Chronic prostatitis is an inflammatory disease characterized by damage to the prostate gland and severe urodynamic disorders. One of the causes of chronic inflammation of the prostate is improper or untimely treatment in the acute stage, when the desquamation and proliferation of the glandular epithelium returns and is successfully corrected with medication within 2-3 weeks.
Treatment of chronic prostatitis includes mass antibiotic therapy aimed at eliminating the infectious agent, a number of measures to increase the body's immune resistance, physiotherapy and heat therapy. Psychocorrection can also be included in the therapy regimen, as cases such as neurasthenic and neurosis are often observed in men with long-term and recurrent prostatitis.
Why does inflammation become chronic?
It is necessary to know the causes of chronic prostatitis, to prevent exacerbations and to improve the quality of life of patients. There are a number of factors that can affect the functional state of the prostate gland (glandular) tissue and cause inflammation based on the desquamation and proliferation of epithelial cells.
The main cause of chronic prostatitis in men is extensive contamination of the mucous membrane of the genitourinary system by pathogenic microorganisms. In most cases of infectious prostatitis (more than 80%) gram-negative and gram-positive bacteria become the cause of infection: enterobacteria (especially Escherichia coli), gonococci, staphylococci. Less infectious and inflammatory processes continue against the background of infection with viruses, fungi and protozoa, but such forms of prostatitis are treated quite successfully in the acute period and rarely recur with proper and timely therapy.
It should also be noted that a single acute urinary tract infection is sufficient for the development of chronic aseptic prostatitis, so personal hygiene, condom use during sex and timely treatment of urinary tract diseases are important in the prevention of this disease in men. bears. Medicine is aware of cases of hematogenous (systemic circulatory) infection of the prostate in chronic sinusitis, tonsillitis and other diseases that contribute to the active growth of pathogenic flora, so the rehabilitation of chronic infections is an important step in the complex treatment of chronic or prolonged inflammation of the prostate.
Adverse factors that may exacerbate prostatitis (including non-infectious course):
- urinary tract damage and surgery on the genitourinary system;
- regular or severe hypothermia of the pelvic organs (swimming in open water, working in refrigerators and freezers, etc. when the water is not hot enough or the air is cool outside);
- Hypodynamics caused by sedentary work and insufficient physical activity of a man (sedentary lifestyle is one of the main factors in the development of chronic cognitive prostatitis);
- bad habits that slow down or disrupt the absorption of the most important macro- and micronutrients that determine the chemical composition and rheological properties of prostate secretions (zinc, chromium, selenium, manganese);
- disorders of the intimate sphere (frequent masturbation, irregular sexual intercourse, prolonged abstinence, frequent arousal that does not end with sexual intercourse);
- overweight;
- eating disorder (increased consumption of spicy, very salty, smoked and fatty foods).
Attention! Urologists note that the pathogenetic factor in the development of chronic inflammation of the prostate gland is posterior urethritis. In men, inflammatory changes in the prostate have been reported in the first months after gonorrheal infection.
Drug treatment of chronic prostatitis
Drug treatment of chronic prostatitis is aimed only at suppressing acute symptoms and eradicating the infection during exacerbation, but drugs can not be used as the only remedy (according to Dr. Pechersky, the effectiveness of such treatment will not exceed 36%).
A complete drug treatment regimen for chronic or recurrent prostatitis, which is used as standard today in uncomplicated diseases, is presented in the table below.
Table. Preparation for the complex treatment of chronic prostatitis.
| Pharmacology group | Purpose of application |
|---|---|
| Macrolides with a broad spectrum of antibacterial activity, semi-synthetic penicillins and antibiotics from the group of third-generation cephalosporins. | Destruction (destruction) of pathogenic bacteria - infectious prostatitis, urethritis, cystitis and other urinary tract infections. |
| Antimicrobial and antiprotozoal substances. | Treatment of infections caused by pathogenic microbes and protozoa. |
| Non-steroidal anti-inflammatory drugs (preferably in the form of rectal suppositories). | Reduces inflammation in prostate tissues, relieves pain in the perineum, intergluteal space, sacrum and groin. |
| Antiseptics in the form of rectal suppositories. | Restoration of rectal mucosa and prevention of long-term prostatitis. |
| Alpha blockers. | Normalization of urine, restoration of daily urine flow. |
| Microcirculation correctors. | Removal of blockage in small pelvic vessels, restoration of normal blood and lymph flow. |
| Correctors of urodynamics (substances that affect metabolism in prostate tissue). | Improving metabolic and metabolic processes in the tissues of the prostate gland and its nutrition. |
| Potential regulators. | Complex treatment of erectile dysfunction, improving the chemical composition, viscosity and fluidity of semen, increasing sperm activity (the use of drugs of this group is indicated for patients with prostatitis autoimmune infertility). |
The duration of antibiotic treatment is at least 4-6 weeks. Under no circumstances should you take antibacterial drugs without a doctor's prescription, because the leading factor in the choice of therapy is the result of microscopic examination of spontaneously released fluids as a result of prostate and prostate massage. Some antibiotics, such as penicillins (a combination of amoxicillin and clavulanic acid), are reserve drugs, and their misuse can lead not only to a clinically insignificant effect and the development of pathology, but also to the development of superinfection.
Important! In some cases, men with chronic prostatitis may need psychocorrection, especially if the pain syndrome is combined with behavioral changes, increased anxiety, irritability, and neurasthenia. Antidepressants with selective serotonin reuptake inhibition are used to suppress these symptoms.
Physiotherapy
Heat therapy is the main method of treatment of chronic prostatitis outside the period of exacerbation (after regression of acute symptoms). Heat treatment refers to physiotherapy methods and is the dosing effect of heat on the affected area. The benefits of thermal procedures are normalization of blood circulation, relief of inflammatory processes, reduction of chronic pelvic pain, which is one of the main clinical manifestations of chronic prostatitis, which reduces the quality of life in men. Heat also improves the penetration of drugs into the prostate tissue, so in some cases physiotherapy is used to increase the effectiveness of drug treatment (eg, electrophoresis with antibiotics). It is prescribed for the prevention of fever in men at high risk of thrombosis, because the heat has a moderate restorative effect.
There are many methods of exposure to heat in the body, and the choice of a particular treatment should be made by a physician, taking into account the clinical manifestations, form and stage of the disease, the age of the man and individual tolerance. The most effective heat treatments for prostatitis are:
- thermal applications with minerals (ozokerite, paraffin, bischofite), salt or sand;
- electric heating bags;
- Deep warming of high-strength tissues to directly affect blood vessels and nerve endings (diathermy);
- Exposure to high-frequency alternating magnetic fields to relieve pain, inflammation, and neurosis-like manifestations (induction);
- ultrasound therapy (promotes resorption of abscesses and healing of wounds);
- electrophoresis with electrodes entering the rectum;
- effect on prostate tissue with high-frequency pulse currents (darsonvalization).
In some physiotherapy rooms, chronic inflammation of the prostate is treated with hot mud applications ("mud pants"). Such procedures have a positive effect not only on the blood and lymph circulation, but also on the production of prostate secretions, as well as on the nutrition of the tissue of the inflamed organ. In some cases, the mud is injected directly into the rectum in the form of a buffer, because with this method of application the therapeutic effect and a positive reaction to therapy can be achieved quickly.
Other treatments
In addition to medication and thermal therapy, the complex treatment scheme is complemented by various procedures prescribed by a doctor, taking into account the characteristics of the pathology in each case.
Prostate massage
This is one of the main methods of treatment of chronic inflammation of the prostate gland, and it is recommended to use it in almost 90% (unless otherwise indicated). Massage is the effect of a finger on the prostate to stimulate the secretion of secretory fluid. The duration of the procedure is usually about 1-2 minutes. A sufficient criterion is the complete emptying of the prostate gland, which the patient feels comfortable with (the doctor should be informed).
The benefits of massage are determined by the therapeutic effect that can be achieved after a course of treatment (8-12 procedures). With an uncomplicated course, these are:
- normalization of muscle tone;
- Improving blood circulation in the prostate vessels (due to which the transport of drugs to the tissues of the affected organ is accelerated and the effectiveness of therapy increases);
- restoration of secretory transparency;
- Normalization of blood and lymph flow from the prostate gland (especially important in cognitive prostatitis).
The procedure is contraindicated in the acute period when the infection spreads to surrounding tissues and organs (contraindicated), other infectious diseases of the genitourinary system, cysts or stones in the prostate gland. Prostate massage is not prescribed for patients diagnosed with tuberculosis, adenomas or other neoplastic diseases (including prostate cancer lesions). In the presence of rectal diseases (hemorrhoids, anal fissure, proctitis, paraproctitis), massage can lead to complications and recurrence of the underlying disease.
Important! Studies show that almost 42% of men refuse prostate massage due to the increased psychological discomfort associated with the features of this procedure. The physician's work with such patients should include detailed information on the consequences of refusing treatment and possible complications, especially infertility and persistent sexual dysfunction. In some cases, it may be advisable to prescribe a mild sedative a few days before starting treatment.
Hot enemas
Hot enemas are a home treatment for chronic prostatitis, but urologists recognize its effectiveness and recommend it for faster and more effective treatment of prostatitis. The water temperature of these enemas should be around 42 ° C. Before the procedure, the intestines should be cleaned regularly with an enema or laxatives. The volume of one enema is between 150 and 300 ml. It is recommended to empty the bowel 30-50 minutes after application of the solution.
Recipes for chronic prostatitis are given below.
- Dissolve 10 drops of iodine and 20 ml of chlorhexidine in 200 ml of water. Apply 15 days before bedtime.
- A mixture of chamomile, St. John's wort or calendula should be inserted into the rectum (approximately 250 ml) and then kept for 1 hour. The procedure is repeated once a day for 2 weeks.
- Seafood oil (40-50 ml) is heated to 40 ° C and inserted into the rectum for 20-30 minutes. The course of treatment is 10-15 days. The procedure is best done before bedtime.
- Novocaine microclusters may be used with severe pain syndrome that significantly limits the patient's mobility and worsens quality of life. Dissolve 2 ampoules, 2% novocaine solution in 180 ml of upright chamomile. Hold for at least 50 minutes. Repeat every day for 1 week.
Anti-inflammatory drugs, antiseptics, antibiotics, drugs for microclysters can also be used. The use of these drugs is strictly allowed in the prescribed dose with a doctor's permission.
Treatment of chronic prostatitis: step-by-step instructions
The use of various treatments is not enough to completely get rid of chronic prostatitis. If a man does not follow a diet and does not change his lifestyle, exacerbations occur regularly, leading to irreversible changes in the structure and function of the prostate gland and persistent dysuria and sexually transmitted diseases. For patients with chronic prostatitis, you should follow the recommendations in the instructions below for the effectiveness of treatment and the duration of remission.
- Step 1. If a man is diagnosed with chronic prostatitis, he should first start adjusting his diet. Foods high in fat, salt and spices should be excluded from the menu. Fats increase blood cholesterol levels, and salt increases fluid retention and edema in prostate tissue. Spices (like various chemical additives) irritate the mucous membranes of the urinary tract and aggravate existing symptoms.
- Step 2. Alcohol should be completely eliminated because it slows down the absorption of nutrients, disrupts blood and lymph circulation, and adversely affects metabolism in the prostate. If a man suffers from tobacco dependence, measures should be taken to get rid of this habit (the toxic substances in tobacco smoke disrupt the viscosity and fluidity of prostate secretions and change their chemical composition).
- Step 3. Overweight men should consult an endocrinologist and nutritionist for a comprehensive diagnosis and correction of body weight, taking into account the identified deviations. Obesity is the most important factor in the development of chronic prostatitis, and an important stage of complex therapy is weight loss in patients with high BMI.
- Step 4. In order to overcome the stagnation associated with hypodynamic disorders, it is necessary to provide a level of physical activity appropriate to age and physical fitness. Swimming, physiotherapy exercises, traction exercises, walking are useful for prostatitis.
- Step 5. For the normal functioning of the prostate, it is necessary to monitor the quality of sexual life. It is advisable to have a regular sexual partner, avoid episodes of sexual arousal if you are unlikely to have sex later, and get checked regularly for sexually transmitted infections that can lead to exacerbation of chronic prostatitis.
Men with recurrent prostatitis should watch for emotional stress, avoid stressful situations, and stay in a cold or blackout for a long time.
Chronic prostatitis is a disease that is difficult to treat, especially if the patient does not follow the doctor's instructions and does not take responsibility for nutrition and diet. Inflammation of the prostate is dangerous with serious complications, so you need to approach the problem comprehensively. Men with this diagnosis should understand that the pills alone are not enough to completely restore all the functions of the prostate gland, so you should not give up the basic therapies for chronic prostatitis recommended by your doctor, even if they cause initial psychological or physical discomfort.