Chronic prostatitis is a long-term inflammation of the prostate gland, diagnosed only in men and indicates a neglected pathological condition in the reproductive organs. The disease leads to a violation of the morphology and functioning of the prostate, is characterized by pain in the pelvis, genitals with irradiation to the groin, urination disorders, sexual disorders. Long-term treatment consists in stabilizing the general condition, excluding relapses and AUR.
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 disease 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 (abscesses, through the urethra, caries, etc. ).
- Chronization with inflammatory components of prostate secretion. The study reveals an increased level of leukocytes and pathogens, infectious agents.
- Chronic abacterial prostatitis. It manifests itself as an inflammatory process with a symptom complex 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 disrupt the functioning of the reproductive organs. But when analyzed in secret, inflammation products - leukocytes - are found.
Conventionally, STB (pelvic pain syndrome) can be attributed to the chronicity of the process in the prostate. With it, a symptom complex develops, resembling a protracted 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 is bacterial in nature, in the rest - a chronic disease is abacterial in nature. This means that most of the problems with the gland in men come from leading an unhealthy lifestyle.
Causes of infectious chronic 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 distant 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, prolongation of sexual intercourse.
- chronic intoxication.
Symptoms of abacterial inflammation in the prostate almost always appear in men who lead a sluggish lifestyle. Physical inactivity, overweight, unwillingness to move intensively, laziness, all this affects the work of the prostate, provoking congestive (stagnation) phenomena.
It is difficult to prevent the development of chronic prostatitis and men employed in production associated with constant vibration. 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 the pathology of the prostate. 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 pains that are constant, aching in nature and radiating (transferring) to the genitals, pubis, scrotum, rectum and sacrum. In fact, a man constantly, during the day, feels discomfort in the pelvic area. 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 urethra, false urging, especially at night.
- Prostatothorrhoea (discharge from the urethra, anus during exercise).
- In the groin there are sensations of cold, sweating, burning.
The 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 breaks down on close people, 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, erased orgasms, infertility - all these are visual manifestations of chronic prostatitis.
If chronic prostatitis is not treated, the disease will be repeated by constant relapses of acute prostatitis with a short period of weakening. It can be complicated by vesiculitis, urinary incontinence, calculus formation, cysts, sclerosis, and prostate cancer.
Diagnosis of chronic prostatitis
A complete diagnosis of the state of the body of a man is necessary if a pathology of the prostate gland 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 recurrence of the disease.
Differential Diagnosis
It consists in conducting many additional studies to exclude diseases similar in symptoms to chronic prostatitis. Its variety of manifestations makes it difficult to make a true diagnosis, so the doctor methodically excludes similar pathologies one by one.
As a differential diagnosis for chronic prostatitis are:
- Inflammation of the prostate is not in the stage of chronicity.
- Anogenital symptom complex.
- Vegetative urogenital syndrome.
- Adenoma, prostate cancer.
When making a diagnosis, it is not the patient's feelings or his complaints that matter, but only the actual data obtained through research.
Laboratory diagnostics
| 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 may be the result of a distant focus of infection, the bacterial microflora from which enters the gland through the lymphatic blood. |
| Fence, study of prostate secretion | Through massage of the prostate gland, 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 gland and give an accurate assessment of its condition.
| Name of the instrumental diagnostic method | Characteristic |
|---|---|
| Ultrasound (TRUS) of the prostate | Allows you to assess the state of the gland, its volume, tissues, the presence of foci of inflammation, stones, congestion. |
| Urodynamic examination | It is carried out using uroflowmetry, profilometry, cystometry, electromyography. With the help of these techniques, it is possible to exclude stress urinary incontinence, neurogenic bladder, etc. , similar in symptoms. |
| Biopsy with morphological examination | Necessary for suspected prostate cancer. |
Treatment of chronic prostatitis
The course of treatment for chronic prostatitis has to be repeated periodically, it is almost impossible to cure the disease completely. The main principle of therapy is to avoid relapse and make the "quiet" phase of the disease long. Primarily 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 food that causes acute inflammation, physical inactivity, excessive exercise, etc.
Medical treatment
For the treatment of chronic prostatitis, complex treatment is used, since it is impossible to cure using only one type of pill. Men are prescribed drugs:
- Antibiotics. They are needed to suppress pathogenic microflora in the gland, eliminate the cause of a bacterial infection, and stop inflammation. Of the popular ones, drugs of the penicillin group, cephalosporins, aminoglycosides, fluoroquinols, macrolides are prescribed.
- NSAIDs (non-steroidal anti-inflammatory). Drugs in this group eliminate severe inflammation and relieve pain.
- Hormones. Assign when other means are powerless, or you need to quickly remove an acute relapse. Patients with chronic prostatitis are prescribed drugs 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 likelihood of stagnation, the formation of stones, spasm of the prostatic part of the urethra.
Physiotherapy
One of the effective methods of treatment, its essence is the effect on the body of 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 are slight congestion. With combined treatment with medicinal 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 penetrate better into 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 consists in exposing the body to high-frequency vibrations. Ultraphonophoresis is a variety - ultrasound is combined with the use of drugs.
Folk remedies
Here, the treatment of prostatitis at 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 relapse, but they cannot completely replace conservative therapy.
It is forbidden to turn to folk methods in critical condition. If a man is shown an urgent operation and there is a risk of developing AUR, trying to stop the disease with herbs means starting the pathological condition even more.
What folk methods are used for chronic prostatitis:
- Decoctions of herbs. They help to cleanse the body of toxins, relieve general inflammation, lower the temperature.
- Douching, 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 in the prostate.
- Compresses. For their preparation, propolis oil, mustard powder or herbal decoctions are used. The application is only external, done in the evening, so that after them you do not go outside and do not cool.
- 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, remove congestion in the prostate and reduce the effect of hypodynamia if the work of a man is sedentary.
For chronic inflammation of the prostate, the following exercises are recommended:
- Gymnastics Kegel. Its essence is to strengthen the muscles of the pelvic floor, perineum. This is achieved by regular (up to 150 times / day) contraction / tension of the muscles of the anus and between the scrotum and penis.
- Charging with a tennis ball. It is placed in the crotch area, sit on the floor and sway, moving back and forth massaging and straining the desired area.
- Steps on the buttocks. The essence of the exercise is sitting on the buttocks and rolling from side to side to move forward (step like a duck). You can’t help with your hands; they are pulled out 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 exercises are prohibited. Resume physical education when the acute syndrome is removed.
Surgical intervention
The duration of conservative treatment does not always relieve chronic prostatitis, it regularly reminds of itself with relapses. In a critical condition, the andrologist recommends an operation, although it does not exclude recurrence if the man does not follow the measures to prevent the disease.
List of surgical techniques for the treatment of chronic prostatitis:
- resection of the prostate. With severe inflammation or areas of sclerosis, a 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 done through the urethra.
- Urinary neck incision. Do with sclerosis, obstruction of the bladder, to improve the outflow 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" food. Any semi-finished products, spicy, 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 ones, 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 very beginning. To do this, it is necessary to treat any 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 to 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 not try to be treated on your own. Do not be overweight and do not abuse alcohol, cigarettes.
Consequences and complications
Only a specialist can determine the degree of complications, but as common with chronicity, there are:
- Androgen deficiency.
- Violation of sexual and reproductive functions.
- Vesiculitis, pyelonephritis.
- Erectile dysfunction (impotence), urethritis, cystitis and epididymo-orchitis.
- Psychological problems.
- Prostate necrosis.
Forecast
The prognosis depends on when the patient went to the doctor. In advanced cases and in the presence of age-related factors in 97%, the treatment of chronic prostatitis will require surgical intervention. If conservative treatment is carried out in a timely manner at the stage of chronicity and then relapses are regularly prevented, the course of the disease can be improved and periods of exacerbations can be leveled out.