Prostatitis

Prostatitis is a disease in which the prostate becomes inflamed.Prostatitis, the symptoms of which 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 and symptomatic treatment is carried out.

Prostatitis is not a disease that can be diagnosed by photography, as the disease does not have visible manifestations.To notice the first symptoms in a timely manner, you should listen to your own health.

General description

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

The prostate itself looks like a glandular-muscular organ located next to the bladder.With it, the urination process is controlled, in addition, it is due to the presence of the prostate that a certain secret is released, which makes the sperm liquid.

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, they 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.Therefore, it 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.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 will be diagnosed.Several reasons can explain this form of pathology, although none of them have been proven to date.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 just a part of the existing theories about prostatitis.

Let us dwell 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, by whose influence the chronic form of inflammation is maintained even when there is no doubt of bacterial invasion.

Prostatitis: symptoms

Inflammation is accompanied by pain in prostatitis, in particular, it 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.In addition, microliths are also formed;they look like small stones.Mixing with the epithelium and mucus, they cause the appearance of peculiar plug formations, which, in turn, lead to blockage of the excretory ducts.Over time, these plugs turn into suppuration (or microabscesses), the lobes are no longer subject to drainage, they simply stop working.

However, before the onset of such a phase 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 progresses gradually, the patient may not notice anything special, especially since the production of secretions by the prostate gland does not stop.Another thing is when these microabscesses form, this is accompanied by the appearance of unpleasant symptoms, which manifest themselves in 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 bladder neck sclerosis;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, namely:

• the appearance of a burning sensation in the urethra and perineum;
• persistent and frequent urge to urinate;
• the appearance of discomfort during bowel movements;
• “floating threads” in the urine;
• the appearance of urethral discharge during defecation;
• the appearance of prolonged nocturnal erections;
• intermittent and difficult urination;
• very rapid ejaculation;
• increased general fatigue;
• decreased potency;
• manifestation of orgasm in a muted form;
• expectation of the development of other forms of complications in the area in question, against the backdrop of anxiety and general mental depression.

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

When considering the symptoms, it would be helpful to return to the causes.Naturally, the inflammatory process will not appear “out of nowhere”.We are mainly talking about pathogens, already mentioned above.However, it was this factor that caused the formation of an erroneous idea about the presence of certain agents that cause prostatitis, which is still supported by many experts today.However, there is no specific type of agent that causes 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 gland through the bloodstream, which is characterized by a rather powerful blood supply (otherwise its functionality would be in question).

There is a certain risk group for prostatitis, in particular the following people fall into it:

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

Often men are diagnosed with “abacterial prostatitis”, “prostatitis in the prostatosis phase”.If a man is diagnosed with prostatosis, we can say that at this stage there is nothing to particularly worry about.In the meantime, you will have to make some adjustments to your lifestyle.In other words, what we are talking about here is that the stagnation phenomena discussed above are already occurring, but there is still no inflammation as such, this concerns prostatosis.If an option such as abacterial prostatitis is considered, then here we are already talking about the stage of the beginning of the development of an inflammatory process in men, but so far without concomitant infection.

A distinctive feature of prostatitis is that it practically does not manifest itself in an 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 through treatment of 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 its extremely slow course, the manifestations of symptoms are usually smoothed out.

Prostatitis: consequences

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

Returning to chronic prostatitis, we can say that it is characterized by the undulation of its own course, that is, periodically the symptoms of the chronic form of prostatitis appear with more intensity, and periodically they are practically not felt.Because of this type of change, many patients opt for a wait-and-see approach.However, as indicated above, the inflammatory process can worsen, spreading more and more.When it spreads, even pyelonephritis can develop.Meanwhile, the complications of prostatitis, in most cases, are limited to diseases such as vesiculitis, in which the inflammatory process affects the seminal vesicles, and also orchiepididymitis, in which the testicles and appendages become inflamed.As a result of the transfer of the disease in a similar way to its spread, the development of infertility in men may be indicated.Infertility treatment is a long and complex process and, in some cases, completely impossible.The listed features mainly fall under the development of a chronic form of prostatitis, due to the specific etiology of its occurrence (in particular, we are talking about STDs).

Diagnosis

Examination of patients to identify their specific type of prostate pathology can be performed in several ways.However, in each specific case, an individualized approach to the problem in question is important, from which it is now possible to determine the diagnostic option to obtain sufficient information about the disease.

To begin with, the doctor surveys the patient's complaints, studies the medical history, if any, 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 (that is, this is the specialist you should consult if disturbing symptoms of prostatitis appear) is not definitive and reliable for making a diagnosis, because the first examination is just an opportunity for the doctor to determine what additional diagnostic measures are necessary.

Given the sensitivity of the problem, men are interested in the 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 assesses his own sexual function (that is, are there any changes, what exactly has changed, since what period).Additionally, the doctor will ask what illnesses 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 there are rashes, irritation, discharge, etc.

Then, after an external examination, the doctor moves on to the next step, which is the rectal examination.O exame retal permite determinar os contornos gerais da próstata, sua consistência, limites, etc.

After that, you will need to obtain results of instrumental and laboratory diagnostics.Instrumental diagnostics is called TRUS, which in expanded form means transrectal ultrasound.This is the most accurate method for identifying diseases in a man compared to standard ultrasound.

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

Based on the current classification of prostatitis diagnostic methods, only microscopic examination of the secretion obtained from the prostate, as well as any of the topical diagnostic options that can detect the presence of an inflammatory process in the lower genital tract, can be considered as 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.Furthermore, it is important to remember that, with overdiagnosis, this phase itself prolongs and symptoms only worsen.That is, here, as in any matter, the principle of “golden mean” is appropriate.

Prostatitis treatment

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

In essence, the treatment of prostatitis may contain a number of measures, namely, methods of antibacterial therapy, prostate massage, immunotherapy, physiotherapy and general correction of the patient's lifestyle.Only based on a set of these measures can the desired result be achieved;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 choosing antibacterial drugs is a number of factors, in particular these:

• the ability of the components of the proposed drug to enter prostate secretion and tissue to create a concentration that exceeds the MIC values of the pathogens;
• features of the spectrum of antimicrobial activity (for example, the use of macrolide antibiotics determines the possibility of their good penetration into prostate tissue, although they do not have any activity against gram-negative bacteria, that is, they are the main etiological agents when considering the acute form of prostatitis).

What draws attention is that acute prostatitis, when compared to 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 increased perfusion of the prostate, as well as an increase in the degree of permeability characteristic of the hemoprostatic barrier.Another feature of drugs in this group is that as inflammation decreases, the degree of penetration into the prostate gland decreases.For this reason, it is recommended to switch to another type of oral medication.

prostate massage

In most cases, 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;
• increased penetration of antibiotics used into glandular tissue;
• the possibility of activating microorganisms that are in an inactive state, enhancing the results of the commercialization of antibacterial medicines.

How is prostate massage performed?To begin with, it is of course important to establish a certain amount of trust between the doctor and the patient;This will ensure greater relaxation for the patient, which, in turn, will allow the necessary manipulations to be carried out with minimal pain and maximum efficiency.When preparing for a massage, the patient leans forward, spreading their legs about 60 cm wide and supporting themselves on the examination table with their elbows.The doctor puts on gloves and applies a gel to the index finger (sometimes this gel has an analgesic effect).Then, with his free hand, he opens the buttocks to a width that allows the anal sphincter to be palpated with his index finger.The natural reaction to this contact is muscle contraction.Then, after relaxing them, the index finger is inserted into the ampulla of the rectum.

In some cases, patients experience dizziness and even fainting during these manipulations (on average in 10% of cases).These manifestations are mainly caused by excessive fear, shame and anxiety and, if the massage is performed correctly, do not accompany it in any way.A massage can be considered 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 massage according to the Manila Protocol.In this case, the massage is carried out three times a week, a study of microbiological dynamics is also carried out and antibiotics are taken.

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 state of the immune system cannot be ruled out.Treatment of prostatitis requires not only eliminating the infection from the gland and, in fact, inflammation, but also preventing the further development of inflammation in it.However, like other areas of treatment, immunotherapy should not be reduced to self-medication or treatment based on the recommendations of a pharmacist in a pharmacy;here you will need to consult an immunologist and also, most likely, take 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 implementing antibacterial therapy measures.Physiotherapy can use ultrasonic waves, electromagnetic waves, laser therapy, increasing the temperature directly in the rectum, etc.If there are no opportunities for physical therapy, your doctor may recommend microenemas with warm water and certain 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 predisposing 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 wake/sleep hours, nutritious and balanced eating, walking, eliminating bad habits.

If symptoms indicating prostatitis appear, you should consult a urologist.