Features 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 this in our article.

Chronic prostatitis is characterized by long-term inflammatory processes in the prostate gland, which leads to morphological and functional disorders of the prostate.It is difficult to get rid of the pathology, the complications are severe, 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 passes into the next phase.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, which occurs 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 rich fatty foods.
6. Disturbances 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.The harmful substances released by such products lead to vasospasm, reducing the level of blood circulation.Consequently, the nutrition of all organs deteriorates.

Symptoms

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

How to recognize chronic prostatitis:

• pain periodically occurs in the pelvis and perineum;
• discomfort during urination and bowel movements;
• discharge from the urethra is observed;
• 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;
• the occurrence of pain after normal physical activity;
• acute urinary retention and false urges;
• sluggish urine stream.

In the initial stages, symptoms appear sluggishly, 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 in the following:

• severe anxiety;
• depression or, conversely, aggressiveness;
• insomnia at night;
• 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.Occurs against the background of an untreated acute bacterial disease.It manifests itself with typical symptoms, but with increased body temperature, chills, and fever.When examined, an increased number of leukocytes and pathogenic microorganisms is detected in the secretions and urine.
2. Chronic prostatitis occurs most often.
3. Asymptomatic inflammatory prostatitis is characterized by the absence of specific signs.Most often discovered by chance.

Based on statistics, the most common form is non-bacterial prostatitis.Much less common (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 exacerbation and remission occur, and inflammatory processes rapidly destroy the prostate gland, so the following complications arise, which are considered the most dangerous to 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 hyperplasias, increasing the organ in size.Against this background, benign hyperplasia develops.
2. Cancerous growth in the prostate.More often occurs after prostate adenoma.At an early stage of the onset of an oncological tumor, recognizing cancer is problematic.This is due to the fact that men with chronic prostatitis experience the same symptoms.For this reason, the patient must undergo appropriate urological tests to detect 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 becomes slightly weakened, after which it does not appear regularly and ejaculation occurs very quickly.Further, sexual desire decreases and the patient experiences pain during ejaculation.Then comes impotence.
4. Infertility.It occurs within a year after 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 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, against the background of which acute urinary retention occurs, leading to death.
7. Prostatic sclerosis.The disease is manifested by the replacement of the prostate gland with connective tissue.That is, connective tissue cords are formed, which entails sexual dysfunction.

Other consequences:

• cyst formation;
• stones in the prostate;
• haemorrhoids;
• 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, since the disease leads to infection of his partner.Bacteria penetrate the fallopian tubes, genital tract and organs, which leads to diseases and female infertility.

Which doctor is treating 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 first need to visit a therapist.

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

Diagnostics

At the initial visit to the andrologist, the doctor initially collects an anamnesis, 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 this, the doctor visually and palpably examines the man and refers him for further examination.

Laboratory methods

What is being done:

1. Collection of secreted fluids from the urethral canal.Pathogenic microflora, mucus, and leukocytes are determined.
2. PCR – scraping from the urethra.Pathological agents are identified.
3. Microscopic examination of prostate secretion.Macrophages, amyloid and Trousseau-Lallement bodies, and leukocytes are counted.
4. Immunological examination to assess the level of nonspecific 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 gland.Usually the transrectal method is performed (the sensor is inserted into the rectum).The stage of the disease and its shape 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 and computed tomography.Pathological disorders in the pelvic organs, as well as cancerous tumors, are detected.After this, a differential diagnosis is established.

Differential diagnosis

Establishing a differential diagnosis is necessary, since it allows for the 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;
• prostate sclerosis and so on.

Treatment of chronic prostatitis

Therapy for chronic prostatitis is carried out comprehensively - medications are used, massages, physiotherapeutic procedures, and 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 intercourse.In some cases, the help of a psychotherapist and psychologist is required.One treatment method cannot be used without the other, since 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 are detected, an advanced form of the disease and the absence of a positive result during therapy.

Antibiotics

Antibacterial medications 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 process of urination.In addition, the functioning of the muscular system and sphincter is normalized.

Nonsteroidal anti-inflammatory drugs

Chronic prostatitis is characterized by inflammatory processes in the prostate gland, 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.

Hormone therapy

If non-steroidal (non-hormonal) medications do not have a positive effect, or the patient has a hormonal imbalance, then 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 appropriate medications.When blood circulation returns to normal, regeneration processes are launched and local metabolism accelerates.Accordingly, the patient quickly gets rid of unpleasant symptoms.Additionally, many products strengthen the walls of blood vessels and reduce blood viscosity.

Other drugs

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

1. Muscle relaxants are aimed at relaxing muscles, pain relief, accelerating blood circulation and reducing tone in the smooth muscles of the genital organ.
2. Immunomodulators correct immune changes, but are prescribed primarily when the patient has an immunodeficiency.
3. If stones are found in the prostate, the patient should take medications that regulate uric acid.
4. To destroy the formed adhesions and speed up the process of action of non-steroidal anti-inflammatory drugs and antibiotics, enzyme medications 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, which are made from the prostate gland removed from cattle.
7. If the disease is accompanied by anxiety, depression, aggression and other mental disorders, sedative medications or selective antidepressants are prescribed: tincture of valerian, motherwort.

Surgery

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

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 removing the prostate gland and, in some cases, lymph nodes.Radical prostatectomy according to the method of surgery can be of the following types:

• robotic type - several small incisions are made in the lower abdomen, after which the prostate is removed (the 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.

Peculiarities:

1. Any type of operation 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 one and a half to 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

Surgery involves cutting the tissue that surrounds the prostate, making 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.

Peculiarities:

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

Abscess drainage

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 feels the prostate with his index finger by inserting it into the rectal opening.After suctioning out the pus, antiseptic treatment and drainage with rubber tubes are performed.If the patient has an extensive abscess, then pumping out the purulent fluid is carried out through the perineal approach, that is, through the rectum.

Peculiarities:

• Duration of the procedure is an hour and a half;
• the maximum time spent in the drainage cavity is 72 hours;
• rehabilitation period – a 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 installed in the urethral canal, the beam of which removes excess tissue.In this case, no incision is made.

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

1. Photoselective vaporization - the laser vaporizes 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.

Peculiarities:

• minimal number of contraindications;
• absence of adverse 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 negative is that it cannot be used for cancer.

What consequences may occur after surgery of any type:

• bleeding;
• temporary problems with urination;
• infection;
• urinary incontinence;
• reverse ejaculation (when sperm enters the bladder);
• swelling of tissues;
• 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 cannot self-medicate.

Physiotherapy

Thanks to physiotherapeutic procedures, the level of inflammation is reduced, pain is relieved, tissue swelling is eliminated, and the effectiveness of medications 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 advisable to carry it out from a specialist, but if this is not possible, then it can be done at home (but another person should do the massage movements, 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 the lower part of his body and take a lying position - on his side, with his knees pulled up to the abdominal area.
2. There is another pose - knee-elbow.
3. The person doing the massage must wash their hands thoroughly, wear medical gloves and lubricate the index finger with Vaseline or other emollient.
4. The masseur inserts a finger into the anus (the man is relaxed).
5. Massage the prostate gland with gentle stroking.
6. The duration of the procedure is 2-5 minutes.

If a man lives alone and cannot visit a massage therapist, 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 adhere to 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 permissible to bake, but without using oil.

Authorized products:

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

Prohibited products:

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

Folk remedies

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

Recipes:

1. Eat about 30-40 pumpkin seeds daily, 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.Brew according to the standard scheme (for a glass of water - 2 tablespoons of the mixture).Pour into the bath, add sea salt in a free proportion and take a sitz bath for 15 minutes.The water temperature is no higher than 40 degrees.
4. Use parsley - add to salad, squeeze the juice and drink.The seed part can also be used.
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 shape, wrap each suppository in cling film and place in the refrigerator.Every evening before 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 you notice the development of a chronic form and carry out treatment in a timely and correct manner, then the prognosis is quite favorable.

However, you need to know that a complete cure for the disease occurs in very rare cases, but it is possible to achieve 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:

• contact a urologist in a timely manner;
• lead a healthy and active lifestyle (eliminate bad habits, engage in moderate sports);
• eat right;
• having sex should be regular - at least 3 times a week;
• monitor the state of the immune system;
• do not get too 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 the andrologist, you can lead an active sex life without experiencing unpleasant symptoms.