How is chronic prostatitis treated? Chronic prostatitis: symptoms, diagnosis and treatment

Content

This disease occurs in men of any age, and the catalyst is various types of infections - staphylococci, trichomonas, gonococci. Bacteria that enter the body provoke inflammation of the urethral canal and the prostate gland itself. The chronic form of the pathology is often asymptomatic and makes itself felt only after the transition to the acute form. Late diagnosis and treatment are also due to the fact that the first symptoms of the disease are often ignored by men.

What is chronic prostatitis

The disease has code 41.1 according to ICD 10 and is a long-term inflammatory process in the prostate gland. The main functions of the latter are to protect bladder from ingestion of seminal fluid. In addition, the prostate gland is involved in the production of prostate secretion, an important component of male semen. Inflammation of gland tissue caused by infection, congestion or other factors becomes permanent over time.

Chronic prostatitis gradually leads to degenerative changes, in which the tissue structure is deformed and the urinary canal narrows. Often, against the background of inflammation, stones appear in the ducts. Some types of the disease cause the development of malignant tumors. 9 out of 10 patients are diagnosed with non-infectious chronic prostatitis, in which inflammation provokes stagnation of secretions in the prostate or impaired circulation in the veins.

Causes of the disease

Two main factors that cause inflammatory process in the prostate gland it is bacterial and non-infectious. The first is caused by pathogens and infections entering the man’s body. As a rule, the catalyst in this case is sexually transmitted bacteria. The second factor is not related to the infectious agent. Inflammation can be stimulated by:

disruption of hormonal levels associated with irregular sex life, aging of the body;
hypothermia;
pelvic organ injuries
bad habits (smoking, alcohol abuse);
stagnation due to metabolic disorders and a sedentary lifestyle.

After making a diagnosis, the doctor must determine the root cause of chronic prostatitis. The course of treatment is prescribed only after identifying the factor that caused the development of the pathology. Thus, non-infectious and bacterial types of disease are treated differently. Urologists identify several additional factors that aggravate the situation, complicating the course of the disease. These include:

sexual abstinence;
past inflammatory pathologies;
defective ejaculation (interruption of sexual intercourse as a method of contraception);
stress;
poor nutrition;
frequent cystitis, urethritis;
chronic pyelonephritis.

Symptoms of exacerbation of the disease

As a rule, with the development of the chronic form of the disease, symptoms practically do not appear. In this case, the signs of the acute course of the disease either will not manifest themselves, or will manifest themselves to a much lesser extent than they could during the primary development of acute inflammation. The most common symptoms of the disease in the acute stage are:

discomfort, moderate pain when urinating, defecating;
periodic pain in the perineum;
discharge from the urinary canal;
irradiation of pain to the anus, testicles, thigh;
burning in the urethra;
frequent urge to urinate;
signs of deterioration in libido (decreased sexual activity, sexual desire);
erectile dysfunction, tissue swelling;
pain in the rectum, lower abdomen;
increased irritability, fatigue, short temper, depression;
sleep disorders.

Pain syndrome

Pathology in the late stage of development gives pronounced symptoms. It is characterized by severe pain that does not go away on its own and requires the use of antispasmodics and analgesics. Pain in chronic prostatitis accompanies the entire period of development of inflammation, and it gradually becomes more intense. Sometimes soreness is mistakenly attributed to muscle fatigue or radiculitis. After taking a painkiller, temporary relief occurs.

Over time, the clinical picture becomes more pronounced. The pain syndrome increases and becomes intense, discomfort accompanies every trip to the toilet and the act of ejaculation. The pain radiates from the spine (lower back) to the scrotum area, sometimes to the limbs, accompanied by numbness and cramps. At the same time, a man may experience burning, itching, rashes on the tissues in the genital area and prostate - this is a natural reaction of the body to an internal inflammatory process.

Fever

One of the main signs of prostatitis in acute form is fever. In this case, the man experiences a sharp increase in temperature, up to 39-40 degrees. The indicators remain stable, the fever goes away only after taking antipyretics. Sluggish pathology is characterized by a subfebrile course. Constant thermometer readings fluctuate between 37-37.2 degrees. In this case, it is strictly forbidden to lower the temperature yourself by taking medications.

Discharge from the urethra

Pathology can develop after the penetration of bacteria or other pathogenic microorganisms into the male body. This causes discharge from the urethra. They are caused by opportunistic flora, represented by cocci, Escherichia coli species, Proteus, and other pathogens. Almost all of them are permanent inhabitants of the human skin and mucous membranes, but under certain conditions they can cause inflammation of the prostate. The prerequisites for this are:

advanced infections of the genitourinary system;
hypothermia;
physical inactivity;
lack of regular sexual activity.

When the blood supply to the pelvic organs is disrupted, bacteria quickly penetrate the prostate tissue. More often, discharge is observed in severe forms of prostatitis; during diagnosis, a large amount of the pathogen is detected in the secreted secretion. In the presence of purulent discharge, in addition to pathogenic bacteria, they contain an excess of leukocytes. These factors indicate the rapid development of inflammation and activation of the body’s protective properties.

The discharge has a different appearance, on the basis of which such types of symptoms as spermatorrhea, prostatorrhea, mucous and purulent discharge are distinguished. Blockage of the excretory channels is characterized by increasing dynamics, which is explained by clogged ducts in which dead epithelial cells, microbes, and mucus accumulate. As a result, pus is formed, which comes out when the prostate gland is palpated. Stagnation of the outflow of secretions leads to the appearance of discharge. If alarming signs of pathology appear, the patient should consult a doctor.

Increased urination

The initial signs of chronic prostatitis are manifested in impaired urination. Gradually, the symptoms become more pronounced, making it easier to identify the disease. However, it may also indicate the development of other pathologies, including hyperplasia, the appearance of benign formations and oncology. Dysuria is manifested by the following symptoms:

hematuria (blood in the urine), purulent discharge;
frequent urge to urinate, especially at night;
pain when emptying the bladder;
feeling of incomplete emptying of the bladder.

Pain in the glans penis after ejaculation

With chronic inflammation of the prostate, congestion affects the nerve endings that transmit impulses to the brain. Due to pathological changes in the prostate gland, the processes of ejaculation and erection are disrupted. As a rule, men experience premature ejaculation, weakened erectile function, and a deterioration in the severity of sensations during orgasm. In a normal state, men ejaculate some time after the start of sexual intercourse, but patients experience sperm incontinence, that is, ejaculation occurs much earlier.

Characteristic symptoms of prostate adenoma and chronic prostatitis depending on the form of the disease

Today, the classification of disease types developed in 1995 is used. According to it, there are several forms of prostatitis, including:

Acute bacterial. One of the most common. Its occurrence is associated with a bacterial infection entering the body. ABP is easily diagnosed due to the presence of characteristic symptoms. Acute bacterial prostatitis has no age criteria; the risk of its development exists in young, mature and elderly representatives of the stronger sex.
Chronic bacterial. Pathology characterized by typical symptoms of chronic inflammation with increased amount bacteria, leukocytes in urine and prostate secretion released when it is squeezed.
Chronic prostatitis. The most common form of the disease, which is often a consequence of acute bacterial prostatitis (which could not be completely cured due to the patient’s negligence).
Asymptomatic inflammatory prostatitis. It is characterized by the absence of classical signs of pathology; the disease itself is diagnosed accidentally, during a routine examination by a urologist.

If there is an infection, a man is diagnosed with bacterial chronic prostatitis, in other cases they speak of a non-infectious form of the disease. The following table describes the symptoms characteristic of each type of inflammatory pathology:

Form of the disease	Main signs (symptoms)	Laboratory data
	acute onset; severe pain in the perineum; urine is cloudy, sometimes with blood; elevated temperature, signs of intoxication.	increased number of leukocytes in the blood; high level leukocytes, erythrocytes in urine; accelerated ESR; gonococci may be observed.
Chronic bacterial	moderate pain in the abdominal area; dysuria, premature ejaculation; pain during ejaculation.	the presence of red blood cells in the analysis of glandular secretions; Escherichia coli, Klebsiella or other bacteria identified by cytoscopy.
Chronic abacterial	moderate pelvic pain for at least 3 months.	absence of pathogenic bacteria when examining the patient.
inflammatory	severe dysuria; moderate pain in the lower abdomen, in the genital area.	leukocytes in the secretion of the gland and in the third portion of urine according to the Meares-Stamey test.
2. stagnant	mild pelvic pain, discomfort; dysuria.	laboratory data of the inflammatory process are not detected.
Asymptotic inflammatory prostatitis	There are no specific clinical signs.	there are signs of inflammation.

Bacterial

Signs of chronic prostatitis caused by pathogenic microflora periodically occur in the patient with varying intensity. With exacerbation, the symptoms of inflammation become more pronounced. Chronic infectious disease manifests itself:

General inflammatory signs: fever, muscle pain, chills, weakness.
Local inflammation syndrome. It manifests itself as pain in the lower part of the peritoneum, which intensifies during sexual intercourse, urination, defecation, and prolonged absence of sex.
Deviations in laboratory tests. Fungi and bacteria are found in prostate secretions and the patient’s urine. In addition, leukocytosis, increased ESR, leukocyturia, and increased protein in the urine are diagnosed.
Disorders of the genitourinary system. Impaired functioning of the genital organs, decreased sensitivity of the penis, intermittent urination.

Chronic pelvic pain syndrome

The key symptom of this form of the disease is painful sensations. Due to the low severity of the latter, pathology of a nonbacterial nature often goes unnoticed by the patient. Over time, the pain intensifies, and in the clinical picture there are symptoms of genital dysfunction, caused by impaired blood flow, decreased tone of the muscles of the pelvic day and urinary sphincter, and congestion against this background.

How to diagnose the disease

Identifying progressive chronic inflammation of the prostate is not difficult and is based on a classic set of symptoms. Considering that pathology often occurs without clinical symptoms, it is important to use laboratory, physical and instrumental examination methods, including determining the patient’s neurological and immune status. When assessing subjective signs of prostatitis great value takes an anamnesis, during which the doctor listens to the patient’s complaints and finds out what his relatives were sick with.

There are many questionnaires that are filled out by the patient in order to determine by the doctor the frequency and intensity of pain, the presence of sexual disorders, dysuria in the patient, and the patient’s attitude towards these clinical manifestations of the disease. The most popular is the NIH-CPS symptom scale questionnaire, developed by the US National Institutes of Health. The questionnaire is highly effective in identifying signs of a male illness, and is used to determine its impact on the patient’s quality of life.

General blood and urine analysis

For this test, blood is taken from the capillaries of the fingers, and during the study the leukocyte sedimentation rate is checked. This reveals the presence of infection and inflammatory process in the patient’s body (with prostatitis, the number of leukocytes exceeds 9 × 10 ^ 9). In addition, the patient has a high ESR threshold (the optimal indicator is 5) - this also indicates the presence of prostate inflammation.

The main purpose of a general urine test is to find physical and chemical changes in the structure and color of the samples taken. In laboratory studies, attention is paid to the following factors:

Appearance. Changes in odor, color, and the appearance of foreign inclusions are taken into account.
Physico-chemical properties. Normally, the acidity of urine is 5-7 pH; exceeding these values indicates prostatitis or other inflammation. Determining density helps to exclude diseases with similar symptoms.

A general urine test cannot show complete information about the patient’s health status and the presence of inflammatory processes in the genitourinary system, so a biochemical urine test is additionally performed. During the latter, the number of red blood cells, protein, leukocytes, and oxalates is determined. Indicators can indicate obstructive processes in the male body, help detect cancer, acute, calculous, and infectious inflammation of the prostate.

Laboratory diagnostics

Using laboratory research methods used today, it is possible to detect infection of the prostate with atypical, nonspecific fungal or bacterial flora, or viruses. The disease is diagnosed if the prostate secretion or the fourth urine sample contains pathogenic microbes or more than 10 leukocytes in the field of view. If during diagnosis no bacterial growth was detected with an increased number of leukocytes, it is necessary to conduct a study for chlamydia and other STIs. Laboratory diagnosis of chronic prostatitis includes the following methods:

During a microscopic examination of the secretion discharged from the urethra, the number of leukocytes, trichomonas, connective tissue cells, gonococci, the volume of mucus, and nonspecific flora is determined.
Examination of a scraping of the urethral mucosa using the PCR technique helps determine the presence of bacteria that cause sexually transmitted diseases.
Using a microscopic examination of prostate secretion, the volume of leukocytes, amyloid bodies, macrophages, lecithin granules, Trousseau-Lallemand bodies and macrophages is determined.
Bacteriological examination of secretions obtained through prostate massage helps determine the nature of the pathology (abacterial or infectious prostatitis). The disease can stimulate an increase in PSA concentrations. Blood sampling to determine PSA concentration is carried out no earlier than 10 days after a digital rectal examination. If the PSA concentration is more than 4 ng/ml, the patient is indicated for a number of additional studies, including a prostate biopsy to exclude cancer.
Study of the immune status (state of humoral cellular immunity) and the amount of nonspecific antibodies in the prostate secretion, including IgA, IgG, IgM. This diagnostic method helps determine the stage of the inflammatory process and monitor the effectiveness of drug treatment.

If the pathology is bacterial in nature, antibiotics are required. The doctor prescribes the drug based on bacterial culture data of prostate secretions, which not only determines the type of pathogen, but also its sensitivity to medications. If during the examination it was revealed that the disease is of non-infectious origin, a short course of antibiotics is prescribed.

If the dynamics of changes in the patient’s body are favorable, antibacterial treatment is continued. This suggests that the bacterial agent was simply not detected or its diagnosis was not carried out. Additionally, histological examination of prostate biopsies can be used as the most accurate diagnostic method.

Instrumental diagnostic methods

There are several basic diagnostic techniques for signs of prostate inflammation. Each instrumental method provides information about changes in the structure of glandular tissue and has indications and contraindications:

TRUSY. Transrectal ultrasound accurately indicates the presence of an inflammatory process. Sonographic signs of structural changes in the prostate gland include deviations from the norm in size and volume, and the presence of neoplasms. The study helps to differentiate the pathology, determine the type of prostatitis, its stage. TRUS is not prescribed for constipation, acute inflammation of the rectum, hemorrhoids, or the presence of anal fissures.
Tomography. MRI provides the opportunity to obtain a layer-by-layer image of the prostate. The study is carried out for differential diagnosis with prostate cancer, if a non-inflammatory form of non-infectious inflammation is suspected, when it is important to exclude the possibility of pathological changes in the spine and pelvic organs. MRI is an absolutely harmless method, but has contraindications due to the inability to examine patients with pacemakers, metal shunts and staples (left in during surgery).
Ultrasound. This technique has no contraindications, but is less informative compared to TRUS or MRI. Sonographic features make it difficult to accurately determine space abdominal cavity, therefore, the results of such diagnostics are controversial and often require clarification. Ultrasound is used because of its simplicity and speed.
UDI. Determination of the urethral pressure profile, flow study, cystometry, myography of the pelvic floor muscle tissues help to obtain additional data if neurogenic urination disorders or dysfunction of the pelvic floor muscles are suspected. During the examination, pressure sensors are placed at the level of the pubic joint, which take the necessary readings.

Why is chronic prostatitis dangerous?

When making a diagnosis, the doctor takes into account the presence of prostatic intraepithelial neoplasia (the proliferation of fibrous tissue, which is a harbinger of oncology). Advanced disease often leads to the need for surgery– prostatectomy. The consequences of pathology in men are disorders of the functioning of the genitourinary system, including:

impotence (erectile dysfunction, lack of attraction to the opposite sex);
infertility (deterioration in sperm quality);
acute urinary retention (in severe cases, it may be necessary to install a catheter with a urine collector to remove urine);
renal failure;
urolithiasis;
benign hyperplasia prostate gland (adenoma)

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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The development of inflammation of the prostate gland is caused by both the penetration of pathogenic microorganisms into its tissue and an incorrect lifestyle. The latter reason is more common, although there is a relationship between both factors. After all, infectious pathogens attack the body precisely when it is more weakened.

Prostatitis is considered the most common problem in male urology. Sometimes the cause of the disease lies in the organ itself, but often changes occur due to the influence of certain factors. Here are some of them:

General symptoms

The prerequisite for the appearance of the disease is the inflammatory process occurring in the excretory ducts. As a result, mucus and small stones accumulate in the canals, which begin to fester. The man begins to experience pain. Sometimes the signs of prostatitis are barely noticeable or insignificant early stage.

The course of the disease is different for all men. Some patients early stages felt only mild discomfort in the lower abdomen and perineum. In most cases, the symptoms of the disease are characterized by the following manifestations:

Difficulty urinating, as the enlarged prostate puts pressure on the excretory ducts.

Frequent urge, feeling of incomplete emptying of the bladder.

Sexual disorder, resulting in impaired erectile function.
Urine contains white flakes and pus.
Discomfort during bowel movements.
Cutting pain when urinating.

Symptoms will vary depending on the form of the disease. Inflammation of the prostate gland can have an acute and chronic course.

For the acute form, general symptoms are typical. The patient feels weakness and pain in the groin, especially during urination. The urge to go to the toilet is frequent and difficult. At the same time, the temperature rises. Cases of early detection of the disease are very rare, so it quickly becomes protracted.

The chronic form often occurs without pronounced symptoms. The pathology causes discomfort in the perineum and lower back, and pain during urination is weak and passes quickly. There are problems in sexual life: untimely ejaculation, decreased libido. Such changes in the body seem erased, and few people attach importance to them. But if you ignore these symptoms, the disease progresses and leads to complications: cystitis, vesiculitis, infertility, impotence.

As a result of inflammation, the nerve endings are irritated, which is why the patient urinates in small portions even at night. Complete urinary retention is rarely observed. Such a manifestation should be alarming; you should immediately consult a doctor. After all, he will be the one who will be able to correctly diagnose the disease and select treatment.

The consequences are irreversible, since the listed symptoms may be caused by diseases such as adenoma or prostate cancer.

Stages of prostatitis and their signs

Sometimes the pathology is very difficult to recognize because it does not manifest itself in any way. And the transition to different stages makes the disease more or less noticeable. There are three stages of prostatitis in men, which have a unique character:

Stages	Characteristic	Symptoms
First	Inflammation in the prostate gland is just beginning and at the same time regeneration of its tissues occurs.	1. The pressure of the urine stream is weakened. 2. Discharge appears from the urethra. 3. Discomfort in the anus. 4. Pain in the perineum and testicles. 5. Erection decreases.
Second	Symptoms of inflammation become less pronounced than at the beginning. Patients mistakenly conclude that the disease has subsided. The structure of the prostate changes as scars appear on it.	1. Erectile function is impaired. 2. Irritability. 3. Fatigue. 4. Concomitant diseases appear: radiculitis, vegetative-vascular dystonia, heart failure.
Third	The scars that appear increase, the soft tissue of the prostate gland changes or necrosis occurs. The bladder is compressed.	1. Frequent and unbearable urge to urinate due to severe pain. 2. Even after using the toilet there is a feeling of a full bladder.

The initial stage of prostatitis development has the following symptoms: weak urine pressure, decreased libido, discomfort in the groin and during ejaculation. This stage can last for several years. The acute course of the disease is characterized by four phases of clinical development:

Catarrhal. The mucous membrane of the male organ is enlarged, painful and swollen.

Its excretory ducts change.

Follicular. The walls of the ducts swell, which leads to stagnation of mucopurulent secretion.

In the prostate follicle, lobules suppurate and the ducts become clogged.

Parenchymatous. Small pustules form into a prostate abscess.

The source of infection becomes a source of intoxication for the entire body.

Abscessing. The resulting abscess spreads, affecting neighboring organs.

Inflammation of the posterior urethra occurs.

The course of the follicular and parenchymal forms is accompanied by modifications of the bladder neck and the posterior part of the urethra.

Urologists distinguish only two stages of chronic prostatitis: exacerbation and remission, but this does not diminish their significance. The occurrence of relapses is explained by the fact that the acute form of the pathology was advanced, the man did not start treatment on time, or it was chosen incorrectly.

During periods of exacerbation, the disease has pronounced symptoms: severe pain in the paired organs, fever, discharge from the urethra in the morning, often problematic deurination, increased fatigue and sweating, wrinkling of the unpaired gland. In this case, supervision by the attending physician is mandatory.

When the remission phase begins, the patient experiences improvements. Symptoms either disappear completely or partially. Usually this stage The chronic course of the pathology does not require special therapy.

Sometimes patients stop treatment due to the latent course of the disease, since nothing bothers them. But after some time, the problem may return again, so during remission you still need a regular visit to the doctor and a set of preventive actions.

Making a diagnosis

To correctly establish the diagnosis, the urologist examines the clinical picture. Characteristic signs pathologies simplify the definition of both acute and chronic forms. In case of suspicious symptoms, an examination of the prostate through the rectum is required. Thanks to palpation, the doctor determines the pain, consistency of the prostate gland and its symmetry.

The collection of secretions from the prostatic gland is being studied. This helps detect low lecithin levels. A general analysis of urine and blood in the acute form should show a high content of leukocytes.

When there is a need to identify structural changes (tumors, metastases, cysts, adenoma), a transrectal (through the rectum) ultrasound is performed, and in case of pain, transabdominal (through the abdomen). Such an examination helps confirm the conclusion and see if there is another pathology of the urinary system with similar symptoms. This diagnostic method will show the size of the organ, whether its structure is homogeneous, and whether there are any stones. In addition to other research techniques, when planning surgical treatment, some doctors consider it advisable to conduct MRI.

The doctor must find out from the patient how long the pain lasts. If three months or more, the pathology has entered the chronic stage. Additional research into the changes occurring in the male gland will help an experienced specialist see a clear clinical picture and treat the patient with an effective remedy.

Features of therapy

Treatment of the initial stage of prostatitis gives good results and prognosis. The patient has a good chance of recovery. Thanks to a set of laboratory tests, the cause and degree of development of the disease becomes clear. If the inflammation is caused by an infection, antibiotics are prescribed. For effectiveness, a culture is first done to test the sensitivity of the microflora to therapeutic agents.

For a congestive illness, medications are recommended that improve blood circulation in the male pelvic region. In addition to the main treatment at the initial stage of inflammation, physiotherapy and prostate massages are used to increase the tone of its muscles.

Sometimes therapy includes a complex of painkillers, antispasmodics, and diuretics. Their use is recommended based on symptoms. Thanks to the therapeutic effects of soothing herbs, you can quickly achieve the expected results.

Traditional medicines are considered highly effective. To restore men's health, it is recommended to include a list of following products: pumpkin seeds, parsley, cabbage, asparagus, propolis.

Treatment of the chronic stage takes longer and is more difficult, especially when the causes of the disease are not so obvious. Often bacteria from the urinary tract enter the prostate during urethritis. The process does not have an exact picture; it develops barely noticeably. Therefore, therapy should focus on the primary infection.

In chronic cases, the patient should be treated in close collaboration with the doctor. In most cases, therapy is similar to the initial stage of the disease. The treatment regimen is often complex, which may include: antibacterial, antispasmodic, vasodilator, immunostimulating agents.

Possible consequences

With improper treatment or its absence for a long time, undesirable consequences are inevitable. The function of the prostate is aimed at producing the necessary secretion that is part of sperm. Due to inflammation, the prostate gland increases in size, the urethra and seminal ducts are compressed, blood flow is disrupted, and sperm characteristics deteriorate. The consequence of prostatitis can be: problems in sexual life up to impotence, dysuric syndrome, infertility.

After an acute course, the risk of a purulent abscess, which is removed by surgery, increases. Chronic disease will also leave its mark on the body. In this situation, the consequence may be loss of organ functionality, which leads to its sclerosis, the development of cystitis or pyelonephritis, prostate adenoma.

Prevention

As research progresses, scientists conclude that the exact cause of the pathology is unknown. Perhaps heredity and hormonal processes play a role. Fortunately, two risk factors - poor diet and lack of physical activity - are within everyone's control. Moderate body exercises increase blood circulation in the pelvis, which prevents congestion.

A man needs to make changes in his lifestyle. The consumption of spices, smoked meats, alcoholic beverages and foods high in carbohydrates and animal fats should be reduced. Such food tends not only to irritate the mucous membrane of the genitourinary system, but also to slow down blood circulation in the urinary area. Abstaining from beer leads to a full-fledged sex life, since the intoxicating drink contains phytoestrogen, which suppresses sexual function. You need to enrich your daily menu with vegetables, fruits, legumes, cereals, pasta, and herbal teas.

A preventive examination can sometimes save a life. An annual urological examination helps to identify not only prostate adenoma at an early stage, but also prostatitis, which will allow the use of more gentle methods of therapy. An orderly sex life protects a man from sexually transmitted diseases, which can also cause of this disease.

Chronic prostatitis is a long-term inflammatory process in the tissues of the prostate gland. Inflammation in chronic prostatitis persists for at least 3 months. In this case, the functioning of the prostate is disrupted. Chronic prostatitis refers to abacterial prostatitis. Therefore, it is quite difficult to identify the main causes of this disease. Urologists say that chronic prostatitis can hide a number of pathological processes, abnormalities, and diseases. The functions of not only the prostate gland, but also all organs of the young man’s genitourinary system, bladder, urinary system, and other organs may be impaired.

Classification of the disease

Chronic prostatitis ranks first among all types of prostatitis. In addition, inflammation of the prostate gland is the most common urological disease in men. Statistics say that on average 50% of men suffer from some form of inflammation. In this case, chronic prostatitis is typical for men aged 20-40 years. This is precisely the period when maximum sexual, social, and labor activity of the stronger sex is observed. By the age of 75, 40% of men suffer from a chronic or acute form of prostate inflammation.

Speaking of classification, it is worth dividing inflammation of the prostate into several forms. So, acute prostatitis is popular. Further, the most common is chronic prostatitis of a bacterial nature. Non-bacterial chronic prostatitis occurs regardless of the presence of bacteria and infection in the body. This form of the disease lasts from 3 months or more.

Non-bacterial chronic prostatitis, in turn, is divided into 2 types:

A - the presence of an inflammatory component is diagnosed. Thus, a large number of leukocytes and infectious agents are detected in the prostate secretion.
B - the inflammatory component is not detected. There are no leukocytes or infectious agents in the prostate secretion.

Urologists often diagnose asymptomatic chronic prostatitis. In this case, leukocytes are present in the prostate secretion, but there are no symptoms or complaints. Experts note that in 90% of all cases, men are diagnosed with non-bacterial chronic prostatitis. And only 10% of patients are given the bacterial form.

Causes of chronic prostatitis

The causes of bacterial prostatitis are very clear. So, the infection will enter the prostate gland through the urethra and urethra. This is called the upward path. The descending path is characterized by the process of reflux of infected urine from the bladder. The hematogenous route of infection involves damage to the prostate through the bloodstream. The most common pathogens are the following infections and bacteria:

Along with this, chronic prostatitis can develop against the background of the presence of such pathogens: chlamydia, trichomonas, gonococci, gardnerella, mycoplasma. In addition, for the development of chronic prostatitis, the main thing is not so much the presence of pathogenic microflora, but rather the condition and blood circulation in the pelvic organs. Immunity is also important. When the body's defense reactions are poor, bacteria and microbes develop very quickly and are highly active. In such conditions, it is very difficult to cope with the disease.

Among the concomitant diseases that provoke chronic prostatitis, both bacterial and non-bacterial, pyelonephritis, cystitis, acute prostatitis, epididymitis, and orchitis can be distinguished. Sometimes a pathogenic microorganism enters the prostate gland through other foci of the disease. Thus, even sinusitis, caries, bronchitis, tonsillitis, and pneumonia can lead to prostatitis. Urologists note a number of factors that often become the cause of both chronic and strictly prostatitis. These could be:

Hypothermia;
Irregular sex life;
Sedentary lifestyle;
Increased fatigue;
Frequent exposure to a humid environment;
Overheating;
Unbalanced diet;
Rare urination.

Chronic prostatitis of a non-bacterial nature is associated with congestive processes in the pelvic organs. Thus, there is a deterioration in blood circulation in the prostate gland, stasis of the venous circulation. Local stagnation provokes overflow of the gland's vessels with blood. Next, swelling develops, incomplete secretion of the prostate secretion, complete disruption of the functioning of the prostate gland (secret, barrier, motor, contractile functions).

Stagnant processes are usually caused by the lifestyle of a young person - prolonged sexual abstinence, interruption of sexual intercourse, prolongation of sexual intercourse, increased sexual activity, sedentary sedentary lifestyle, alcohol and nicotine intoxication, professional activity. Experts also note some pathologies of the pelvic organs and spinal cord injuries. Non-bacterial chronic prostatitis can also be triggered by such ailments as hemorrhoids, constipation, prostate adenoma, and deficiency of the male sex hormone testosterone.

Modern urologists do not exclude neurogenic dysfunction of the pelvic floor muscles, which leads to non-inflammatory, non-bacterial chronic prostatitis. In this case, the patient experiences chronic pelvic pain syndrome. Trigger points are formed, which are located at the places where the muscles attach to the pelvic bones. Impact on these points leads to pain. After all, they are located close to the organs of the genitourinary system. These points occur against the background of many diseases, operations, and injuries to the genital organs.

Symptoms of chronic prostatitis

Symptoms of chronic prostatitis can be local and general. For any type of symptomatology, the prostatic triad is characteristic: impaired sexual activity, dysuria, pain. In the case of chronic prostatitis, the pain is constant and aching. The locations of pain syndrome are the following areas:

Crotch;
Testicles;
Pubic area;
Genitals.

The pain always intensifies during urination. Unpleasant sensations can radiate to the head of the penis, rectum, scrotum, and lower back. Also, pain syndrome actively manifests itself during sexual intercourse, with prolonged erection and arousal. Peak intensity is reached during ejaculation and orgasm. Chronic prostatitis is characterized by both mild and severe excessive pain. The syndrome often leads to disruption of sleep and performance. Quite often, men regard lower back pain as manifestations of osteochondrosis or radiculitis. In this regard, chronic prostatitis is not treated, it turns into a severe advanced form, which leads to serious consequences.

Chronic prostatitis is characterized by such symptoms as painful and frequent urination. So, the presence of inflammation of the prostate gland can be indicated by the urge to go to the toilet more than 2 times a night. Men complain of a burning sensation in the urethra and incomplete emptying of the bladder. With chronic prostatitis, floating threads may be visible in the urine. Due to decreased prostate tone, after physical activity, defecation, secretion from the urethra is observed. In severe cases of chronic prostatitis, pain is also observed during defecation.

Sometimes patients with this diagnosis are also diagnosed with the following symptoms:

Itching of the perineum;
Increased sweating, feeling of cold in the perineum;
Change in skin color of the genital organs;
Red, purple color of the penis.

The chronic form of prostatitis is always characterized by disturbances in the sexual function of men. Patients complain of decreased libido, lost orgasm, prolonged painful night erections, early ejaculation, lack of ejaculation, weak erection. Among the complications, experts note aspermia, male infertility. Any disorders in the intimate sphere of life always affect the psycho-emotional background of a young person. Thus, depression and neuroses bring even greater discord into family relationships.

The acute stage of chronic prostatitis is accompanied by a deterioration in the general well-being of the stronger sex and an increase in body temperature. Thus, anxiety, irritability, nervousness, and fatigue increase. You can also experience loss of appetite, insomnia, and decreased physical activity. If you do not treat any form of prostatitis, including chronic, the risk of developing severe complications increases: urinary incontinence, impotence, formation of prostate cysts, vesiculitis, prostate sclerosis, adenoma, prostate cancer.

Diagnosis of chronic prostatitis

Before starting treatment for the disease, it is worth conducting a comprehensive diagnosis. For this purpose, laboratory tests are carried out. A qualified specialist will be able to make a preliminary diagnosis using a simple survey. To confirm the diagnosis, instrumental diagnostics are prescribed. So, the doctor begins collecting anamnesis by examining the genitals to identify external changes in the skin, rashes, and discharge from the urethra.

A prerequisite for diagnosing chronic prostatitis is a rectal digital examination. During palpation, the doctor determines the boundaries of the prostate, its contours, structure, and consistency. Also, this method allows you to recognize possible neoplasms and cysts. When pressing on the gland, the patient often feels severe pain, which also indicates the presence of prostatitis.

To recognize many functional changes in the prostate gland, the doctor prescribes an ultrasound examination of the prostate. Ultrasound can be performed rectally or through the skin of the upper abdominal wall. It is the first version of ultrasound examination that has the most information. After all, the location of the gland allows you to examine it completely, with an accurate probability of identifying violations. Transrectal examination of the prostate requires certain preparation of the patient:

Cleanse the intestines several hours before the diagnosis;
Bladder filling;
Refusal to eat a few hours before the diagnosis;
Avoid eating foods that cause bloating and flatulence 1-2 days before the ultrasound.

If the doctor decides to perform an ultrasound through the anterior wall of the abdomen, it is enough to simply fill the bladder. It is very important to carry out other laboratory tests. Thus, analysis of prostate secretions, general urine analysis, analysis of a smear from the urethra, a three-cup urine sample, bacterial culture of a smear from the urethra, diagnosis of scrapings for the presence of sexually transmitted infections, and identification of prostate-specific antigen will have high information content.

Every doctor must examine scrapings from the urethra for the presence of sexually transmitted diseases such as chlamydia, gonorrhea, trichomoniasis, herpes, candidiasis, mycoplasmosis, and syphilis. The presence of microflora also plays an important role. Prostate secretions are taken for analysis after emptying the bladder and performing a light prostate massage. So, when you press on the gland, prostate secretion will be released.

Chronic prostatitis will be indicated by the detection of a large number of leukocytes in the analysis, a decrease in the level of lecithin grains, and the presence of pathogenic microflora. It can be determined using the following studies: cystometry, uroflowmetry, profilometry. These methods for diagnosing chronic prostatitis make it possible to differentiate the disease from stress incontinence (enuresis).

Self-diagnosis

Every man can suspect prostatitis. There are also home methods for diagnosing this disease. So, all the symptoms indicate the presence of chronic prostatitis. There is also a home research method. The man must defecate into three different transparent containers. If the urine in the first and third containers is different in color, then there is cause for concern. Cloudy urine is also considered abnormal. If there is cloudy liquid in two containers, there is a possibility of prostatitis. If cloudy urine is in only one container, some kind of inflammatory process is taking place.

Treatment of chronic prostatitis

It is worth noting that chronic prostatitis is quite difficult to treat. But still, a cure is possible. Everything depends entirely on the man’s mood and on following all the doctor’s recommendations. Bacterial chronic prostatitis requires the use of antimicrobial therapy. As a rule, treatment of chronic prostatitis involves a combination of several drugs. Antibiotics are required to treat infectious prostatitis. Yes, it is eliminated sexually transmitted infection, inflammation of the prostate gland is relieved.

Most often, for chronic prostatitis, doctors prescribe the following medications:

Ofloxacin;
Ciprofloxacin;
Azithromycin;
Vilprafen;
Sumamed;
Ceftriaxone;
Furamag;
Sulbactomax;
Amoxiclav.

These drugs can be produced in the form of either tablets or powder for injection. The course of therapy lasts an average of 14 days. For the treatment of chronic or acute prostatitis, it is better to use the injection form intramuscularly or intravenously. To eliminate pain, experts prescribe painkillers and anti-inflammatory drugs: Diclofenac, Naproxen, Ibuprofen, Piroxicam. To relax the muscles of the prostate gland, restore normal urodynamics, and outflow of prostate secretions, alpha-blockers must be used: Dalfaz, Omnic.

These drugs form the mandatory basis for the treatment of chronic prostatitis. Doctors often recommend that patients undergo prostate massage. This will improve blood circulation in the gland and give tone. Each massage session ends with a slight discharge of secretion from the urethra. As a rule, this is only 3-5 drops of liquid. But, there are a number of factors that prohibit massage: hemorrhoids, acute bacterial prostatitis, gland stones, gland abscess, fissures in the rectum, prostate cancer.

Speaking about non-drug therapy for chronic prostatitis, experts recommend resorting to acupuncture and paraprostatic blockade. Very important point during treatment, physiotherapy in combination with medicinal electrophoresis, ultraphonophoresis. Also, ultrasound, magnetic therapy, laser magnetic therapy, mud therapy, inductometry, hot sitz baths (45 degrees), hydrogen sulfide enemas are prescribed.

Rectal suppositories for chronic prostatitis are highly effective. Very often, suppositories based on tetracyclines, penicillins, and rifampicin are chosen to combat inflammation of the prostate gland. Also, suppositories are antibacterial, analgesic, antimicrobial, decongestant, anti-inflammatory. Suppositories consisting of natural ingredients are very popular. They do not have any systemic effect on the male body. But, any drug is selected only by a doctor, taking into account the individual characteristics of the young man’s body and the course of chronic prostatitis. So, the choice is made from the following list of rectal suppositories against prostatitis:

Vitaprost;
Prostatilen;
Voltaren;
Indomethacin suppositories;
Ichthyol candles;
Longidaza;
Sea buckthorn suppositories;
Genferon;
Dicloberl;
Tykveol;
Viferon;
Bioprost.

In case of complications from chronic prostatitis, surgery may be necessary. Surgery is required to remove urethral strictures. The patient is prescribed prostatectomy for prostate sclerosis. Patients often require resection of the bladder in case of sclerosis of the bladder neck. The presence of cysts and neoplasms necessarily requires surgical intervention.

Disease prevention

To maintain normal functioning of the prostate during chronic prostatitis, it is very important to follow preventive measures. To begin with, a man must carefully monitor his intimate hygiene. This is the only way to prevent bacteria from entering the genitourinary system from the outside. Chronic prostatitis implies periodic relapses. And here it is important to consult a doctor in a timely manner. Thus, the manifestations of the disease will not be acute, without disturbing the usual rhythm of a man’s life.

To avoid stagnation in the prostate, regular sexual intercourse is important. Also, you should not lead an overly active sex life. Experts define the concept of regular sex as 2-4 times a week. This best option to restore the male body, improve the quality of sperm and prostate secretion. Regular but moderate physical activity will also help avoid relapses of stagnant processes.

It is important to prevent the development of constipation. Therefore, a balanced diet for chronic prostatitis is the main condition. So, the diet of young people should consist of the following products:

Lean meats;
Green;
Cauliflower;
Pumpkin;
Carrot;
Melon;
Watermelon;
Green peas;
Vegetable soups, light meat broths;
Brown bread;
Dried fruits.

For the prevention of chronic prostatitis, a microelement such as zinc plays an important role. In this regard, doctors recommend that men eat more seafood, pumpkin seeds, beef, and nuts. A sufficient amount of zinc is also found in chicken eggs. But, use this product No more than one egg per day is allowed. Speaking of drinks, it is useful to drink fruit drinks, dried fruit compotes, and purified non-carbonated water.

In case of chronic prostatitis, it is important to completely exclude from the diet foods that irritate the prostate gland. These include alcohol, large amounts of salt and spicy foods, smoked foods, animal fat, offal, canned food, marinades, vinegar, radishes, radishes, herbs, spices, seasonings, mushrooms and mushroom broths, sorrel, spinach, strong tea and coffee, large amount of sweets, pastries, chocolate. Various synthetic products are also harmful. food additives— dyes, emulsifiers, stabilizers.

Urologists and andrologists recommend regular examinations and physical therapy. Periodic preventive courses of physiotherapy will help not only to avoid the re-development of chronic prostatitis, but also to completely cure the disease. Taking multivitamin complexes and immunomodulators will strengthen the immune system. It is important to exclude stressful situations, overheating, hypothermia, a sedentary lifestyle, and bad habits. In general, chronic prostatitis is curable; you just need to follow all the recommendations of a qualified specialist.

Prostatitis is an inflammatory disease of the prostate gland. Its most common form is chronic prostatitis. Almost a third of men of reproductive age suffer from inflammation of the prostate, and 90% of them face a chronic course. Unlike the acute form, this pathology is characterized by a long-term, over 3 months, manifestation of relatively mild symptoms. Despite its significant prevalence, chronic prostatitis has not been studied enough and is difficult to treat.

Classification and reasons

There are several approaches to classifying forms of prostatitis. According to one of them, according to the causal factor, the following options are distinguished:
infectious – bacterial, viral, fungal;
stagnant (congestive) – caused by venous stagnation in the pelvic and scrotal organs, stagnation of prostatic secretion/ejaculate caused by the lack of regular sexual activity, etc.

According to the route of spread, prostatitis is classified into:
hematogenous - with the introduction of infection through the blood from infectious foci in the corresponding diseases;
arising from contact - urinogenic with the spread of infection ascending in patients with urethritis, with urethral strictures and descending in patients with renal diseases, canalicular - against the background of funiculitis (inflammation of the spermatic cord), orchiepididymitis (inflammation of the testicle with the epididymis), etc.;
arising through the lymphogenous route - when infection penetrates through the lymphatic vessels from neighboring organs (for example, with thrombophlebitis of hemorrhoidal veins, proctitis, etc.).
urethroprostatic reflux, in which urethral contents and/or urine flow into the prostate.

The most widespread classification of forms of prostatitis abroad is National Institute US health, distinguishing categories:
I – acute;
II - chronic bacterial;
III - chronic abacterial
inflammatory chronic pelvic pain syndrome;
non-inflammatory chronic pelvic pain syndrome (otherwise known as prostatodynia);
IV - asymptomatic inflammatory.

The cause of the chronic bacterial form is most often bacteria: mainly Escherichia coli, then Proteus, Enterobacteriaceae, Klebsiella, Pseudomonas. Staphylococci, streptococci and enterococci are rarely the causative agents of the disease. In approximately 20% of cases, the infection is mixed - provoked by two or more microorganisms.

It has not been reliably established whether pathogens of sexually transmitted infections can be a direct cause of prostatitis, although it is known that their presence is a risk factor for the development of inflammation of the gland. Modern studies have confirmed the relationship between the chronic form of the disease and infection with ureaplasma, chlamydia, and trichomonas.

The following factors predispose to the development of chronic pathology:
Congestion directly in the gland or in the pelvis, provoking disturbances in blood microcirculation and accompanied by a local increase in temperature, disruption of the supply of necessary substances to the tissues (favorable conditions for the proliferation of pathogenic microorganisms). Such problems can be caused by insufficient physical activity, alcohol abuse, smoking, hemorrhoids, varicose veins of the legs, etc.
Damage to the antimicrobial urethral barrier (for example, when chlamydia, gonococci affect the urethral mucosa).
Hormonal changes when low testosterone levels cause a decrease in the formation of prostate secretions and a weakening of the antimicrobial functions of the organ.

With the development of chronic prostatitis, the protective function of the gland is disrupted, creating a permanent source of infection. That is why this pathology is often accompanied by complications such as epididymitis, vesiculitis (inflammation of the seminal vesicles), paraproctitis, etc.

Also, chronic prostatitis is often combined with stones in the prostate gland (so-called calculous prostatitis). Such formations themselves may contain infectious agents and maintain chronic inflammation. In addition, the presence of stones injures the gland tissue and interferes with the movement of biological fluids.
At the same time, modern studies have not revealed a connection between this disease and prostate cancer.

Symptoms

Manifestations of chronic prostatitis are very diverse and can differ markedly in different patients (and in some patients, signs may be completely absent, and the inflammatory process is detected by chance during urological examination). There are no complaints specific to this pathology. The disease is characterized by periods of calm and exacerbation of symptoms.

It is customary to divide symptoms into several groups.

Pain syndrome

The cause of pain in chronic prostatitis is a violation of the blood supply to the prostate gland, as a result of which substances that act on the nerve endings are formed. Patients may complain of:
feeling of heaviness, pressure in the perineum;
sensations of burning, stinging and itching in the urethra (such sensations, especially noticeable after urination or sexual intercourse, are caused by the acidic reaction of prostatic secretions);
pain of varying intensity, discomfort (torsion sensations, aches, etc.) in the perineum, rectum, testicles;
increased pain after physical activity, sexual intercourse, or alcohol abuse.

Urinary dysfunction syndrome

This syndrome includes:
increased and painful urge to urinate;
partial urinary retention;
uncontrollable uncontrollable urge to urinate in small portions;
feeling of incomplete emptying of the bladder;
lack of fullness, intermittent flow;
completion of urination by releasing a drop of urine, etc.

Sexual dysfunction syndrome

In chronic prostatitis, inflammation of the seminal tubercle (colliculitis) may develop, causing sexual dysfunction, which manifests itself:
pain in the urethra, rectum during ejaculation;
premature ejaculation or excessive prolongation of the act;
weak erection;
erasure or loss of orgasm.
The disease also leads to a deterioration in the quality of sperm, which negatively affects reproductive function (death of sperm due to increased acidity of the environment, gluing of sperm, decreased number of motile ones, etc.).

Violations by nervous system include neurotic disorders caused by the patient’s fixation on his illness.
The bacterial form of chronic prostatitis is mainly manifested by pain, difficulty urinating, premature ejaculation and the appearance of blood in the semen. This form may be accompanied by the development of urethritis (urethroprostatitis), for which small purulent mucous discharge is typical.

In the abacterial form, pelvic pain is prolonged, and standard examination methods do not allow identifying the causative agent of the disease. In the inflammatory subtype, tests of urine, semen, and prostate secretions reveal an increased number of leukocytes; pelvic pain is combined with impaired urination. The non-inflammatory variant (previously called “congestive prostatitis”) is manifested by pelvic pain, rare problems with urination, and the absence of signs of inflammation in tests.
Sometimes, in the presence of laboratory signs of inflammation, there are no symptoms. Then they talk about inflammatory asymptomatic prostatitis.

Diagnostics

The diagnosis begins with a clinical examination - a rectal examination of the prostate with an assessment of the size, shape, consistency, contours of the gland, the presence of lumps, pain, etc.

Laboratory tests include detection of white blood cells in prostate secretions and a third urine sample in the Meares-Stamey four-glass test. Laboratory detection of an infectious agent using PCR and bacterial culture methods can be useful for selecting medications.

Ultrasound allows you to suspect an inflammatory process in the prostate by unevenness and blurred contours, an increase in volume, the presence of formations, etc.
In case of relapse of the disease, additional studies are carried out for anatomical abnormalities.

Treatment

The main method of treating chronic prostatitis is long-term, about a month, use of antibiotics together with alpha-blockers. To achieve the treatment effect, it is important to give up alcohol and smoking, optimize your work and rest schedule.

Among drugs with antibacterial activity, preference is given to fluoroquinolone drugs (especially active against chlamydia, gonococci), sulfonamides (trimethoprim-sulfamethoxazole). If there is no effect from taking the tablets, injections (directly into the prostate gland) of doxycycline, gentamicin, etc. may be prescribed. If discontinuation of the antibiotic is accompanied by a relapse of the disease, constant use of low-dose forms is recommended.

Alpha blockers are prescribed for symptomatic treatment: to reduce the tone of the smooth muscles of the prostate gland and bladder. Taking these medications together with antibiotics has been proven to reduce the risk of relapses of chronic bacterial prostatitis.

Additionally, the following may be prescribed:
massage of the prostate gland (not recommended if there are stones in the prostate);
local hyperthermia (tissue heating) transurethral or transrectal;
traditional medicine.

If it is determined that relapses of the disease are due to anatomical features, surgical treatment may be recommended by the presence of prostatic stones.