Chronic prostatitis is a long-term inflammation of the prostate gland, diagnosed only in men and indicates a neglected pathological condition of the reproductive organs. The disease leads to a violation of the morphology and functioning of the prostate gland, is characterized by pain in the pelvis, genitals with radiation to the groin, urination disorders, sexual disorders. Long-term treatment consists of stabilizing the general condition, excluding relapses and RAU.
Types of chronic prostatitis
The chronic form of prostatitis can be of several types, it all depends on what underlies the onset of the disease. According to the classification, the following types of diseases are distinguished:
- Chronic prostatitis of bacterial origin. The cause of the inflammatory process in the gland is the penetration of bacterial microflora along the descending or ascending path (abscess, through the urethra, caries, etc. ).
- Chronization with inflammatory components of prostatic secretion. The study reveals an increased level of leukocytes and pathogens, infectious agents.
- Chronic abacterial prostatitis. It is manifested by an inflammatory process with a complex of symptoms similar to acute inflammation with the participation of pathogenic microflora. But in fact there are no inflammatory components (pathogen + leukocytes).
- Latent chronic prostatitis. The disease has no pronounced signs, does not bring discomfort, almost does not disturb the functioning of the reproductive organs. But when analyzed in secret, products of inflammation - leukocytes - are discovered.
Classically, PTS (pelvic pain syndrome) can be attributed to the chronicity of the process in the prostate. With it, a symptom complex develops, resembling a prolonged course of prostatitis, more than 3 months, with obvious signs of infection.
Causes of chronic prostatitis
According to WHO statistics, only 5-10% of cases of inflammation of the prostate are bacterial in nature, in the rest - a chronic disease is abacterial in nature. This means that most gland problems in men stem from an unhealthy lifestyle.
Causes of chronic infectious prostatitis:
- Penetration into the prostate of uropathogenic microflora (E. coli, Proteus, Staphylococcus aureus, viral, fungal or parasitic particles).
- Violation of blood circulation in the pelvic organs (physical inactivity, poor condition of blood vessels, blood clots).
- Urological diseases (urethritis, cystitis, pyelonephritis).
- The presence of remote foci of infection in the body (bronchitis, tonsillitis, caries).
- Systematic local hypothermia/overheating of the pelvic region.
- Stress, fatigue, chronic sleep deprivation.
- Poor nutrition, including the predominance of "empty" dishes without enough vitamins and minerals.
- Rare urination.
The clinic of abacterial (non-infectious) prostatitis is associated with stagnant processes in the body:
- Violation of drainage in the acini of the prostate.
- Poor venous circulation in the pelvis.
- Overflow of the prostate with blood (swelling, poor secretion).
- Prolonged abstinence or excessive sexual activity.
- PPA practice, prolonging sexual intercourse.
- chronic poisoning.
Symptoms of abacterial inflammation of the prostate almost always appear in men who lead slow lifestyles. Physical inactivity, overweight, reluctance to move intensively, laziness - all this affects the work of the prostate gland, causing congestive phenomena (stagnation).
It is difficult to prevent the development of chronic prostatitis and men employed in the production associated with constant vibrations. Additional etiological factors are pathologies of the pelvic organs, nerves, blood vessels, hemorrhoids, regular constipation, androgen deficiency and BPH.
Signs and symptoms of chronic prostatitis
Specific signs of chronic prostatitis are weakly expressed and outwardly often not typical for prostate pathology. The picture changes only during the period of exacerbation, when the general symptoms resemble the course of an acute inflammatory process.
Sensations in a chronic process are a prostatic triad. It is characterized by constant pain, aching in nature and radiating (transfer) to the genitals, pubis, scrotum, rectum and sacrum. In fact, a man constantly feels discomfort in the pelvic area during the day. The pain does not stop, it only changes intensity and direction.
Typical symptoms of chronic inflammation of the prostate:
- Increased pain at the end of urination.
- Irradiation of unpleasant sensations in the head of the penis, scrotum, sacrum.
- Pain during intercourse, especially during ejaculation.
- Painful and frequent urination.
- Burning in the urethra, false desire, especially at night.
- Prostatothorrhea (discharge from the urethra, anus during exercise).
- In the groin there are feelings of coldness, sweating, burning.
General (visible) disorders associated with chronic prostatitis also include psychological disorders (discomfort prevents a man from working, resting, sleeping and eating normally). Irritability appears, he collapses on relatives, subordinates, he loses the desire to do anything.
In chronic prostatitis, a violation of sexual function is strongly expressed, which does not improve a man's mood. Painful erections, low libido, unfinished sexual intercourse, faded orgasms, infertility - all these are visual manifestations of chronic prostatitis.
If chronic prostatitis is not treated, the disease will repeat itself with constant relapses of acute prostatitis with a short period of relaxation. It can be complicated by vesiculitis, urinary incontinence, stone formation, cysts, sclerosis and prostate cancer.
Diagnosis of chronic prostatitis
A comprehensive diagnosis of the condition of a man's body is necessary if a pathology of the prostate is suspected. A urologist (andrologist) conducts an initial examination, prescribes laboratory and instrumental diagnostics. After the diagnosis is made, the specialist prescribes the treatment of chronic prostatitis, which includes the use of drugs, physiotherapy, the use of folk and specific methods to prevent the recurrence of the disease.
Differential diagnosis
It consists of carrying out numerous complementary studies to exclude diseases whose symptoms resemble chronic prostatitis. Its variety of manifestations makes it difficult to establish a true diagnosis, so the doctor methodically excludes similar pathologies one by one.
As differential diagnosis for chronic prostatitis are:
- Inflammation of the prostate is not at the stage of chronicity.
- Anogenital symptom complex.
- Vegetative urogenital syndrome.
- Adenoma, prostate cancer.
When establishing a diagnosis, it is not the feelings of the patient or his complaints that count, but only the actual data obtained through research.
Laboratory diagnosis
| Name of laboratory diagnostic method | Characteristic |
|---|---|
| General inspection | They note the appearance of the patient, the condition of the skin, genitals, note complaints, collect an anamnesis. |
| Identification of infectious agents | The inflammatory process in the prostate can be the result of a distant focus of infection, from which bacterial microflora enters the gland through lymphatic blood. |
| Closing, study of prostatic secretion | Thanks to prostate massage, they examine it and identify / exclude the presence of leukocytes, bacterial microflora, erythrocyturia. |
| Urinalysis, urethral swab, 3-glass urine sample, RIF, PCR. | Reveal infections of the genital tract (chlamydia, herpes, candidiasis, gonorrhea, etc. ), nonspecific bacterial microflora. |
Instrumental diagnostic methods
The examination is carried out using endoscopic instruments, devices that allow the urologist to "penetrate" closer to the prostate and give an accurate assessment of its condition.
| The name of the method of instrumental diagnostics | Characteristic |
|---|---|
| Ultrasound (TRUS) of the prostate | Allows you to assess the condition of the gland, its volume, tissues, the presence of foci of inflammation, stones, congestion. |
| Urodynamic examination | It is performed by uroflowmetry, profilometry, cystometry, electromyography. Using these techniques, it is possible to exclude stress urinary incontinence, neurogenic bladder, etc. , whose symptoms are similar. |
| Biopsy with morphological examination | Necessary in case of suspected prostate cancer. |
Treatment of chronic prostatitis
The course of treatment for chronic prostatitis must be repeated periodically, it is almost impossible to completely cure the disease. The main principle of therapy is to avoid relapses and prolong the "calm" phase of the disease. Mainly eliminate the main causes of chronicity and periods of exacerbation, if they arise from systematic hypothermia, change clothes, try to avoid drafts. Be sure to follow the clinical recommendations of a urologist, exclude foods that cause acute inflammation, physical inactivity, excessive exercise, etc.
Medical treatment
For the treatment of chronic prostatitis, a complex treatment is used, since it is impossible to cure using only one type of pill. Men are prescribed medication:
- Antibiotics. They are needed to suppress pathogenic microflora in the gland, eliminate the cause of bacterial infection and stop inflammation. Among the most popular, drugs from the penicillin group, cephalosporins, aminoglycosides, fluoroquinols, macrolides are prescribed.
- NSAIDs (nonsteroidal anti-inflammatory drugs). Drugs of this group eliminate severe inflammation and relieve pain.
- Hormones. Assign when other means are powerless or you need to quickly suppress an acute relapse. Patients with chronic prostatitis are prescribed medication in ampoules, tablets.
- Alpha blockers. They are designed to relax smooth muscles, reduce tone and allow urine to drain completely. Means are prescribed during an exacerbation, the risk of AUR.
- Antispasmodics. Eliminate vasospasm and improve blood flow in the pelvic organs. This reduces the risk of stagnation, the formation of stones, spasms of the prostatic part of the urethra.
Physiotherapy
One of the effective methods of treatment, its essence is to influence the body with an electric current, magnetic field, ultrasound and other natural means. Physiotherapy is not contraindicated in 97% of cases of diagnosis of the disease, does not cause side effects. The following methods are used:
- Electric current (electrophoresis). Electrical stimulation of the prostate with direct or alternating current is useful if the tone of the gland is reduced, there is a slight congestion. With combined treatment with drug solutions, the effect of the latter will be higher.
- Magnetotherapy. A man's body is affected by a magnetic field of different frequencies. When the process is chronic, vasodilation occurs, blood flow improves and congestion is eliminated, drugs better penetrate the tissues and accumulate.
- Laser therapy. The prostate is affected by a laser beam, while inflammation is suppressed, blood circulation is stimulated and the outflow of prostatic fluid improves.
Chronic prostatitis is treated with ultrasound, the technique involves exposing the body to high frequency vibrations. Ultraphonophoresis is a variety - ultrasound is associated with the use of drugs.
Folk remedies
Here, the treatment of prostatitis in the chronic stage is based on the complex use of decoctions, tinctures, baths and other methods, coupled with traditional drugs for chronic prostatitis. Herbal preparations help the body cope with inflammation and prevent relapses, but they cannot completely replace conservative treatment.
It is forbidden to turn to folk methods in a critical condition. If a man is indicated for an urgent operation and there is a risk of developing AUR, trying to stop the disease with herbs means triggering the disease state even more.
What folk methods are used for chronic prostatitis:
- Herbal decoctions. They help cleanse the body of toxins, relieve general inflammation, lower the temperature.
- Showers, enemas. To do this, make warm infusions, decoctions of nettle, oak bark, wormwood, calendula. A solution is injected into the pre-cleansed intestine, this contributes to the rapid relief of inflammation of the prostate.
- Compress. For their preparation, propolis oil, mustard powder or herbal decoctions are used. The application is only external, carried out in the evening, so that after them you do not go out and cool down.
- Rectal suppositories. They are made from propolis, beeswax, cocoa butter, pork lard, bee bread and royal jelly. Apply rectally after a cleansing enema, insert suppositories at night or during the day, but you need to lie down for at least 40 minutes.
Exercises
With the help of daily exercises, you can increase the tone of smooth muscles, improve blood circulation in the pelvic organs, eliminate prostate congestion and reduce the effect of hypodynamia if a man's work issedentary.
For chronic inflammation of the prostate, the following exercises are recommended:
- Kegel gymnastics. Its essence is to strengthen the muscles of the pelvic floor, perineum. This is achieved by regular contraction/tension (up to 150 times/day) of the muscles in the anus and between the scrotum and the penis.
- Charge with a tennis ball. It is placed in the crotch area, sitting on the floor and rocking, moving back and forth, massaging and tensing the desired area.
- Walk on the buttocks. The essence of the exercise is to sit on the buttocks and roll from side to side to move forward (walking like a duck). You cannot help yourself with your hands, they are pulled in front of you and try to walk at least 3-5 meters.
- Scissors. The well-known complex is to give a load to the press, pelvic muscles, thighs.
With exacerbation of chronic prostatitis, any exercise is prohibited. Resume physical education when the acute syndrome is relieved.
Surgical intervention
The duration of conservative treatment does not always relieve chronic prostatitis, it is regularly remembered by relapses. In critical condition, the andrologist recommends an operation, although this does not exclude recurrence if the man does not comply with the measures for the prevention of the disease.
List of surgical techniques for the treatment of chronic prostatitis:
- prostate resection. In case of severe inflammation or areas of sclerosis, part of the affected prostate is removed using an endoscope.
- prostatectomy. This is a complete removal of the prostate gland, performed in a critical situation, when inflammation and changes in the gland interfere with normal urination.
- Drainage of a cyst, abscess. If an abscess or cystic formation has formed on the prostate, a puncture is performed using an endoscope, ultrasound or manipulation is performed through the urethra.
- Incision of the urinary cervix. To do with sclerosis, obstruction of the bladder, to improve the flow of urine and ejaculate.
Diet
The main principle of proper nutrition in chronic prostatitis is the exclusion of harmful foods and a change in diet with a predominance of "clean" foods. All semi-finished products, spicy and spicy dishes with artificial preservatives, alcohol, strong tea or coffee are removed from the diet.
The body should receive a sufficient amount of protein in the form of boiled fish, meat, dairy products. Vegetables, fruits and natural juices - instead of fast food, soda. Overcooked dishes are replaced with steam, boiled dishes, and those that create increased gas formation in the intestines are also prohibited.
Prevention
Chronic prostatitis is mostly incurable, so the main point of prevention is to prevent the disease from the beginning. To do this, it is necessary to treat all infectious pathologies in a timely manner, not to overcool, always remember about sexually transmitted diseases and follow the principles of healthy sexual relations.
Physical inactivity is a precursor to stagnation, so daily exercise and an active lifestyle will help avoid prostatitis. Adhere to a healthy lifestyle, undergo an examination by a urologist once a year, contact a specialist for the slightest problems with the genitourinary system and do not try to self-medicate. Do not be overweight and do not abuse alcohol, cigarettes.
Consequences and complications
Only a specialist can determine the degree of complications, but as is often the case with chronicity, there are:
- Androgen deficiency.
- Violation of sexual and reproductive functions.
- Vesiculitis, pyelonephritis.
- Erectile dysfunction (impotence), urethritis, cystitis and epididymo-orchitis.
- Psychological problems.
- Prostatic necrosis.
Provide
The prognosis depends on when the patient went to the doctor. In advanced cases and in the presence of age-related factors in 97% of cases, the treatment of chronic prostatitis will require surgery. If conservative treatment is carried out in a timely manner at the stage of chronicity and relapses are regularly avoided, the course of the disease can be improved, and periods of exacerbations can be leveled.