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 what symptoms you should see your doctor for 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 sexual activity and with excess, and so on. This article will help you understand the basic nuances of the disease.
About 10% of men experience symptoms of chronic prostatitis, but only about 60% of them seek medical help (Nickel JC et al. , 2001).
Prostatitis affects men of all age groups, and its prevalence continues to grow. Men under 50 years old 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, from 8 to 35% of men aged 20-40 years suffer from inflammation of the prostate. Among older men, the real picture is "masked" by the incidence of benign prostatic hyperplasia (prostate adenoma), since their symptoms are largely the same. Up to 65% of patients with adenoma are operated on for it with unrecognized prostatitis. (Nickel JC et al. , 2007). Given that inflammatory diseases of the genital organs are a common cause of male infertility, scientists speak of a threat to the reproductive health of the nation.
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 what 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, develops against the background of predisposing factors (impaired urine outflow, suppressed immunity). In 5% of cases, it turns into chronic bacterial prostatitis.
II category: Chronic bacterial prostatitis. . . It is also a rare disease that is considered a recurrent urinary tract infection with the main focus in the prostate.
III category: Chronic prostatitis / chronic pelvic pain syndrome. . . Previously, this disease was called chronic abacterial prostatitis, and it 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 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, primarily by the presence of leukocytes in urine or prostate secretions.
IV category: Asymptomatic inflammatory prostatitis. . . It is an accidental finding when examining a patient. It is most often diagnosed when examining men for infertility or an elevated level of the PSA marker in the blood. We do not consider this type of disease in detail, since scientists have not yet developed a unified view of this form (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, difficult. Urine comes out in intermittent portions, there is no feeling of satisfaction from urination. Blood may be found in the last portions of urine. The pain is worse with bowel movements. This is a serious illness that requires urgent help.
Complications of acute prostatitis are:
- acute urinary retention;
- abscess of the prostate (formation of a purulent focus);
- paraprostatitis (inflammation of the tissue around the gland, can be caused by a breakthrough abscess);
- phlebitis of the paraprostatic venous plexus (inflammation in the surrounding veins).
Chronic prostatitis symptoms
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 can be present with varying severity.
- Pain:
- pain or discomfort in one of the characteristic areas (groin, supra-groin, testicles, penis, lower back, abdomen, rectum);
- pain when urinating or increased pain when urinating;
- pain during or after ejaculation;
- increased sensitivity of the muscles in the perineum;
- neuropathic pain;
- pain due to intestinal irritation.
- Urinary symptoms:
- lower urinary tract symptoms (LUTS) associated with emptying (urge to empty the bladder, incontinence, urge to urinate, nocturnal urge, pain when urinating);
- LUTS associated with obstruction (weak urine pressure, intermittent stream, need to push);
- burning sensation in the urethra;
- recurring urinary tract infections.
- Sexual dysfunctions:
- erectile disfunction;
- 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 have manifestations of psychological stress and sexual dysfunction (A. Mehik, 2001).
If symptoms of prostatitis and chronic pelvic pain syndrome appear, you need to see a urologist or 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 in 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, inadequate sexual regimen, difficulty in the outflow of urine, and deterioration of 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 with the throwing of urine, by an ascending infection, through the lymph from the rectum, or with blood from other foci 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 carried out through the urethra;
- biopsy of the prostate;
- violation of secretion and excretion of prostatic juice.
The risk factors and causative agents of chronic bacterial prostatitis are similar to those for acute. Of particular importance are the causative agents of genital infections: Trichomonas, chlamydia, ureaplasma, mycoplasma.
Chronic pelvic pain syndrome is currently not considered a homogeneous disease, doctors find it difficult to name its main cause. Only in one third of these patients, biopsy revealed inflammatory changes in the prostate gland. It is believed that the leading role in its development is played by immune, neurological and endocrine disorders.
Among the causes of the syndrome considered by scientists:
- infections
- autoimmune disorders;
- chemical inflammation due to urine ingress;
- disorders of the immune system;
- throwing urine into the prostatic ducts;
- pain in the muscles of the pelvic floor due to their pathological tension;
- entrapment of nerves;
- psychological stress.
Diagnostics of the prostatitis
Diagnosisacute prostatitisis put on the basis of:
- complaints;
- medical examination;
- urine tests, which should include bacteriological culture to identify the pathogen.
In uncomplicated cases, imaging of the prostate is usually not needed. Transrectal ultrasound (ultrasound) or computed tomography (CT) of the pelvis is done when urinary retention is severe and a prostate abscess is suspected. PSA testing is also not recommended, as in an acute illness its level will in any case be increased. 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 the quality of life, and detail the symptoms. During the examination, the doctor palpates the abdomen, conducts a digital examination of the prostate gland (through the rectum), assesses the condition of the pelvic muscles. In most cases, the diagnosis is made on the basis of medical examination and 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 secretions, semen culture, or urinalysis after prostate massage (Budía A; 2006).
If the analysis of the secretion of the prostate and urine does not provide enough information in the presence of symptoms of chronic prostatitis, the following additional studies are carried out:
- 2-glass sample (urinalysis to determine the localization of the infection);
- 4-glass sample;
- urine flow rate;
- determination of residual urine;
- cytological analysis of urine.
In differential diagnosis (to exclude prostate stones, abscess, cancer), the following tests are also used:
- sowing a smear from the urethra;
- screening for sexually transmitted diseases;
- analysis for PSA;
- uroflowmetry;
- cystoscopy;
- biopsy of the prostate;
- retrograde urethrography;
- Ultrasound of the kidneys;
- magnetic resonance imaging, computed tomography.
Treatment of prostatitis
Treatment of bacterial prostatitis
Ideally, antibiotic therapy should be based on bacteriological data. But usually it starts before the results are obtained, assuming that the most common pathogens are intestinal 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 of the fluoroquinolone, macrolide, tetracyclines groups. 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 not possible 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, 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 Treatment
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 drugs 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 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 to 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 in the quality of life and the difficult attitude of patients to the situation require the intervention of a psychologist.
Prophylaxis
For warningacute prostatitistimely treatment of any urological diseases is required, remember about a safe sex life and the prevention of genital infections. Partial prevention should be carried out by doctors without prescribing unnecessary invasive procedures (biopsies, cystoscopy) and radically curing urinary tract infections.
The main points of chronic prostatitis prevention:
- Personal hygiene. To prevent infections, the intimate areas should 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, aerobic exercise give a good effect. Among other things, physical activity reduces the anxiety often associated with prostatitis.
- Normal sexual activity in accordance with age.
- Liquid. You need to drink enough to help flush bacteria out of the urinary tract.
- Diet. It is recommended to limit the use of foods that irritate the prostate gland: coffee, tea, carbonated drinks, spices, pickles, canned food, fried foods and alcohol. The proportion of fruits and vegetables in the diet should be increased. These recommendations are 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 infections.
- Avoiding hypothermia.
- Timely visit to the doctor when dangerous symptoms appear: painful urination, frequent urge, discomfort in the lower abdomen and perineum.