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 for 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, they 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 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 older men, the real picture is "hidden" by the frequency of benign prostatic hyperplasia (prostate adenoma), because their symptoms are mostly the same. Up to 65% of patients with adenoma were operated on for unrecognized prostatitis. (Nickel JC et al. , 2007). Since 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. . . Relatively rare species, accounting for only 5% of cases. It is a consequence of urinary tract infection, it develops against the background of predisposing factors (disturbed urine outflow, suppressed immunity). In 5% of cases, it progresses to chronic bacterial prostatitis.
Category II: Chronic bacterial prostatitis. . . It is a rare disease that is considered a recurrent urinary tract infection with the main focus on the prostate.
Category III: Chronic prostatitis / chronic pelvic pain syndrome. . . Previously, this disease was called 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 in the absence of urinary tract infection. It does not include urethritis, carcinomas, urethral narrowing, neurological bladder damage. Divided into categories IIIa and IIIb: with signs of inflammation and without signs of inflammation. These signs are determined in the laboratory, primarily by the presence of leukocytes in the urine or prostate secretions.
Category IV: Asymptomatic inflammatory prostatitis. . . It is an accidental finding during the examination of the patient. It is most often diagnosed when examining men for infertility or elevated levels of PSA markers in the blood. We do not consider this type of disease in detail, because scientists have not yet developed a unique 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 common (at least 5-7 per night), urination becomes painful, difficult. Urine comes out in intermittent parts, there is no feeling of satisfaction due to urination. Blood can be found in the back of the urine. The pain is worse when emptying the bowel. This is a serious illness that requires urgent care.
Complications of acute prostatitis are:
- acute urinary retention;
- prostate abscess (formation of purulent focus);
- paraprostatitis (inflammation of the tissue around the gland, may be caused by the penetration of an abscess);
- phlebitis of the paraprostatic venous plexus (inflammation of the surrounding veins).
Symptoms of chronic prostatitis
All types of chronic prostatitis (both 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 present of varying severity.
- Pain:
- pain or discomfort in one of the characteristic areas (groin, upper arms, testicles, penis, lower back, abdomen, rectum);
- pain when urinating or increased pain when urinating;
- pain during or after ejaculation;
- increased muscle sensitivity in the perineum;
- neuropathic pain;
- pain due to intestinal irritation.
- Urinary symptoms:
- lower urinary tract symptoms (LUTS) associated with urination (urge to empty the bladder, incontinence, urge to urinate, nocturnal urge, pain when urinating);
- LUTS associated with obstruction (weak urine pressure, intermittent jet, should be pushed);
- 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:
- anxiety;
- 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 symptoms of prostatitis and chronic pelvic pain syndrome appear, you must visit a urologist or andrologist. In case of 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 can resist infection and inflammation. The appearance of the disease is facilitated by a decrease in immunity, violation of the outflow of secretions from the prostate, inadequate sexual regime, difficult outflow of urine and worsening of blood circulation in the pelvic organs. Other risk factors include a cold climate, alcohol abuse and an inactive lifestyle.
Acute prostatitis is a bacterial inflammation, the most common pathogens of which are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter and others. The disease develops when the infection enters the gland by urinating, ascending infection, through the lymph from the rectum, or through blood from other foci of infection. Sexual transmission of the pathogen 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 the secretion and secretion of prostate juice.
Risk factors and causes of chronic bacterial prostatitis are similar to those of acute. Of particular importance are the causes of genital infections: trichomonas, chlamydia, ureaplasma, mycoplasma.
Chronic pelvic pain syndrome is not currently considered a homogeneous disease; it is difficult for doctors to name its main cause. Only in one third of these patients did a biopsy reveal inflammatory changes in the prostate. Immune, neurological and endocrine disorders are considered to play a leading role in its development.
Among the causes of the syndrome that scientists have considered:
- infections
- autoimmune disorders;
- chemical inflammation due to urine entry;
- immune system disorders;
- throwing urine into the prostate ducts;
- pelvic floor muscle pain due to their pathological tension;
- nerve entrapment;
- psychological stress.
Diagnosis of prostatitis
Diagnosisacute prostatitisis based on:
- complaints;
- medical examination;
- urine tests, which should include bacteriological culture to identify pathogens.
In uncomplicated cases, prostate imaging is usually not necessary. Transrectal ultrasound (ultrasound) or computed tomography (CT) of the pelvis is done if urinary retention is difficult and if a prostate abscess is suspected. PSA testing is also not recommended, because in acute disease its level will increase in any case. Prostate biopsy is contraindicated due to pain and high risk of complications.
To facilitate diagnosischronic prostatitisdoctors use several special questionnaires that specify medical history, changes in quality of life, and details of 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. Criteria for the diagnosis of chronic bacterial prostatitis are a history of recurrent urinary tract infections and a tenfold increase in bacterial levels in prostate secretion, semen culture, or urine analysis after prostate massage (Budía A; 2006).
If the analysis of prostate and urine secretion does not provide sufficient data in the presence of symptoms of chronic prostatitis, the following additional studies are performed:
- Sample of 2 cups (urine analysis to determine the location of the infection);
- Sample of 4 glasses;
- urine flow rate;
- determination of residual urine;
- cytological analysis of urine.
The following tests are also used in the differential diagnosis (to exclude prostate stones, abscesses, cancer):
- shining of urethral smears;
- 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 it usually starts before the results are obtained, assuming that the most common pathogens are 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 from the group of fluoroquinolones, macrolides and tetracyclines. 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 the 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 of 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 should abstain from sexual intercourse for a week.
Chronic prostatitis / chronic pelvic pain syndrome
As we have pointed out, the cause of this syndrome is very difficult to identify. Hence the difficulty in choosing therapy. Usually the doctor starts treatment by naming 1-2 drugs, which can be changed if the effectiveness is insufficient. European guidelines for the treatment 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-inflammatory drugs improve the quality of life and relieve pain.
- 5-alpha reductase inhibitors alleviate the symptoms of prostatitis.
- Muscle relaxants have a similar effect as alpha blockers.
- Phytotherapy. The bioflavonoid quercetin and several other drugs relieve pain thanks to 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 a finger through the rectum, courses 1-3 times a week for 3-4 weeks are recommended.
- Physical methods:
- electromagnetic therapy;
- microwave thermotherapy;
- outpatient 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. Deteriorating quality of life and difficult attitude of patients to the situation require the intervention of a psychologist.
Prevention
For a warningacute prostatitisit is necessary to timely treat any urological diseases, remembering a safe sex life and avoiding genital infections. Partial prevention should be carried out by physicians without prescribing unnecessary invasive procedures (biopsies, cystoscopy) and radical treatment of urinary tract infections.
The main points of prevention of chronic prostatitis:
- Personal hygiene. To prevent infections, intimate areas should be kept clean.
- Physical activity. When you sit for a long time, the blood in the pelvic area stagnates, which can contribute to inflammation of the prostate. You should get up and move at every opportunity. Stretching, aerobic exercises give a good effect. Among other things, physical activity reduces anxiety often associated with prostatitis.
- Normal sexual activity in accordance with age.
- Liquid. You need to drink enough to help expel bacteria from the 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 the treatment of the disease.
- Maintaining a healthy weight.
- Stress control. To do this, you can talk to a specialist (psychotherapist), learn how to relax.
- Safe sex to prevent infection.
- Avoiding hypothermia.
- Timely visit to the doctor when dangerous symptoms appear: painful urination, frequent urge, discomfort in the lower abdomen and perineum.