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 about all that in our article.

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

Causes

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

1. Infection of the genitourinary tract with mycoplasma, chlamydia, herpes, ureaplasma, candida, E. coli, cytomegalovirus or trichomonas.
2. Congestion in the pelvic organs, which occurs against the background of a sedentary lifestyle, disturbed blood supply, poor diet and bad habits.
3. Frequent hypothermia (the risk group includes people who are engaged in surfing, diving, skiing and so on).
4. Prolonged abstinence from sexual relations, interrupted acts.
5. Obesity due to high fat foods.
6. Disorders in the endocrine system.
7. Inflammatory processes in the whole body, especially chronic ones.
8. Weak immune system.
9. Injury to the genital organ.
10. Constant constipation.
11. Depression, stress, overload.

Special attention should be paid to bad habits - consumption of alcohol, drugs, smoking.Harmful substances released by such products lead to vasospasm, reducing the level of blood circulation.Consequently, the nutrition of all organs deteriorates.

Symptoms

In chronic prostatitis, the prostate enlarges, which compresses the elements of the genitourinary system and narrows the urethra.As the disease progresses, the gland completely closes the urethra, strongly compressing the channel.Because of this, problems arise with the excretion of urine.

How to recognize chronic prostatitis:

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

In the initial stages, symptoms appear slowly, but as they progress, they intensify.The pain syndrome becomes very strong, radiating to nearby organs and areas.Special attention should be paid to the process and frequency of urination.Against the background of such changes, a person experiences psycho-emotional problems that are manifested in the following:

• severe anxiety;
• depression or, conversely, aggressiveness;
• insomnia at night;
• obsessions;
• fear of sexual intercourse and urination;
• angry temper and irritability.

Classification

The current requirements for the classification of chronic prostatitis were developed in 1995.Based on this, the disease is divided into:

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

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

Possible complications and consequences

In chronic prostatitis, there is alternating exacerbation and remission, and inflammatory processes quickly destroy the prostate, so the following complications arise, which are considered the most dangerous for human life:

1. Adenoma.It is produced in the prostate.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 hyperplasia, increasing the size of the organ.Benign hyperplasia develops against this background.
2. Cancerous growth of the prostate.It occurs more often after prostate adenoma.In the early stage of an oncological tumor, cancer recognition is problematic.This is due to the fact that men with chronic prostatitis have the same symptoms.For this reason, the patient must undergo appropriate urological tests to detect the prostate-specific antigen in the blood.
3. Significant reduction in erection and further impotence.This is the most common unpleasant consequence.The disease develops in a certain order.At first, the erection becomes slightly weakened, after which it does not appear regularly and ejaculation comes very quickly.Furthermore, the sexual desire decreases and the patient feels pain during ejaculation.Then comes impotence.
4. Infertility.It appears within a year after the chronic course of prostatitis.The fact is that chronic inflammatory processes lead to a decrease in the amount of spermatozoa, slowing of spermatozoa motility and destruction of their 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, on the background of which there is acute retention of urine, which leads to death.
7. Sclerosis of the prostate.The disease is manifested by the replacement of the prostate by connective tissue.That is, connective tissue is formed, which entails sexual dysfunction.

Other consequences:

• cyst formation;
• prostate stones;
• hemorrhoids;
• cystitis;
• mental instability that needs to be treated.

If a man is diagnosed with chronic bacterial prostatitis, he will have to have sex only with a condom, because the disease leads to infection of his partner.Bacteria penetrate the fallopian tubes, genital tract and organs, leading to disease and female infertility.

Which doctor treats you?

A urologist treats a man's genitourinary system.But if you are visiting the clinic for the first time with a similar problem, then you should first visit a therapist.

As diagnostic measures are carried out, consultations with other highly specialized doctors - infectious disease specialist, psychologist, depending on the cause of the disease - will be necessary.

Diagnostics

During the first visit to the andrologist, the doctor first collects the medical history, which includes the following:

• studying the history of urological, infectious, chronic and other diseases;
• interviewing the patient about lifestyle and bad habits;
• identification of factors contributing to pathology;
• questioning the patient about the nature, type and duration of symptoms.

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

Laboratory methods

what is being done:

1. Collection of excreted fluid from the urethral canal.Pathogenic microflora, mucus and leukocytes are determined.
2. PCR – scraping from the urethra.Pathological agents have been identified.
3. Microscopic examination of prostate secretions.Macrophages, amyloid and Trousseau-Lalement bodies, and leukocytes are counted.
4. Immunological examination to assess the level of non-specific antibodies.
5. Taking blood fluid to determine PSA levels.If high levels are detected, then a prostate biopsy is additionally prescribed, which will rule out or confirm a cancerous tumor.

Instrumental methods

Instrumental diagnostics are as follows:

1. Ultrasound examination of the prostate.The transrectal method is usually 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. Pelvic floor muscle myography and urodynamic study.Neurogenic disorders and bladder outlet obstruction are determined.
3. Magnetic resonance and computer tomography.Pathological disorders in the pelvic organs, as well as cancerous tumors, are revealed.After that, a differential diagnosis is made.

Differential diagnosis

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

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

Treatment of chronic prostatitis

Chronic prostatitis therapy is carried out comprehensively - medicines are used, massages, physiotherapeutic procedures, exercises are performed.Of particular importance is the correction of the patient's own life - complete abandonment of bad habits, proper nutrition, normalization of sexual relations.In some cases, the help of psychotherapists and psychologists is needed.One method of treatment cannot be used without the other, as each method complements each other.

Indications for hospitalization

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 is 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 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 urination process.In addition, the work of the muscular system and sphincter is normalized.

Nonsteroidal anti-inflammatory drugs

Chronic prostatitis is characterized by inflammatory processes in the prostate, so anti-inflammatory non-steroidal 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 the existing inflammatory mediators are not absorbed.

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

Hormonal therapy

If non-steroidal (non-hormonal) drugs do not have a positive effect or the patient has a hormonal imbalance, then hormonal drugs are prescribed.They remove 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 appropriate drugs.When blood circulation returns to normal, regeneration processes are initiated and local metabolism is accelerated.Accordingly, the patient quickly gets rid of unpleasant symptoms.In addition, many products strengthen the walls of blood vessels and reduce blood viscosity.

Other drugs

Also, other groups of drugs are used for chronic prostatitis:

1. Muscle relaxants are aimed at relaxing the 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 primarily when the patient has immunodeficiencies.
3. If stones are found in the prostate, the patient should 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, enzyme drugs are prescribed.
5. Vitamin-mineral therapy is indicated for strengthening the immune system.The drug is selected based on the lack of a certain vitamin or mineral.
6. To restore metabolism in the prostate and regenerate damaged tissue, bioregulatory peptides are used, which are made from prostates removed from cattle.
7. If the disease is accompanied by anxiety, depression, aggressiveness and other psychological disorders, sedatives or selective antidepressants are prescribed: tincture of valerian, lemon balm.

Operation

Surgical intervention in chronic prostatitis is rarely resorted to, only in cases where the operation is justified and does not carry the risk of complications.In addition, there is a fairly long period of rehabilitation after surgical procedures.

In which cases the operation is 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 surgery involves removing the prostate and, in some cases, lymph nodes.According to the method of operation, radical prostatectomy 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 - one incision is made in the lower abdomen;
• laparoscopic - a small incision is made into which a microscopic camera and instruments are inserted.

Features:

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

Transurethral resection of the prostate

The operation involves cutting the tissue surrounding the prostate, which makes it easier to urinate.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.

Features:

• intervention duration – from an hour to an hour and a half;
• stay in the outpatient clinic – 2 days;
• wearing a catheter – 5-7 days;
• recovery period - a month and a half;
• the beginning of sexual activity is after 6 weeks.

Abscess drainage

Surgery is used for prostate abscess, which occurs as a complication.In this disease, a large amount of purulent exudate accumulates in the prostate, 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 the injection procedures, the urologist surgeon feels the prostate with his index finger, inserting it into the rectal opening.After suctioning the pus, antiseptic treatment and drainage with rubber tubes are performed.If the patient has an extensive abscess, then the purulent liquid is pumped out through the perineal approach, i.e. through the rectum.

Features:

• The duration of the procedure is an hour and a half;
• the maximum time spent in the drainage cavity is 72 hours;
• rehabilitation period - one month.

Laser surgery

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

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

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

Features:

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

What consequences can arise 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 follow all the surgeon's recommendations during the recovery period.You cannot self-medicate.

Physiotherapy

Thanks to physiotherapeutic procedures, the level of inflammation is reduced, pain is alleviated, tissue swelling is removed 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 have it done by a specialist, but if this is not possible, then it can be done at home (but another person should do the massage movements, because the patient is in a relaxed state).

Contraindications for massage:

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

Procedure progress:

1. The man should uncover the lower part of the body and assume a lying position - on his side, with his knees drawn to his stomach.
2. There is another pose - knee-elbow.
3. The person performing the massage must wash their hands well, wear medical gloves and apply petroleum jelly or other emollient to the index finger.
4. The masseur inserts a finger into the anus (the man is relaxed).
5. Massage the prostate with light stroking.
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 will have to be steamed or boiled.It is allowed to bake, but without the use of 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 bean;
• cabbage;
• carbonated beverages;
• alcohol;
• spicy and salty dishes;
• strong tea and coffee;
• pastries with yeast.

Folk remedies

Prescriptions of traditional medicine are used exclusively in consultation with an andrologist, as 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, make a decoction of herbs in equal proportions: chamomile, sage, pine needles, calendula.Cook according to the standard scheme (for a glass of water - 2 tablespoons of the mixture).Pour into the bathtub, add sea salt liberally and bathe in a sitz bath for 15 minutes.The water temperature is not higher than 40 degrees.
4. Use parsley - add it to a salad, squeeze the juice and drink it.Some of the seeds can also be used.
5. Make your own rectal suppositories.To do this, mix propolis in equal proportions with butter and cocoa powder.Shape a candle with your hands, wrap each candle in cling film and put it in the fridge.Give 1 suppository every night before going to bed 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 the therapy, the behavior of the patient himself.If you notice the development of a chronic form and timely and correctly carry out treatment, then the prognosis is quite favorable.

However, you must know that a complete cure of the disease occurs in very rare cases, 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 medication.

Prevention measures

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

• consult a urologist in a timely manner;
• lead a healthy and active lifestyle (eliminate bad habits, engage in moderate sports);
• eat right;
• sex should be regular - at least 3 times a week;
• monitor the state of the immune system;
• don't catch a cold;
• exclude casual sex;
• train the muscles of the genitourinary system - do special exercises.

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