According to statistics, about 40% of men with symptoms of prostatitis do not seek medical assistance. At the same time, the consequences of the disease, including the risk of male infertility, are very serious. Find out what symptoms you should see a doctor about and what to do to avoid getting sick.
What is prostatitis
Prostatitis is inflammation of the prostate 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 the disease.
About 10% of men experience symptoms of chronic prostatitis, but only about 60% seek medical help (Nickel JC et al. , 2001).
Prostatitis affects men of all ages and its prevalence continues to rise. Men under 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 between the ages of 20 and 40 suffer from inflammation of the prostate. Among older men, the real picture is "masked" by the incidence of benign prostatic hyperplasia (prostate adenoma), as their symptoms are largely the same. Up to 65% of patients with adenoma are operated on for unrecognized 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 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, accounting for only 5% of cases. It is a consequence of urinary tract infection, develops against the background of predisposing factors (impaired urinary outflow, suppressed immunity). In 5% of cases it turns into chronic bacterial prostatitis.
II category: chronic bacterial prostatitis. . . It is also a rare disease considered to be a recurrent urinary tract infection with the main target in 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 a urinary tract infection. It does not include urethritis, tumors, 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, mainly by the presence of leukocytes in the urine or prostatic secretions.
Category IV: asymptomatic inflammatory prostatitis. . . It is an accidental discovery during a patient examination. It is most often diagnosed when examining men for infertility or an elevated level of the PSA marker 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, the body temperature rises. The urge to urinate is frequent (at least 5-7 a night), urination becomes painful, difficult. Urine comes out in intermittent portions, there is no feeling of satisfaction from urination. Blood can be found in the last portions of urine. The pain gets worse with bowel movements. This is a serious disease that requires urgent 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);
- paraprostatic venous plexus phlebitis (inflammation in 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 highly variable, below is a list of symptoms that may be present with varying severity.
- Ache:
- pain or discomfort in one of the characteristic areas (groin, supra-groin, testicles, penis, lower back, abdomen, rectum);
- pain when urinating or increased pain when urinating;
- pain during or after ejaculation;
- increased sensitivity of the muscles of the perineum;
- neuropathic pain;
- pain due to intestinal irritation.
- Urinary symptoms:
- lower urinary tract symptoms (LUTS) associated with emptying (urge to empty the bladder, incontinence, urge to urinate, nocturnal urge, pain when urinating);
- LUTS associated with obstruction (weak urinary pressure, intermittent flow, need to push);
- burning sensation in the urethra;
- recurrent urinary tract infections.
- Sexual dysfunctions:
- erectile dysfunction;
- violation of ejaculation (premature or delayed ejaculation, blood in the sperm);
- decreased libido.
- Psychosocial symptoms:
- anxiety;
- depression;
- cognitive and behavioral impairment;
- decreased quality of life.
Men with chronic pelvic pain syndrome are more likely to have manifestations of psychological distress and sexual dysfunction (A. Mehik, 2001).
If symptoms of prostatitis and chronic pelvic pain syndrome appear, a urologist or andrologist should be consulted. If you have severe symptoms of acute prostatitis, you should seek emergency help to prevent 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 potential to 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 deterioration of blood circulation in the pelvic organs. Other risk factors include cold climates, alcohol abuse, and a sedentary lifestyle.
Acute prostatitis is bacterial inflammation, its most common pathogens are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter and some others. The disease develops when the infection enters the gland with the passing of urine, from 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;
- operations performed through the urethra;
- prostate biopsy;
- violation of secretion and excretion of prostate juice.
The risk factors and causative agents of chronic bacterial prostatitis are similar to those of acute prostatitis. 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 name the root cause. In only one third of these patients, biopsy revealed inflammatory changes in the prostate gland. 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 disorders;
- chemical inflammation due to the entry of urine;
- immune system disorders;
- throw urine into the prostatic ducts;
- pain in the pelvic floor muscles due to their pathological tension;
- entrapment of the nerves;
- psychological stress.
Prostatitis diagnostics
Diagnosisacute prostatitisis placed on the basis of:
- complaints, disputes;
- medical examination;
- urinalysis, which should include a 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 if a prostate abscess is suspected. PSA testing is also not recommended, since in an acute disease its level will still be increased. Prostate biopsy is contraindicated due to pain and the high risk of complications.
To facilitate diagnosischronic prostatitisdoctors use several special questionnaires that specify the history of the disease, changes in quality of life, and detail symptoms. During the examination, the doctor palpates 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 on the basis of a medical examination and bacteriological and clinical examination of the urine or sperm. Criteria for the diagnosis of chronic bacterial prostatitis are a history of recurrent urinary tract infections and a tenfold increase in bacterial levels in prostatic 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 sufficient information in the presence of symptoms of chronic prostatitis, the following additional studies are carried out:
- 2-glass sample (urinalysis to determine the location of the infection);
- Sample of 4 glasses;
- urine flow rate;
- determination of residual urine;
- cytological analysis of urine.
In differential diagnosis (to exclude prostate stones, abscess, cancer), the following tests are also used:
- sow 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. But it usually starts before the results are achieved, assuming the most common pathogens are gut bacteria. According to the 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, macrolides, tetracyclines groups. After specifying the pathogen, the antibiotic can be replaced.
Complicated acute bacterial prostatitis sometimes requires surgical treatment. In the case 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 treatment for acute prostatitis includes pain relief, fever, drinking plenty of fluids, stool softeners. Alpha blockers are also used to improve urine flow. After treatment for acute prostatitis, patients must abstain from sexual intercourse for one week.
Chronic prostatitis / treatment of chronic pelvic pain syndrome
As we have pointed out, the cause of this syndrome is very difficult to identify. Hence the difficulties with the choice of therapy. Usually, the doctor begins treatment with the appointment of 1-2 drugs, which can be changed if the effectiveness is insufficient. The European guidelines for the management of chronic pelvic pain offer the following medications and treatments:
- Alpha blockers relax the bladder and prostate, significantly relieving symptoms.
- Antibiotics can also be prescribed because empirical experience has shown that they can be effective.
- Anti-inflammatories 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 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 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 gland, and even its removal if 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 patients to the situation require the intervention of a psychologist.
Prevention
For warningacute prostatitisprompt treatment of any urological diseases is necessary, remembering a safe sex life and avoiding genital infections. Partial prevention should be performed by doctors without prescribing unnecessary invasive procedures (biopsies, cystoscopy) and radically cure urinary tract infections.
The main points of the prevention of chronic prostatitis:
- Personal hygiene. To prevent infections, intimate areas should be kept clean.
- Physical activity. When sitting for a long 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 give a good effect. Among other things, physical activity reduces the anxiety often associated with prostatitis.
- Normal sexual activity based on age.
- Liquid. You need to drink enough to help expel bacteria from the urinary tract.
- Diet. It is advisable to limit the use of foods that irritate the prostate gland: 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 the treatment of the disease.
- Maintain a healthy weight.
- Stress control. To do this, you can talk to a specialist (psychotherapist), learn to relax.
- Safe sex to prevent infections.
- Avoid hypothermia.
- Timely visit to the doctor when dangerous symptoms appear: painful urination, frequent urgency, discomfort in the lower abdomen and perineum.