pain
As we noted, the cause of this syndrome is very difficult to identify. Hence the difficulty with the selection of therapy. Usually, the doctor begins treatment with the appointment of 1-2 drugs, which can be changed if their effectiveness is insufficient. The European Guidelines for the Management of Chronic Pelvic Pain offer the following medications and treatments:
- Alpha blockers loosen the bladder and prostate, significantly reducing symptoms.
- Antibiotics can also be prescribed because empirical experience shows that they can be effective.
- Anti-inflammatory improves quality of life and relieves pain.
- 5-alpha reductase inhibitors relieve the symptoms of prostatitis.
- Muscle relaxation has a similar effect to alpha blockers.
- Phytotherapy. Quercetin bioflavonoids and some other drugs relieve pain through their 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 performed with the fingers through the rectum, the course is recommended 1-3 times a week for 3-4 weeks.
- Physical method:
- electromagnetic therapy;
- microwave thermotherapy;
- extrasorporeal shock wave therapy.
- Surgical treatment includes endoscopic incision of the bladder neck, transurethral resection of the prostate gland, and even its removal if other methods fail. This method of treatment is rarely used.
- Psychological treatment. The deterioration of the quality of life and the difficult attitude of the patient to the condition requires the intervention of a psychologist.
prevention
For a warningacute prostatitistimely treatment for any urological diseases is required, keeping in mind a safe sex life and avoiding genital infections. Partial prevention should be performed by a physician without prescribing unnecessary invasive procedures (biopsy, cystoscopy) and radically cure urinary tract infections.
The main points of prevention of chronic prostatitis:
- Hygiene. To prevent infection, the intimate area should be kept clean.
- Physical activity. When sitting for long periods of time, blood in the pelvic area stagnates, which can contribute to inflammation of the prostate gland. You have to get up and move at every opportunity. Stretching, aerobic exercise has a good effect. Among other things, physical activity reduces the anxiety often associated with prostatitis.
- Normal sexual activity is age -appropriate.
- You need to drink enough fluids to help get rid of bacteria from the urinary tract.
- Diet. It is recommended to limit the consumption of foods that irritate the prostate gland: coffee, tea, carbonated beverages, spices, pickles, canned foods, fried foods and alcohol. The portion of fruits and vegetables in the diet should be increased. This recommendation is also important in the treatment of this disease.
- Maintain a healthy weight.
- Pressure control. To do this, you can talk to a specialist (psychotherapist), learn how to relax.
- Safe sex to prevent infection.
- Avoid hypothermia.
- A visit to the doctor is timely when dangerous symptoms appear: painful urination, frequent urging, discomfort in the lower abdomen and perineum.