Characteristics of symptoms, diagnosis and treatment of chronic prostatitis

If you do not want to prevent chronic prostatitis, carefully study the causes of the development of the disease, pay attention to the signs of a chronic course and be sure to read the rules of diagnosis and treatment.Read all this in our article.

Chronic prostatitis is characterized by long-term inflammatory processes in the prostate gland, leading to morphological and functional disorders of the prostate.It is difficult to get rid of the pathology, the complications are serious, so it is easier to prevent the disease if the causes of its development are known.

Causes

The main reason for the chronic course is untreated prostatitis, which passes to the next stage.The following reasons and factors may contribute to this:

1. Infection of the genitourinary tract with mycoplasmas, chlamydia, herpes, ureaplasmas, candida, E. coli, cytomegalovirus or trichomonas.
2. Congestion in the pelvic organs, occurring against the background of a sedentary lifestyle, impaired blood supply, poor nutrition and bad habits.
3. Frequent hypothermia (the risk group includes people involved in surfing, diving, skiing and so on).
4. Prolonged abstinence from sexual intercourse, interrupted acts.
5. Obesity due to high-fat foods.
6. Disorders in the endocrine system.
7. Inflammatory processes throughout the body, especially chronic ones.
8. Weak immune system.
9. Injury to the genital organ.
10. Constant constipation.
11. Depression, stress, overwork.

Particular attention should be paid to bad habits: drinking alcohol, drugs, smoking.Harmful substances released from such products lead to vasospasm, reducing the level of blood circulation.As a result, the nutrition of all organs deteriorates.

Symptoms

With chronic prostatitis, the prostate gland enlarges, compressing the elements of the genitourinary system and narrowing the urethra.As the disease progresses, the gland completely encloses the urethra, severely compressing the canal.This is why problems with urine production arise.

How to recognize chronic prostatitis:

• pain occurs periodically in the pelvis and perineum;
• discomfort during urination and bowel movements;
• discharge from the urethra is observed;
• the pain spreads to the thighs, testicles, anus;
• you experience problems with urination;
• severe burning and itching in the urethra;
• frequent pulse;
• decreased libido and erection;
• rapid ejaculation with the presence of pain;
• if an infection occurs, body temperature rises and the condition worsens;
• after a year infertility appears;
• the appearance of pain after normal physical activity;
• acute urinary retention and false urges;
• slow urine flow.

In the initial stages, symptoms appear slowly, but as they progress they intensify.The pain syndrome becomes very powerful, radiating to nearby organs and areas.Particular attention should be paid to the process and frequency of urination.Against the background of such changes, a man experiences psycho-emotional problems, which manifest themselves as follows:

• severe anxiety;
• depression or, conversely, aggression;
• nocturnal insomnia;
• obsessions;
• fear of sexual intercourse and urination;
• hot temper and irritability.

Classification

The current requirements for the classification of chronic prostatitis were developed in the 95th year of the last century.Based on this, the disease is divided into:

1. Chronic bacterial prostatitis.It occurs against the background of an untreated acute bacterial disease.It manifests itself with typical symptoms, but with increased body temperature, chills and fever.On examination, an increased number of leukocytes and pathogenic microorganisms are detected in secretions and urine.
2. Chronic prostatitis occurs more often.
3. Asymptomatic inflammatory prostatitis is characterized by the absence of specific signs.Most often discovered by accident.

Based on statistics, the most common form is non-bacterial prostatitis.Much less widespread (in a maximum of 10 cases out of 100) is the bacterial form.This is due to the fact that when infected the symptoms are always pronounced, so the patient, as a rule, undergoes examination and treatment in a timely manner.

Possible complications and consequences

With chronic prostatitis, alternating exacerbations and remissions occur, and inflammatory processes rapidly destroy the prostate gland, then the following complications arise, which are considered the most dangerous for human life:

1. Adenoma.It is formed in the prostate gland.Inflammatory processes that occur over a long period of time lead to intense cell division.At the same time, the glandular epithelium in the ducts hyperplastic, increasing the size of the organ.Against this background, benign hyperplasia develops.
2. Cancerous growth in the prostate.Most often occurs after prostatic adenoma.At an early stage of the onset of an oncological tumor, recognizing cancer is problematic.This is due to the fact that men suffering from chronic prostatitis experience the same symptoms.For this reason the patient must undergo appropriate urological tests to identify the prostate specific antigen in the blood.
3. Significant decrease in erection and further impotence.This is the most common unpleasant consequence.The disease develops in a certain sequence.At first the erection weakens slightly, after which it no longer appears regularly and ejaculation occurs very quickly.Furthermore, sexual desire decreases and the patient experiences pain during ejaculation.Then comes the impotence.
4. Infertility.It occurs within a year of the chronic course of prostatitis.The fact is that chronic inflammatory processes lead to a decrease in the amount of sperm, slower sperm motility and destruction of tails and heads.Infertility can be determined using a spermogram.
5. Vesiculitis.Inflammation occurs in the seminal vesicles, which contain sperm.
6. Swelling of the sphincter in the bladder, against the background of which acute urinary retention occurs, leading to death.
7. Prostate sclerosis.The disease manifests itself with the replacement of the prostate gland with connective tissue.That is, connective tissue cords are formed, which leads to sexual dysfunction.

Other consequences:

• cyst formation;
• stones in the prostate;
• hemorrhoids;
• cystitis;
• psychological instability that needs to be treated.

If a man is diagnosed with chronic bacterial prostatitis, he will have to have sexual intercourse only with a condom, as the disease leads to infection of his partner.The bacteria penetrate the fallopian tubes, genital tract and organs, which leads to diseases and female infertility.

Which doctor is treating you?

A urologist treats the genitourinary system of a man.But if you visit a clinic for the first time with a similar problem, you must first visit a therapist.

As diagnostic measures are carried out, consultation with other highly specialized doctors will also be necessary: an infectious disease specialist, a psychologist, depending on the cause of the disease.

Diagnostics

At the first visit to the andrologist, the doctor initially collects a medical history, which includes the following:

• study the history of urological, infectious, chronic and other diseases;
• interview the patient about lifestyle and bad habits;
• identification of factors that contribute to the pathology;
• question the patient about the nature, type and duration of symptoms.

After that, the doctor visually and palpably examines the man and sends him for further examination.

Laboratory methods

What is being done:

1. Collection of fluids secreted from the urethral canal.Pathogenic microflora, mucus and leukocytes are determined.
2. PCR – curettage from the urethra.Pathological agents are identified.
3. Microscopic examination of prostatic secretion.Macrophages, amyloid and Trousseau-Lallement bodies, and leukocytes are counted.
4. Immunological test to evaluate the level of non-specific antibodies.
5. Taking blood fluids to determine PSA levels.If high levels are detected, a prostate biopsy is also ordered, which will rule out or confirm a cancerous tumor.

Instrumental methods

The instrumental diagnostics are as follows:

1. Ultrasound examination of the prostate gland.Usually the transrectal method is performed (the sensor is inserted into the rectum).The stage of the disease and its form are clarified by studying the size and echostructure of the prostate, the density and uniformity of the seminal vesicles.
2. Myography of the pelvic floor muscles and urodynamic study.Neurogenic disorders and bladder outlet obstruction are determined.
3. Magnetic resonance imaging and computed tomography.Pathological disorders in the pelvic organs and cancerous tumors are detected.A differential diagnosis is subsequently established.

Differential diagnosis

Establishing a differential diagnosis is necessary because it allows timely identification of diseases such as:

• prostate cancer;
• dysfunction in the bladder of neurogenic etiology;
• disorders of the detrusor-sphincter system;
• pseudodyssynegria;
• stricture in the bladder;
• hypertrophy of the bladder neck;
• cystitis;
• adenoma;
• sclerosis of the prostate and so on.

Treatment of chronic prostatitis

Therapy for chronic prostatitis is carried out comprehensively: medications are used, massage, physiotherapeutic procedures and exercises are performed.Of particular importance is the correction of the patient's life: complete abandonment of bad habits, proper nutrition, normalization of sexual relations.In some cases, the help of a psychotherapist and a psychologist is necessary.One treatment method cannot be used without the other, as each method complements each other.

Indications for hospital admission

Treatment of chronic prostatitis is carried out on an outpatient basis, but some patients are subject to hospitalization - when serious complications, an advanced form of the disease and the absence of a positive result during therapy are detected.

Antibiotics

Antibacterial drugs are used for chronic bacterial prostatitis.The choice of drug depends on the type of pathogen.The duration of therapy ranges from 2 to 8 weeks.Antibiotics are aimed at destroying the pathogenic microorganism and reducing the inflammatory process.

Different groups are used:

1. Aminopenicillin group.
2. Cephalosporin-based drugs.
3. Macrolides.
4. Fluoroquinolone group.

Alpha blockers

This is a group that blocks adrenergic receptors in the tissues of the pelvic organs, thereby stopping spasms in the bladder, improving the outflow of urine and facilitating the process of urination.In addition, the functioning of the muscular system and sphincter is normalized.

Non-steroidal anti-inflammatory drugs

Chronic prostatitis is characterized by inflammatory processes in the prostate gland, therefore non-steroidal anti-inflammatory drugs are necessarily prescribed.They are aimed at relieving pain and eliminating inflammation.In addition, non-steroids normalize the permeability of the walls of the circulatory system, restore blood circulation, against the background of which existing inflammatory mediators are not absorbed.

The products are used in the form of gels, tablets, injections.

Hormone therapy

If non-steroidal (non-hormonal) drugs do not have a positive effect or the patient has a hormonal imbalance, hormonal drugs are prescribed.They eliminate inflammation, help stimulate erectile function and tissue regeneration.

Restoration of blood circulation

Since prostatitis worsens the process of microcirculation in the genitourinary system, the doctor prescribes the appropriate drugs.When blood circulation returns to normal, regeneration processes are started and local metabolism accelerates.As a result, the patient quickly gets rid of unpleasant symptoms.In addition, many products strengthen the walls of blood vessels and reduce blood viscosity.

Other drugs

In addition, other groups of drugs are used for chronic prostatitis:

1. Muscle relaxants are aimed at relaxing muscles, relieving pain, accelerating blood circulation and reducing the tone of the smooth muscles of the genital organ.
2. Immunomodulators correct immune changes, but are prescribed mainly when the patient has an immunodeficiency.
3. If stones are found in the prostate, the patient must take drugs that regulate uric acid.
4. To destroy the formed adhesions and accelerate the process of action of non-steroidal anti-inflammatory drugs and antibiotics, enzymatic drugs are prescribed.
5. Vitamin and mineral therapy is indicated to strengthen the immune system.The drug is selected based on the lack of a particular vitamin or mineral.
6. To restore metabolism in the prostate and regenerate damaged tissue, bioregulatory peptides are used, obtained from the prostate gland removed from cattle.
7. If the disease is accompanied by anxiety, depression, aggression and other mental disorders, sedative drugs or selective antidepressants are prescribed: valerian tincture, motherwort.

Surgery

Surgery for chronic prostatitis is rarely used, only in cases where the operation is justified and does not involve the risk of complications.Furthermore, a fairly long rehabilitation period is expected after surgery.

In what cases is surgery prescribed:

• in the absence of a positive result after complex conservative treatment;
• prostate abscess;
• tissue suppuration;
• inability to urinate:
• benign prostatic hyperplasia;
• cancerous tumors;
• other complications.

Prostatectomy

This operation involves the removal of the prostate gland and, in some cases, the lymph nodes.Radical prostatectomy according to the surgical method can be of the following types:

• robotic type: several small incisions are made in the lower abdomen, after which the prostate is removed (actions are controlled by a special robotic device);
• open type: an incision is made in the lower abdomen;
• laparoscopic: a small incision is made into which a microscopic camera and instruments are inserted.

Peculiarities:

1. Any type of operation is performed under general or local anesthesia (spinal anesthesia).
2. The duration of the procedure is from 2 to 3 hours.
3. The rehabilitation period is one and a half months.
4. The patient's stay in hospital lasts a maximum of three days.
5. The onset of sexual life occurs between one and a half and two months.
6. In many cases, a urinary catheter is placed for a week.
7. Complications are rare, but they are treatable.

Transurethral resection of the prostate

The surgery involves cutting the tissue surrounding the prostate, making urination easier.To do this, a resectoscope is used, which is inserted into the urethra.The operation is indicated in the absence of urination, as well as for the prevention of such complications: hematuria, inflammatory processes in the kidneys and bladder, stones, urinary incontinence.

Peculiarities:

• duration of surgery – from one hour to one and a half hours;
• stay in clinic – 2 days;
• wearing a catheter – 5-7 days;
• recovery period – one and a half months;
• the onset of sexual activity occurs after 6 weeks.

Drainage of abscesses

The operation is used for prostate abscess, which occurs as a complication.With this disease, a large amount of purulent exudate accumulates in the prostate gland, which must be removed from the body.During the operation, a puncture needle is inserted into the gland under the control of ultrasound equipment.The method resembles a puncture.

Before injection procedures, the urologist surgeon palpates the prostate with his index finger by inserting it into the rectal opening.After aspiration of the pus, antiseptic treatment and drainage with rubber tubes are performed.If the patient has an extensive abscess, pumping of purulent fluid is carried out through the perineal approach, that is, through the rectum.

Peculiarities:

• The duration of the procedure is one and a half hours;
• the maximum residence time in the draining cavity is 72 hours;
• rehabilitation period – one month.

Laser surgery

Laser treatment is an innovative and most common technique, because the operation is considered minimally traumatic, safe and with minimal recovery times.During the operation, a laser instrument is installed in the urethral canal, the beam of which removes excess tissue.In this case no incision is made.

Removal is performed in 2 ways: ablative (excess tissue is burned) and enucleated (tissue is cut).Based on the type of removal, laser surgery is divided into the following types:

1. Photoselective vaporization: the laser vaporizes the tissues.
2. Holmium laser ablation - the procedure is identical to the previous one, but a holmium laser is used.
3. Holmium laser enucleation: The prostate tissue is crushed with a morcellator and then removed.

Peculiarities:

• minimum number of contraindications;
• absence of adverse reactions (bleeding, etc.);
• You can go home immediately after the operation;
• the period of use of a urinary catheter is 24 hours;
• recovery period – maximum 7 days;
• The only downside is that it cannot be used for cancer.

What consequences can occur after surgery of any kind:

• bleeding;
• temporary problems with urination;
• infection;
• urinary incontinence;
• reverse ejaculation (when sperm enters the bladder);
• tissue swelling;
• weakening of erection;
• inguinal hernia;
• reduction in the length of the penis (only when part of the urethral canal is removed).

To prevent complications, you must strictly adhere to all the surgeon's recommendations during the recovery period.You can't self-medicate.

Physiotherapy

Thanks to physiotherapeutic procedures, the level of inflammation is reduced, pain is relieved, tissue swelling is eliminated and the effectiveness of drugs is increased.What is used:

• phonophoresis;
• electrophoresis;
• laser therapy;
• Transrectal microwave hyperthermia.

Massage

Massage is one of the mandatory procedures in the treatment of chronic prostatitis.It is recommended to perform it by a specialist, but if this is not possible, it can be performed at home (but the massage movements should be performed by another person, since the patient is in a relaxed state).

Contraindications to massage:

• hyperplastic changes in the prostate;
• the presence of stones in the organ;
• venous stagnation;
• formation of cysts and other tumors.

Progress of the procedure:

1. The man should expose his lower body and assume a lying position, on his side, with his knees raised up to the abdominal area.
2. There is another pose: knee-elbow.
3. The person performing the massage should wash his hands thoroughly, wear medical gloves and lubricate the index finger with petroleum jelly or other emollient.
4. The masseur inserts a finger into the anus (the man is relaxed).
5. Massage the prostate gland with gentle movements.
6. The duration of the procedure is 2-5 minutes.

If a man lives alone and cannot visit a masseur, special urological massagers can be used.The treating urologist will help you choose the optimal model for you.

Diet therapy

A patient with prostatitis must follow a special diet to prevent the formation of cholesterol plaques, constipation and increased gas formation.Dishes should be steamed or boiled.Cooking is allowed, but without using oil.

Authorized products:

• seafood;
• pumpkin seeds;
• fruits and vegetables that do not cause gas;
• porridge;
• fermented milk products;
• dried fruit;
• lean meat and fish.

Prohibited products:

• any beans;
• cabbage;
• carbonated drinks;
• alcohol;
• spicy and savory dishes;
• strong tea and coffee;
• leavened baked goods.

Folk remedies

Recipes of traditional medicine are used exclusively in agreement with the andrologist, since many of them may have contraindications.

Recipes:

1. Eat about 30-40 pumpkin seeds a day, preferably on an empty stomach.
2. You can drink pear compote, but only without adding sugar.
3. Take a medicinal bath three times a week.To do this, prepare a decoction of herbs in equal proportions: chamomile, sage, pine needles, calendula.Prepare according to the standard scheme (for a glass of water - 2 tablespoons of the mixture).Pour into the bath, add sea salt in free proportion and take a sitz bath for 15 minutes.The water temperature is not higher than 40 degrees.
4. Use parsley: add to salad, squeeze juice and drink.You can also use the seed part.
5. Make your own rectal suppositories.To do this, combine propolis in equal proportions with butter and cocoa powder.Use your hands to form a candle, wrap each suppository in cling film and place in the refrigerator.Every evening before going to bed, administer 1 suppository for 30 days.

Forecast

If we talk about the prognosis, it directly depends on many circumstances: the degree of neglect, the form of the disease, the adequacy of therapy, the behavior of the patient himself.If the development of a chronic form is noticed and treatment is carried out timely and correctly, the prognosis is quite favorable.

However, it is necessary to know that in very rare cases complete recovery from the disease occurs, but it is possible to achieve a stable remission, during which symptoms do not appear.

Throughout his life, the patient will have to strictly adhere to preventive measures, periodically undergo examinations and take medications.

Prevention measures

To prevent the development of chronic prostatitis and its exacerbation during remission, follow simple rules:

• promptly contact a urologist;
• lead a healthy and active lifestyle (eliminate bad habits, practice moderate sports);
• eat well;
• having sex should be regular - at least 3 times a week;
• monitor the state of the immune system;
• don't get too cold;
• exclude casual sex;
• train the muscles of the genitourinary system - do special exercises.

If you suffer from chronic prostatitis, do not be alarmed, because this is not a death sentence.With the right therapeutic approach and regular visits to the andrologist, you can lead an active sexual life without experiencing unpleasant symptoms.