Prostatitis - symptoms and treatment

What is prostatitis? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of a doctor, urologist with 28 years of experience.

Definition of the disease. Causes of the disease

ProstatitisIt is an inflammatory process of the prostate, accompanied by pain in the lower back, perineum or pelvis, as well as disorders in the work of the lower urinary system.

The prostate gland (prostate) refers to the male reproductive system. It sits in front of the rectum, below the bladder and surrounds the urethra (urethra). Therefore, when the prostate gland becomes inflamed, it compresses the urethra, which further leads to various problems with urination. The main function of the prostate is to produce secretion (fluid), which is part of the sperm and liquefies it to ensure normal sperm motility.

Prostate conditions, such as cancer or benign hyperplasia, are more common in elderly patients. Prostatitis differs in that it affects men of all ages, but most often the disease occurs in men of reproductive age (from 8 to 35% of cases).

Prostatitis is more common in the practice of a urologist. It can appear suddenly (acute) or gradually, and its manifestations are constant and long-term (chronic). The chronic form is much more common than the acute one. Chronic prostatitis ranks fifth among the twenty major urological diagnoses.

Prostatitis can be either an independent disease or it can be combined with benign prostatic hyperplasia and prostate cancer. In recent years, there has been a decrease in the incidence of prostatitis in the male population: if in 2012 the incidence was 275 per 100 thousand of the population, then in 2017 the primary incidence was 203 per 100 thousand of the population.

The reasons for the development of prostatitisare bacterial (infectious) and non-bacterial (non-infectious).Infectious prostatitismore common in men under 35 years. Most often this form of the disease is caused by gram-negative microorganisms, especially enterobacteriaceae, E. coli, toothache, pseudomonas and proteas, as well as sexually transmitted infections, such as gonococcus, chlamydia, etc. Very rarely, prostatitis may occur due to mycobacterium tuberculosis. In chronic bacterial prostatitis, the range of pathogens is wider and may include atypical pathogens. We must remember that chronic bacterial prostatitis is a multiethnic disease, ie it can have many causes.

Factors that contribute to the development of inflammationin the prostate gland:

• sexually transmitted infections;
• immunodeficiency conditions
• prostate biopsy
• invasive manipulations and functions;
• LIFESTYLE;
• diarrhea, constipation
• homosexual contacts;
• frequent change of sexual partners
• sedentary lifestyle etc.

Chronic non-bacterial prostatitisdiagnosed in patients complaining of chronic pain in the prostate area, while no infectious (bacterial) causative agent of the disease has been found. Despite many studies, the cause of this type of chronic prostatitis is not fully understood, however, there are some factors that can cause it to develop:

• increased prostate pressure
• muscle pain in the pelvic area
• emotional disorders
• Autoimmune disorders (antibodies that are supposed to fight infection, sometimes for some reason infecting prostate cells)
• physical activity;
• irregular sex life
• weightlifting etc.

In some cases, prostatitis can occur after transurethral surgery such as urethral catheterization or cystoscopy, as well as after rectal prostate biopsy.

Although the true incidence of different types of prostatitis has not been conclusively proven, the following data are provided:

• Acute bacterial prostatitis accounts for about 5-10% of all prostatitis cases.
• chronic bacterial prostatitis - 6-10%.
• chronic non-bacterial prostatitis - 80-90%
• prostatitis, including prostatodynia (neurocerebral disorders of the prostate) - 20-30%.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of prostatitis

All forms of inflammationthe prostate gland, in addition to the asymptomatic, joins in the presence of the following symptoms:

• lumbar pain
• feelings of discomfort with intestinal peristalsis;
• pain in the perineal or pelvic area.
• disorders of the lower urinary tract.

The main symptoms of the lower urinary system in the presence of prostatitis:

• frequent urge to urinate
• difficulty urinating, ie a weak current and the need for "stretching".
• burning pain or intensification when urinating.

In men with a diagnosisacute bacterial prostatitisPelvic pain and urinary tract symptoms, such as increased urination and urinary retention. This can lead to the development of systemic manifestations such as fever, chills, nausea, vomiting and malaise. Acute bacterial prostatitis is characterized by an intense onset of the disease with a strong clinical picture. This is a serious disease.

Men with a diagnosischronic bacterial prostatitisnote symptoms of a recurring nature, which increase and decrease. With deterioration, there is pain and discomfort. The sensations of pain are located mainly at the base of the penis, around or above the anus. Also, the pain can occur just above the pubic bone or in the lower back, spreading to the penis and testicles. Defecation also becomes painful. Sometimes there are signs of infection of the lower parts of the urinary system: burning pain and frequent urination, frequent pushing. These symptoms can be confused with the manifestations of acute bacterial prostatitis, but usually have a sudden onset, chills, fever, weakness, pain throughout the body, lower back and genitals, frequent and painful urination, pain with ejaculation. If you notice such symptoms, you should consult a doctor urgently.

If the standard modern examination has not shown that chronic pain is caused by a pathological process in the prostate, then we are dealing with chronic non-bacterial prostatitis, which is also calledchronic pelvic pain syndrome(the term has been used since 2003). In the presence of chronic pelvic pain syndrome, a man's quality of life is significantly reduced, as this syndrome sometimes leads to various psychological and sexual disorders:

• increased fatigue
• feeling helpless;
• erectile dysfunction
• painful ejaculation
• pain after intercourse etc.

In chronic non-bacterial prostatitis / chronic pelvic pain syndrome, there is a feeling of persistent discomfort or pain in the lower back, most often at the base of the penis and around the anus, for at least 3 months. Painful sensations are located in a "target organ" or in various pelvic organs. Most often, with this form of prostatitis, the pain is located in the prostate gland (46%).

In chronic prostatitis, sexual disorders have many characteristics. First, all the components of a man's sexual function are disturbed to varying degrees: libido, erection, ejaculation. Second, sexual dysfunction occurs mainly in people with a long (more than 5 years) history of the disease. Third, sexual dysfunction is often the main reason for seeking medical attention.

Erectile dysfunction occurs in 30% of patients with chronic prostatitis, mainly due to the psychogenic factor - a destructive perception of the disease.

Symptoms of prostatitis occur at least once in a lifetime in 50% of men.

Pathogenesis of prostatitis

The mechanism of development of prostatitis is multifaceted and complex. Many factors are involved in its development. Most cases of acute bacterial prostatitis are caused by a cataract of processes caused by an ascending urethral infection or endoprostatic reflux (urine flow).

The penetration of microorganisms into the prostate gland is possible through the ascending pathway (through the urethra) or transversely through the lymphatic pathway. Diarrhea and constipation associated with rectal obstruction are considered to be a provoking factor in chronic prostatitis. However, the mechanism of penetration of microorganisms into the prostate has not yet been documented.

Urinary incontinence with prostatitis can result from:

• increase the tone of the smooth muscles of the prostate urethra by increasing the activity of adrenergic receptors.
• enlargement of the prostate or narrowing of the urethra, resulting in turbulent urine flow, obstruction of the bladder outlet and endoprostatic reflux.

In the future, there is a violation of the drainage of prostate ducts, stagnation of prostate secretions, edema, activation of arachidonic acid cataract, inflammation and ischemia. A vicious cycle of pathological changes is formed.

Classification and developmental stages of prostatitis

There are 4 main categories (types) of prostatitis.

1. Acute bacterial prostatitis(category I).
2. Chronic bacterial prostatitis(category II).
3. Chronic non-bacterial prostatitis / syndromechronic pelvic pain (category III). It can be inflammatory (category III A) or non-inflammatory (category III B).
4. Asymptomatic inflammatory prostatitis.Histological prostatitis determined by prostate biopsy (category IV).

Chronic bacterial prostatitisDifferentspicy,manifests as recurrent episodes of exacerbation with the presence or absence of complete remission between them. The symptoms are usually less severe than those of acute prostatitis.

Classification of National American Institutes of Health. . .

• Type I(acute bacterial prostatitis) - acute prostate infection: the symptoms of the disease appear suddenly. Chills, fever, pain all over the body, weakness, lower back and genital pain, frequent, painful urination, pain during ejaculation. Possible symptoms of acute bacterial prostatitis include blood in the urine and / or semen. It's rare. It is effectively treated with antibiotics.
• Type II(chronic bacterial prostatitis) - a chronic or recurrent prostate infection: the symptoms are the same as acute prostatitis, but appear gradually and are less severe. Many courses of antibiotic therapy may be required.
• Type III(chronic non-bacterial prostatitis and chronic pelvic pain syndrome): no signs of infection.
• III A guy: presence of leukocytes in ejaculation / prostate secretion / third part of urine obtained after prostate massage
• Type III B: absence of leukocytes in ejaculation / prostate secretion / third part of urine obtained after prostate massage. Lower back and genital pain, frequent urge to urinate, difficulty urinating (often at night), burning or painful urination, and ejaculation. It accounts for about 90% of all prostatitis cases. There are no known causes or clinically proven treatments.
• Type IV(asymptomatic inflammatory prostatitis): Sometimes the number of white blood cells increases. No treatment required. It was found on a prostate biopsy.

The boundaries between the different forms of prostatitis are blurred.

Complications of prostatitis

With inflammatory lesions of the prostate gland, nearby organs are involved in the pathological process: tuberculosis, Cooper glands, seminal vesicles and posterior urethra. The infection can penetrate the prostate and surrounding organs at the same time.

Cystitis- inflammation of the seminal vesicles. The pains are located in the groin area and deep in the pelvis, radiating to the sanctuary. The pain is usually unilateral, as both seminal vesicles are affected to varying degrees. Cystitis may be asymptomatic. The only complaint of patients may be the presence of blood in the semen. There is also periodic pyuria (pus in the urine) and pyospermia (pus in the ejaculate).

Posterior urethritis, colic (inflammation of the sperm of tuberculosis). . . With prostatitis, the infection penetrates the spermatic tuberculosis, this is due to the proximity of the prostate to the secretory pores.

Prostate abscess.Pathogens that cause prostatitis can also cause a prostate abscess. It is a serious septic (bacterial) disease, which is accompanied by weakness, fever, chills with sweat. In some cases, there is reduced consciousness and delirium. The patient needs hospitalization.

Prostate sclerosis (fibrosis).It is a delayed complication of prostatitis, which is based on the replacement of the prostate tissue with scarring (degeneration of the connective tissue, ie hardening), which leads to the fact that the gland shrinks, shrinks in size and completely loses its function. As a rule, sclerosing symptoms develop long after the onset of the inflammatory process in the prostate.

Prostate cysts.These formations can contribute to the formation of stones in the prostate. The presence of a cyst infection can lead to a prostate abscess. It is not difficult to diagnose a prostate cyst using ultrasound. They can also be detected by digital rectal examination.

Prostate stones.They are quite common. The causes of the disease are not fully understood, but most experts agree that they occur as a result of a prolonged inflammatory process in the prostate. The stones are single and multiple, with a diameter of 1 to 4 mm. Large stones are rare. The stones block the gland, due to which the secretion stops inside it, the gland is too large and separate cysts are formed, into which the infection enters. Patients with stones in the prostate gland should experience constant dull pain in the perineum. Painful sensations spread to the glans penis and cause frequent urge to urinate, which becomes difficult and painful.

Infertility.Chronic long-term prostatitis mainly reduces the motor function of the sperm, making them completely immobile. One of the consequences is the violation of their production, the formation of immature sperm that have an unusually altered shape (and a smaller number of them than before).

Ejaculation disorder.Prostatitis of all forms causes sexual dysfunction. Initially, patients experience premature ejaculation, with a normal erection, which then weakens and the degree of orgasm decreases. Prolonged chronic prostatitis helps reduce the production of male sex hormones and weakens libido.

Erectile dysfunction.The relationship between chronic prostatitis / chronic pelvic pain syndrome and erectile dysfunction has been described. This disorder is especially painful for men.

Diagnosis of prostatitis

The appearance of the first signs of inflammation of the prostate gland requires immediate medical attention. The urologist will rule out many diseases that have similar manifestations and will determine to which category (type) the disease belongs. Before choosing a treatment, a specialist will perform the necessary tests and offer to undergo an evaluation test.

What questions can the doctor ask

At the appointment, the doctor will definitely determine: the duration of the clinical manifestations of the disease, the location and nature of the pain, for example, in the perineum, scrotum, penis and inner thigh. changes in the nature of sperm (presence of pus and blood).

At the reception, the urologist will offer to fill in special questionnaires, one of which is the indicator of chronic prostatitis symptoms.

The patient should ask the doctor questionsabout the tests and studies that need to be done, how to prepare for them, what treatment he intends to prescribe and where I can find more information about the disease.

Chronic bacterial prostatitis is diagnosed when the symptoms last for at least three months.

The research will include:

• Digital rectal examination of the gland to determine the extent of prostate enlargement and its consistency.

• Prostate secretion, urine and / or ejaculation tests.
• Determination of urogenital infection.
• Ultrasound examination of the urinary system (kidneys, prostate, bladder with determination of urine residues)

• Urodynamic study.

In the case of acute bacterial prostatitis, a swollen and painful prostate can be found with digital rectal examination. Prostate massage is contraindicated as it can lead to bacteremia and sepsis.

The most important study to examine patients with acute bacterial prostatitis is the culture of prostate secretions. For the categorization of chronic prostatitis, quantitative culture and microscopy of urine samples and prostate secretions obtained after prostate massage are still important methods.

Androflor - a comprehensive study of microgenesis of the urogenital system in men with PCR. It allows you to determine the qualitative and quantitative composition of the microflora. It is used for the diagnosis and control of the treatment of inflammatory infectious diseases of the urinary system.

Once the cause of the disease has been identified, the doctor will recommend a course of treatment. We must remember that standard methods in only 5-10% of cases can detect an infection, which eventually leads to prostatitis.

What is the relationship between prostatitis, prostate specific antigen (PSA) and prostate cancer

Measurement of total PSA levels and free PSA in prostatitis does not provide additional diagnostic information. It is known that in 60 and 20% of patients with acute and chronic bacterial prostatitis, the level of prostate specific antigen (PSA), respectively, increases. After the end of treatment, the PSA level decreases in 40% of patients. PSA is not considered a specific marker for prostate cancer because PSA levels can increase in benign prostatic hyperplasia and prostatitis.

Treatment of prostatitis

The leading role in the treatment of pathology is assigned to drug therapy.

Treatment with alpha inhibitors 1

Alpha-blockers are prescribed for patients who complain of difficulty urinating. These medicines help to facilitate urination and relax the muscles of the prostate and bladder. Some patients are prescribed medications to lower hormone levels, which can help shrink the gland and reduce discomfort. Muscle relaxants can help relieve pain caused by swelling of the prostate that puts pressure on nearby muscles. Non-steroidal anti-inflammatory drugs (NSAIDs) can help if there is pain.

Conventional antibiotic therapy in most cases does not reduce the number of relapses of the disease and therefore an integrated approach is used and is also prescribed.adjuvants: biostimulants, extracts of various plants and insects and their biological components, which may take the form ofanal suppositories. . . Despite the large arsenal of drugs, the effectiveness of their use remains insufficient.

Physiotherapy in the treatment of prostatitis

For chronic prostatitis of categories II, III A and III B, physiotherapy methods can also be used:

• prostate gland massage (prostate)
• laser treatment?
• hyperthermia and heat therapy
• electrical stimulation with modulated currents of dermal or rectal electrodes.
• acupuncture (acupuncture).

The efficacy and safety of these treatments are still under study. It is also used to treat prostatitisfolk methods, e. gidiotherapy.The effectiveness and safety of this method for the treatment of prostatitis has not been proven.

Stem cell injection

Cell therapy (stem cell injections) in the treatment of prostatitis is currently a promising technique in the early stages of development. At present, regarding the injection of stem cells into the prostate, we can only have hypotheses about its mechanisms, as well as empirical data obtained from individual groups of researchers.

Surgical treatment of prostatitis

Surgical methods are used only to treat complications of prostatitis - abscess and evaporation of sperm vesicles.

Treatment of chronic pelvic pain syndrome requires a separate examination. Asymptomatic inflammatory prostatitis (category IV) should not be treated unless the patient intends to undergo prostate surgery. In this case, the patient is given prophylactic treatment with antibiotics.

Diet and lifestyle for prostatitis

No special diet is required for prostatitis, but eating lots of vegetables, lean meats and dairy products will improve bowel function. It is important to consume enough fiber, foods rich in vitamin E (wheat germ, corn oil, etc. ), sugar should be replaced with natural honey. Proper nutrition for prostatitis can improve bowel function and reduce the chance of relapse or speed of recovery. It is recommended to follow a healthy lifestyle, drink more fluids and limit caffeine and alcohol.

Forecast. Prophylaxis

Acute prostatitis often becomes chronic, even with timely and adequate treatment.

Complete recovery is not always possible, however, with the right consistent treatment and according to the doctor's recommendations, it is possible to eliminate discomfort and pain. IndependentProstatitis treatment at homecan be dangerous and lead to complications.

Not all cases of prostatitis can be identified as a cause, but there are some steps you can take to prevent prostatitis. The same steps can help control existing symptoms:

1. Drink plenty of fluids. Consumption of plenty of fluids leads to frequent urination, thus facilitating the flushing of infectious agents from the prostate urethra.
2. Empty your bladder regularly.
3. Avoid irritation of the urethra. Limit your intake of caffeine, spicy foods and alcohol.
4. Reduce the pressure on the prostate. Men who cycle often have to use a separate seat to relieve pressure in the prostate area.
5. Stay sexually active.