According to statistics, about 40% of men with symptoms of prostatitis do not see a doctor. 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 for and what you can 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, etc. 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 age groups and its prevalence continues to increase. Men under the age of 50 make up 65. 2% of patients, according to various sources the prevalence of the disease in 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. In older men, the real picture is "obscured" by the incidence of benign prostatic hyperplasia (prostate adenoma), since their symptoms are largely the same. Up to 65% of patients with adenoma are operated on 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 a different clinical course. Consider what 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 a urinary tract infection, develops against the background of predisposing factors (impaired 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 which is considered to be a recurrent urinary tract infection with the main focus in the prostate.
Category III: chronic prostatitis / chronic pelvic pain syndrome. . . Previously, this disease was called chronic abacterial prostatitis, and it 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. Divided into categories IIIa and IIIb: with signs of inflammation and without signs of inflammation. These signs are determined in the laboratory, mainly by the presence of leukocytes in urinary or prostatic secretions.
Category IV: asymptomatic inflammatory prostatitis. . . It is an accidental discovery during the examination of a patient. 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, body temperature rises. The desire to urinate is frequent (at least 5 to 7 per 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 is worse with bowel movements. This is a serious illness 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 tissues around the gland, can be caused by a pierced 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 highly variable, below is a list of symptoms that may be present with varying severity.
- Pain:
- pain or discomfort in any of the characteristic areas (groin, suprarin, testes, 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 bladder, incontinence, urge to urinate, nighttime urge, pain when urinating);
- LUTS associated with obstruction (low urinary pressure, intermittent spray, 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 semen);
- decreased libido.
- Psychosocial symptoms:
- anxiety;
- depression;
- cognitive and behavioral disorders;
- decreased quality of life.
Men with chronic pelvic pain syndrome are more likely to exhibit manifestations of psychological stress and sexual dysfunction (A. Mehik, 2001).
If symptoms of prostatitis and chronic pelvic pain syndrome appear, you need to consult a urologist or andrologist. 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, improper sexual diet, difficulty in the outflow of urine and deterioration of blood circulationin 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 a few others. The disease develops when the infection enters the gland with the urine stream, through ascending infection, through lymph from the rectum or with blood from other foci of infection. The 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 sex;
- bladder catheterization;
- operations performed through the urethra;
- 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 of acute prostatitis. The agents responsible for genital infections are particularly important: trichomonas, chlamydia, ureaplasma, mycoplasmas.
Chronic pelvic pain syndrome is currently not considered a homogeneous disease; doctors find it difficult to name its main cause. Only in a third of these patients, the biopsy revealed inflammatory changes in the prostate. 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 due to the penetration of urine;
- immune system disorders;
- throw urine into the prostate ducts;
- pain in the muscles of the pelvic floor due to their pathological tension;
- entrapment of nerves;
- psychological stress.
Diagnosis of prostatitis
Diagnosticacute prostatitisis based on:
- complaints;
- medical exam;
- urine tests, which should include a bacteriological culture to identify the pathogen.
In simple cases, imaging of the prostate is usually not necessary. A transrectal ultrasound (ultrasound) or computed tomography (CT) scan of the pelvis is done if urinary retention is severe and a prostate abscess is suspected. The PSA test is also not recommended, because in an acute illness its level will be increased anyway. Prostate biopsy is contraindicated due to pain and the high risk of complications.
To facilitate diagnosischronic prostatitisdoctors use several special questionnaires that detail 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 (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 the urine or semen. The diagnostic criteria for chronic bacterial prostatitis are a history of recurrent urinary tract infections and a ten-fold increase in bacterial levels in prostatic secretions, semen culture or urinalysis after prostate massage (Budía A; 2006).
If the analysis of prostate secretion and urine does not provide sufficient information in the presence of symptoms of chronic prostatitis, the following additional studies are performed:
- 2-glass sample (urinalysis to determine location of infection);
- Sample of 4 glasses;
- urine output;
- determination of residual urine;
- cytological analysis of urine.
In differential diagnosis (to exclude prostate stones, abscesses, 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;
- Kidney ultrasound;
- 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 results are obtained, 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, macrolide, tetracycline groups. After specifying the pathogen, the antibiotic can be replaced.
Acute complicated bacterial prostatitis sometimes requires surgical treatment. In the case of an abscess, surgery is performed through the rectum or through the urethra. In 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, and stool softeners. Alpha blockers are also used to improve urine flow. After treatment for acute prostatitis, patients should refrain from sexual intercourse for a week.
Treatment of chronic prostatitis / 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 medicines and treatments:
- Alpha blockers relax the bladder and prostate, greatly relieving symptoms.
- Antibiotics can also be prescribed because empirical experience has shown that they can be effective.
- Anti-inflammatory drugs improve quality of life and relieve pain.
- 5-alpha reductase inhibitors relieve symptoms of prostatitis.
- Muscle relaxants have a similar effect to alpha blockers.
- Phytotherapy. The bioflavonoid quercetin and several other drugs provide pain relief with 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 in 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 an endoscopic incision of the neck of the bladder, 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 patients to the situation require the intervention of a psychologist.
Prevention
For warningacute prostatitistimely treatment of any urological disease is necessary, remembering a safe sex life and avoiding genital infections. Partial prevention should be carried out 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 avoid infections, intimate areas should be kept clean.
- Physical activity. When sitting for a long time, the blood in the pelvic area stagnates, which can contribute to inflammation of the prostate. You have to get up and move at every opportunity. Stretching and aerobic exercises give a good effect. Among other things, physical activity reduces the anxiety often associated with prostatitis.
- Normal sexual activity according to age.
- Liquid. You need to drink enough to flush bacteria from the urinary tract.
- Diet. It is recommended to limit the use of foods that irritate the prostate: coffee, tea, soft drinks, spices, pickles, canned food, fried foods and alcohol. The proportion of fruits and vegetables in the diet must 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 urge, discomfort in the lower abdomen and perineum.