Prostatitis

Prostatitis is a disease in which the prostate gland becomes inflamed.Prostatitis, whose symptoms are most often found in men of reproductive age (20-40 years), is diagnosed on average in 35% of the population.

Depending on the origin, prostatitis can be bacterial or non-bacterial, depending on the nature of the course: acute or chronic.

When the first signs of prostatitis are detected, the choice of treatment method depends on the form of the disease.As a rule, specific, symptomatic treatment is carried out.

Prostatitis is not a disease that can be diagnosed from a photograph, since the disease has no visible manifestations.To notice the first symptoms in a timely manner, you should listen to your health.

General description

The prostate gland, affected by the pathology in question, is an exclusively male organ;as a result, prostatitis can develop exclusively in men.If we consider a similar area in women, and this is the distal third of the urethra, or urethra, then they have Skene's glands here.These glands are essentially analogous to the prostate, and if inflammation develops, symptoms can resemble those of prostatitis.

The prostate itself appears as a glandular-muscular organ located near the bladder.Thanks to this, the process of urination is controlled, in addition, it is thanks to the presence of the prostate that a certain secret is released, which makes the sperm liquid.

Most often, prostatitis occurs in combination with diseases such as vesiculitis or urethritis, in elderly patients - in combination with benign prostatic hyperplasia.

Prostatitis: causes

Bacterial prostatitis, as the name suggests, develops when exposed to relevant pathogens.Basically these are pathological agents that constantly reside on the surface of the skin or in the environment of the digestive tract.In this case, a certain combination of factors can cause the development of prostatitis.

The causes of prostatitis include a variety of factors.So, this may be premature emptying of the bladder, the presence of diseases of the genitourinary system, constant hypothermia, irregular sex life, sedentary lifestyle, bad habits, etc.The relevance of this type of factors causes the possibility of microbial agents entering the prostate gland, or causes disruption of blood supply to the organs located in the pelvis, or leads to the development of stagnant processes.All this leads to the proliferation of microorganisms, as well as the development and progression of pathological inflammation.

If the infectious pathogen is not detected in prostatitis, a non-bacterial form of prostatitis is diagnosed.Various reasons can explain this form of pathology, although none of them have yet been demonstrated.For example, some experts believe that in this form the disease can develop against the background of real neurogenic disorders, while another part, on the contrary, focuses on the immune nature of the disease in this form.This is only part of the existing theories on prostatitis.

Let's focus on the acute and chronic forms of the disease.Acute prostatitis is based on the influence of a bacterial factor.As for chronic prostatitis, here this factor is not the main one, acting rather as a secondary and important factor in its impact only at the beginning of the disease.Over time, the pathogenetic mechanism can be complemented by a neurogenic, autoimmune or allergic factor, thanks to the influence of which the chronic form of inflammation is maintained even when it is not a question of bacterial invasion.

Prostatitis: symptoms

Inflammation is accompanied by pain in prostatitis, in particular this is caused by damage to the excretory ducts of the acini, from the walls of which the epithelium detaches, which gradually accumulates with mucus in the tubules.Furthermore, microliths are also formed;they look like small pebbles.Mixing with the epithelium and mucus, they cause the appearance of particular formations of plugs which, in turn, lead to blockage of the excretory ducts.Over time, such plugs turn into suppuration (or microabscesses), the lobules are no longer subject to drainage, they simply stop functioning.

Meanwhile, before the onset of such a stage as blockage of the excretory ducts, as a rule, a lot of time passes, in some cases this time is calculated in months, in others even years.The process proceeds gradually, the patient may not notice anything special, especially since the production of secretions by the prostate does not stop.Another thing is that when these microabscesses are formed, this is already accompanied by the appearance of unpleasant symptoms, manifested with varying degrees of intensity.

As the first of these symptoms, patients notice some difficulty urinating.Due to the fact that the prostate enlarges against the background of the inflammatory process, the urethra is compressed to a certain extent.Further progression of the inflammatory process causes the development of sclerosis of the bladder neck;in an even more severe form of the pathological process, complete closure of the ureter occurs.

The next symptom is sexual dysfunction.Due to the pathological processes that occur in the disease, the erection mechanism is subject to disturbances and orgasm is weakened.

There are also other signs of prostatitis, in particular these include:

• the appearance of a burning sensation in the urethra and perineum;
• persistent and frequent need to urinate;
• the appearance of discomfort during bowel movements;
• “floating threads” in the urine;
• the appearance of urethral stretching secretions during defecation;
• the appearance of prolonged nocturnal erections;
• intermittent and difficult urination;
• too rapid ejaculation;
• increased general fatigue;
• decrease in power;
• manifestation of orgasm in an erased form;
• expectation of the development of other forms of complications in the area under consideration, against the background of which anxiety and general mental depression appear.

I would like to add separately that the listed signs (symptoms) do not necessarily all appear overnight.The disease is characterized by a highly variable pattern of manifestation, this applies to different variations in each individual patient and for different periods of time during its course.

Considering the symptoms, it would be useful to return to the causes.Of course, the inflammatory process will not appear “suddenly”.We are mainly talking about pathogens, which we have already talked about above.Meanwhile, it was this factor that caused the formation of an erroneous idea about the presence of certain causative agents of prostatitis, which is still supported by many specialists today.However, there is no specific type of causative agent for this disease.At the same time, any chronic infectious disease can cause the development of prostatitis;it can be of any type, be it sinusitis, tonsillitis, cholecystitis or any other disease.In this case, the pathogen can enter the prostate through the bloodstream, characterized by a fairly powerful blood supply (otherwise its functionality would be called into question).

There is a certain group at risk of prostatitis, in particular the following people include:

• subjects whose professional activity falls within the "sedentary" work criterion;
• people with a sedentary lifestyle;
• people who have previously been diagnosed with a particular genitourinary infection;
• people for whom the problem of chronic constipation is relevant;
• promiscuous people;
• people whose family relationships do not fall within the order criterion;
• people who abuse alcohol.

Men are often diagnosed with “abacterial prostatitis”, “prostatitis in the prostatitis stage”.If a man is diagnosed with prostatosis, we can say that at this stage there is nothing particularly to worry about.In the meantime, you'll need to make some changes to your lifestyle.In other words, we are talking about the fact that the above phenomena of stagnation are already occurring, but there is no inflammation as such yet, it is prostatosis.If we consider such an option as abacterial prostatitis, then we are already talking about the stage of the beginning of the development of the inflammatory process in a man, but so far without a concomitant infection.

A distinctive feature of prostatitis is that it practically does not manifest itself in acute form.In other words, when it manifests itself, it is already a chronic process, which is explained by its often long and gradual development.Complete recovery due to treatment administered to the disease or spontaneous disappearance of the pathological process is estimated in isolated cases during the initial acute phase.The disease is characterized, as already noted, by an extremely slow course, the manifestations of symptoms generally have an attenuated form.

Prostatitis: consequences

Acute prostatitis, if its manifestations are ignored and if resorting to medical help is excluded, can cause the development of an abscess in the prostate gland, that is, the cause of the development of focal purulent inflammation in it.This is accompanied by an increase in temperature (within 39-40 degrees), which at the same time becomes hectic, that is, its differences exceed one degree.Patients also experience high fever, which periodically gives way to chills.The pain in the perineum becomes so strong that urination is difficult, while defecation becomes almost impossible due to the pain.After a while, swelling develops in the prostate gland which, in turn, causes acute retention of urination.Meanwhile, it is rarely about acute prostatitis, which occurs against the background of a chronic spread of the pathological process - unless, at his own peril and risk, a man “endures and endures”.

Returning to chronic prostatitis, we can say that it is characterized by the undulation of its course, that is, periodically the symptoms of the chronic form of prostatitis appear more intensely, and periodically they are practically not felt.Because of this type of change, many patients choose a wait-and-see approach.Meanwhile, as indicated above, the inflammatory process can worsen, spreading more and more.As it spreads, pyelonephritis may also develop.Meanwhile, complications of prostatitis in most cases are reduced to diseases such as vesiculitis, in which the inflammatory process affects the seminal vesicles, as well as epididymo-orchitis, in which the testicles and appendages become inflamed.As a result of the transfer of the disease in a similar form of its spread, the development of infertility in a man can be indicated.Infertility treatment is a long and complex process and, in some cases, completely impossible.The listed characteristics mainly fall into the development of a chronic form of prostatitis, due to the specific etiology of its onset (in particular, we are talking about sexually transmitted diseases).

Diagnosis

Examining patients to identify their specific type of prostate disease can be done in various ways.Meanwhile, in each specific case, an individual approach to the problem in question is important, on the basis of which it is already possible to determine the diagnostic option to obtain sufficient information about the disease.

To begin with, the doctor carries out a survey of the patient's complaints, studies any medical history, based on this, a preliminary conclusion is subsequently made and the principles of an individual diagnostic algorithm are determined.We would like to add that the first consultation with a urologist (i.e. the specialist to turn to if bothersome symptoms of prostatitis appear) is not final and reliable for making a diagnosis, because the first examination is only an opportunity for the doctor to determine what further diagnostic measures are necessary.

Given the sensitivity of the problem, men are interested in what questions a urologist asks if they suspect prostatitis.In particular, he will ask about current problems associated with urination, as well as how the patient himself evaluates his sexual function (that is, are there any changes, what exactly has changed, from what period).Also, the doctor will ask you what diseases you currently have, etc.

This is followed by an examination, in particular an external examination, a rectal examination, a laboratory and instrumental examination.During an external examination, the doctor examines the man's genitals, determining whether any rashes, irritations, discharge, etc. are present.

Then, after an external examination, the doctor moves on to the next stage, which is a rectal examination.Rectal examination allows you to determine the general contours of the prostate, its consistency, its boundaries, etc.

Next, it will be necessary to obtain results from instrumental and laboratory diagnostics.Instrumental diagnostics is called TRUS, which in expanded form means transrectal ultrasound.This is the more accurate method of identifying diseases in a man than standard ultrasound.

As for laboratory tests, these include smear, urine test, prostate secretion test, PCR (a laboratory test to detect sexually transmitted infections).

Based on the current classification of methods for diagnosing prostatitis, only microscopic examination of the secretion obtained from the prostate gland, as well as any topical diagnostic option capable of detecting the presence of an inflammatory process in the lower genital tract, can be considered a necessary option.Other types of diagnostic methods act only as clarifying methods;they are necessary for differential diagnosis and to identify existing complications of the underlying disease.In addition, it is important to remember that with overdiagnosis, this phase itself becomes longer and the symptoms only worsen.That is, here, as in any subject, the principle of the “golden mean” is appropriate.

Treatment of prostatitis

Treatment of prostatitis today is a serious problem, although this does not mean that the doctor cannot help and the disease should be left to chance.Indeed, it is not always possible to completely recover from prostatitis, but it is possible to eliminate the symptoms of the disease and achieve a long-lasting and sustainable remission.Depending on how seriously a man takes the doctor's recommendations, how long the periods of remission will be for him.

Basically, the treatment of prostatitis can contain a number of measures, in particular methods of antibacterial therapy, prostate massage, immunotherapy, physiotherapy and general correction of the patient's lifestyle.Only on the basis of a set of these measures will it be possible to achieve the desired result;in general, the disease is difficult to treat, so it cannot be ignored.

Antibacterial therapy

This type of therapy is considered the basis of conservative treatment.The basis for the choice of antibacterial drugs is a number of factors, in particular these:

• the ability of the components of the proposed drug to enter the secretion and tissue of the prostate to create a concentration exceeding the MIC values of pathogens;
• characteristics of the spectrum of antimicrobial activity (for example, the use of macrolide antibiotics determines the possibility of their good penetration into the prostate tissue, while they have no activity against gram-negative bacteria, that is, they are the main etiological agents in the consideration of the acute form of prostatitis).

What is noteworthy is that acute prostatitis, in comparison with the chronic form of the disease, is characterized by the fact that it allows the possibility of accumulation of aminoglycosides and beta-lactam antibiotics in the tissues of the gland and in concentrations sufficient to suppress the activity of most types of pathogens.This is due to the increase in perfusion of the prostate, as well as the increase in the degree of permeability characteristic of the hemoprostatic barrier.Another feature of drugs from this group is that when inflammation decreases, the degree of penetration into the prostate decreases.For this reason it is recommended to switch to another type of oral medication.

Prostate massage

For the most part, experts consider this method of influence to be a fairly effective solution in the treatment of prostatitis.The basic principles for achieving a therapeutic effect in this case are as follows:

• restoration of duct patency;
• improvement of muscle tone and blood circulation in the prostate gland;
• greater penetration of antibiotics used into glandular tissue;
• the possibility of activating microorganisms that are in an inactive state, thereby improving the results of the sale of antibacterial drugs.

How is prostate massage performed?First of all, it is important to establish a certain contact of trust between doctor and patient;this will ensure greater relaxation of the patient which, in turn, will allow the necessary manipulations to be performed with minimal pain and maximum efficiency.When preparing for a massage, the patient leans forward, spreading his legs about 60 cm wide and leaning on the table with his elbows.The doctor puts on gloves and applies a gel to the index finger (sometimes this gel has an analgesic effect).Then, with your free hand, spread your buttocks wide enough to allow palpation of the anal sphincter with your index finger.The natural reaction to such contact is muscle contraction.Subsequently, after relaxing them, the index finger is inserted into the ampulla of the rectum.

In some cases, during these manipulations patients feel dizziness and even fainting (on average in 10% of cases).These manifestations are mainly caused by excessive fear, shame and anxiety, and if the massage is performed correctly, they do not accompany it at all.A massage can be defined as successful when it is possible to obtain at least 4 drops of the secretion secreted by the prostate.

The most popular recognized method used in the treatment of chronic prostatitis is the use of massage according to the Manila protocol.In this case the massage is performed three times a week, a study of the microbiological dynamics is also carried out and antibiotics are administered.

Immunotherapy

This direction in the treatment of prostatitis is often extremely necessary, since with a prolonged manifestation of inflammation in combination with previously incorrect antibacterial treatment, the possibility of a negative impact on the general condition of the immune system cannot be excluded.Treatment of prostatitis requires not only eliminating the infection from the gland and, in fact, inflammation, but also preventing the new development of inflammation in it.However, like other therapeutic areas, immunotherapy should not be reduced to self-medication or treatment based on the recommendations of a pharmacist in the pharmacy;here you will have to consult an immunologist and, most likely, perform some tests.

Physiotherapy

For prostatitis, this direction of treatment can be implemented in a wide variety of impact options, however, regardless of the specific solution, the impact is focused on improving blood circulation in the pelvic organs, thereby increasing the overall effectiveness of the implementation of antibacterial therapeutic measures.Physiotherapy can use ultrasonic waves, electromagnetic waves, laser therapy, raising the temperature directly in the rectum, etc.If there is no opportunity for physical therapy, the doctor may recommend microenemas with warm water and some medications.

Lifestyle correction

This type of effect is aimed at both the treatment of prostatitis and its prevention.It should be treated in the same way as the main treatment, because if the factors that predispose to the development of prostatitis persist, the disease, sooner or later, will make itself felt again.Taking this into account, you should make some changes in your life, this applies to playing sports, normalizing the wake/sleep schedule, a nutritious and balanced diet, walking, eliminating bad habits.

If symptoms appear that indicate prostatitis, you should consult a urologist.