According to statistics, about 40% of men with prostatitis symptoms 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 for what symptoms you should see a doctor and what to do to avoid getting sick.
What is prostatitis
Prostatitis is an inflammation of the prostate gland 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 and excessive sexual activity, etc. This article will help you understand the basic nuances of the disease.
About 10% of men experience symptoms of chronic prostatitis, but only 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 50 years of age constitute 65. 2% of patients, according to various sources, the prevalence of the disease among men as a whole is 13. 2-35% (Lummus WF, 2001; Meares EM, 1990). According to other data, 8 to 35% of men between the ages of 20 and 40 suffer from inflammation of the prostate. Among older men, the real picture is "masked" by the incidence of benign prostatic hyperplasia (prostate adenoma), since its symptoms are largely the same. Up to 65% of adenoma patients are operated on with 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. . . A 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 (impaired urine outflow, suppressed immunity). In 5% of cases, it turns into chronic bacterial prostatitis.
Category II: chronic bacterial prostatitis. . . It is also 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 represents up to 95% of all diagnosed prostatitis (Habermacher GM, 2006). Chronic pain syndrome combines pathologies characterized by urological pain in the absence of a urinary tract infection. It does not include urethritis, cancers, narrowing of the urethra, neurological damage to the bladder. Divided into categories IIIa and IIIb: with signs of inflammation and without signs of inflammation. These signs are determined by laboratory, mainly by the presence of leukocytes in the urine or prostate secretions.
Category IV: asymptomatic inflammatory prostatitis. . . It is an accidental finding when examining a patient. It is most often diagnosed when men are screened 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 in this way (Nickel JC, 2011).
Symptoms of prostatitis.
Symptoms of acute prostatitis
The disease begins acutely, there is pain in the perineum, the body temperature rises. The urge to urinate is frequent (at least 5-7 per night), urination becomes painful and difficult. Urine comes out in intermittent portions, there is no feeling of satisfaction when urinating. Blood can be found in the last portions of urine. Pain worsens with bowel movements. This is a serious illness that requires urgent help.
Complications of acute prostatitis are:
- acute urinary retention;
- prostate abscess (formation of a purulent focus);
- paraprostatitis (inflammation of the tissue around the gland, can be caused by a breakthrough 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 image of the disease is highly variable, below is a list of symptoms that can occur with varying severity.
- Pain:
- pain or discomfort in one of the characteristic areas (groin, supra-groin, testicles, penis, lower back, abdomen, rectum);
- painful urination or increased pain when urinating;
- pain during or after ejaculation;
- increased sensitivity of the perineum muscles;
- neuropathic pain;
- pain due to intestinal irritation.
- Urinary symptoms:
- lower urinary tract symptoms (LUTS) associated with voiding (urge to empty the bladder, incontinence, urge to urinate, nighttime urge, painful urination);
- LUTS associated with obstruction (weak urinary pressure, intermittent stream, 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 the semen);
- decreased libido
- Psychosocial symptoms:
- anxiety;
- depression;
- cognitive and behavioral impairment;
- decreased quality of life.
Men with chronic pelvic pain syndrome are more likely to present with manifestations of psychological stress and sexual dysfunction (A. Mehik, 2001).
If symptoms of prostatitis and chronic pelvic pain syndrome appear, you should consult a urologist or an andrologist. In the 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 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, an improper sexual regime, difficulty in the outflow of urine, and impaired blood circulation in the pelvic organs. Other risk factors include cold climates, alcohol abuse, and a sedentary lifestyle.
Acute prostatitis is a bacterial inflammation, its most common pathogens are Escherichia coli, Proteus, Pseudomonas aeruginosa, Enterobacter and some others. The disease develops when the infection enters the gland by passing urine, by an ascending infection, through the lymph from the rectum or with blood from other sources 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 intercourse;
- bladder catheterization;
- operations performed through the urethra;
- prostate biopsy;
- violation of the secretion and excretion of prostate juice.
The risk factors and causative agents of chronic bacterial prostatitis are similar to those of acute. Of particular importance are the causative agents of genital infections: Trichomonas, chlamydia, ureaplasma, mycoplasma.
Chronic pelvic pain syndrome is not currently considered a homogeneous disease; doctors have a hard time naming its root cause. Only in one third of these patients, the biopsy revealed inflammatory changes in the prostate gland. The main role in its development is believed to be played by immune, neurological and endocrine disorders.
Among the causes of the syndrome considered by scientists:
- infections
- autoimmune disorders;
- chemical inflammation due to entry of urine;
- immune system disorders;
- throwing urine into the prostate ducts;
- pain in the pelvic floor muscles due to their pathological tension;
- nerve entrapment;
- psychological stress.
Prostatitis diagnosis
Diagnosisacute prostatitisit's based on:
- complaints;
- medical exam;
- urinalysis, which must include bacteriological culture to identify the pathogen.
In uncomplicated cases, imaging of the prostate is generally not needed. A transrectal ultrasound (sonogram) or computed tomography (CT) scan of the pelvis is done if urinary retention is severe and if a prostate abscess is suspected. The PSA test is also not recommended, since in an acute illness 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 the history of the disease, changes in quality of life, and detail the symptoms. During the exam, the doctor feels the abdomen, performs a digital exam of the prostate gland (through the rectum), and 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. The criteria for the diagnosis of chronic bacterial prostatitis are a history of recurrent urinary tract infections and a ten-fold increase in bacterial levels in prostate secretions, semen culture, or urinalysis after prostate massage (Budía A; 2006).
If the analysis of prostate and urine discharge does not provide enough information in the presence of symptoms of chronic prostatitis, the following additional studies are carried out:
- 2-vessel sample (urinalysis to determine location of infection);
- Sample of 4 glasses;
- urine flow rate;
- determination of residual urine;
- cytological analysis of urine.
In differential diagnosis (to exclude prostate stones, abscesses, cancer), the following tests are also used:
- sowing a smear from the urethra;
- detection of sexually transmitted diseases;
- PSA analysis;
- 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 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 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. For an abscess, surgery is done 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 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 abstain from sexual intercourse for a week.
Treatment of chronic prostatitis / chronic pelvic pain syndrome
As we pointed out, the cause of this syndrome is very difficult to identify. Hence the difficulties with the selection 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 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-inflammatories improve quality of life and relieve pain.
- 5-alpha reductase inhibitors relieve the symptoms of prostatitis.
- Muscle relaxants have a similar effect to alpha blockers.
- Phytotherapy. The bioflavonoid quercetin and several other medications relieve pain through 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 through 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 endoscopic incision of the bladder neck, transurethral resection of the prostate gland, 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
To warnacute prostatitisTimely treatment of any urological disease is required, 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 prevent infection, intimate areas must 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 gland. You need to get up and move at every opportunity. Stretching and aerobic exercises work well. Among other things, physical activity reduces the anxiety that is often associated with prostatitis.
- Normal sexual activity according to age.
- Liquid. You should drink enough to help flush bacteria from the urinary tract.
- Diet. It is recommended to limit the use of foods that irritate the prostate gland: coffee, tea, carbonated drinks, spices, pickles, preserves, fried foods and alcohol. The proportion of fruits and vegetables in the diet should be increased. These recommendations are also important in treating the disease.
- Keep a healthy weight.
- Stress management. To do this, you can talk to a specialist (psychotherapist), learn 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.