How much to treat prostatitis

A survey of people in different countries shows that 2-10% of adult men experience symptoms of prostate problems throughout their lives.

Any urinary disorder is a wake-up call, and self-medication should be ruled out in this situation. But problems are not always associated with prostatitis.

Go to the doctor

Our articles are written with a passion for medicine based on evidence. We turn to reliable sources and seek advice from trusted doctors. But remember: you and your doctor are responsible for your health. We do not write recipes, we give recommendations. It is up to you whether to trust our view or not.

How the prostate works

The prostate, or prostate gland, is a nut-like organ located just below the bladder. Between the halves of the "nut" passes a bladder - a tube that comes out of the bladder and sperm from the testicles.

The main function of the prostateconsists of the production of a secretion that is part of the sperm. Thanks to this secret, sperm can move. The second function of the prostate is to contract, which allows it to empty.

Next to the prostate, there are seminal vesicles associated with the vas deferens from the sperm genitals. Seminal vesicles produce a fluid portion of semen and maintain prostate secretion.

The secret of the prostate is a mixture of enzymes with citric acid. This fluid irrigates the semen flowing from the testicular vas deferens to the urethra.

Prostate problems do not always lead to erection problems

In the vast majority of cases, sexual dysfunction is not associated with prostate problems because there is no physical connection between the prostate and the erection mechanism.

However, nervous urination, anxiety about incomplete bladder emptying, pain or discomfort associated with inflammation can make a person feel nervous and shy. For this reason, psychological problems arise - as a rule, these are the ones that negatively affect the erection.

What is prostatitis

Prostatitis is an inflammation of the prostate gland associated with pathogenic microbes or other non-infectious causes. Sometimes inflammation also affects the seminal vesicles - this is called vesiculitis.

At the same time, inflammation of the prostate gland does not always cause pain and urinary incontinence, and the presence of unpleasant symptoms is not necessarily associated with inflammation of the prostate.

To avoid confusion, urologists around the world use the classification proposed by the American Diabetes Mellitus, Digestive and Kidney Diseases Research Institute, or NIDDK.

To simplify a bit, the classification divides prostatitis into bacterial and bacterial, ie non-bacterial. This approach helps doctors make an important decision - whether or not to prescribe antibiotics and additional medications. It is a mistake to give antibiotics to all patients with suspected prostatitis, as non-microbial forms of prostatitis are more common than bacterial ones. Taking unnecessary antibiotics is bad for your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.A disease caused by typical pathogens of most urinary tract infections: for example, E. coli, Klebsiella and Enterobacter.

As a rule, the disease begins unexpectedly and is accompanied by a general deterioration of well-being. The temperature rises to 38-39 ° C, some people feel weak, severe pain or burning in the perineum, scrotum or anus, lower abdomen and sometimes muscles. Some people experience pain during ejaculation. Sometimes with bacterial prostatitis, there is frequent, difficult and painful urination.

Chronic bacterial prostatitis.The disease can also be caused by germs that are characteristic of acute prostatitis. If the symptoms last at least three months, the disease is considered chronic.

The symptoms of chronic bacterial prostatitis are similar to the acute symptoms, but may be less severe or less severe. Fever and weakness are generally absent, the pain in the lower abdomen is more severe than acute, but it is difficult to start urination and completely empty the bladder. In addition, the unpleasant symptoms may disappear temporarily and reappear after a while.

Any man can get acute and chronic bacterial prostatitis. However, those most at risk are those with a higher risk of exposure to germs: those who have sex, especially anal sex, without a condom, have a urinary tract infection, and have recently had surgery or a prostate biopsy. .

Chronic abacterial prostatitis associated with inflammation.The symptoms of inflammatory non-bacterial prostatitis are very similar to those of acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria in the sperm, prostate skeleton and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate gland.

Chronic abacterial prostatitis or chronic pelvic pain syndrome is not associated with inflammation.Symptoms also mimic acute and chronic bacterial prostatitis. At the same time, there is no high concentration of pathogenic bacteria and leukocytes in the semen, prostate skeleton and urine - this indicates that the prostate gland is not inflamed.

In the case of non-bacterial forms of prostatitis, it is not always possible to find the cause of the disease. It is also difficult to identify risk groups.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause any concern. Inflammation is often discovered by chance when the patient is examined for other problems, such as infertility.

How is prostatitis different from prostate adenoma?

After the age of 40, about 8% of men begin to increase their prostate size - this is called prostate adenoma or benign prostatic hyperplasia. An already enlarged prostate narrows the urethra, which can lead to problems with urination: too much urge to use the toilet, or urinary incontinence. When faced with symptoms of adenoma, some patients may think they have developed prostatitis.

Although some of the symptoms of prostate hyperplasia are really similar to prostatitis, they are not the same thing. Prostatitis is an inflammation of the prostate gland. An adenoma is an age-related uncontrolled proliferation of non-inflammatory prostate cells.

Adenoma can be a serious concern, so if you have a problem with urination, it is important to see a urologist as soon as possible. However, an adenoma is still not as dangerous as prostatitis because it does not increase the risk of cancer.

How often is chronic bacterial prostatitis diagnosed?

According to the generalized literature, acute bacterial prostatitis occurs in 5-10% of cases worldwide, and chronic bacterial prostatitis in 6-10%. In addition, both variants of chronic abacterial prostatitis account for 80-90% of all cases of the disease.

If we conduct a mass microscopic examination of the prostate gland, after 40 years, without exception, we will find certain signs of inflammation in all men, without exception. However, it has nothing to do with the diagnosis of chronic bacterial prostatitis.

There are many urological diseases that can hide behind the mask of chronic prostatitis, some of which are very serious and require urgent treatment. For this reason, I recommend that all patients with prostate-like symptoms undergo a more detailed examination to clarify the diagnosis.

How is prostatitis diagnosed?

From the patient's point of view, the symptoms of bacterial and non-bacterial prostatitis are very similar. It is impossible to distinguish one form of prostatitis from another and get quality treatment without consulting a urologist and undergoing special tests. As part of the compulsory health insurance policy, you can see a urologist free of charge or see a doctor at a private clinic.

The main task of a urologist who consults a patient with suspected prostatitis is to rule out other diseases of the prostate gland, such as cancer, and to determine what form a person has the disease. It is very important to differentiate chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen. Here's what a doctor needs to do to understand it.

Ask the patient about symptoms and well-being.To gather more information, your doctor may suggest answering a survey question called the Chronic Prostatitis Symptom Index. In some cases, it makes sense to print and fill out the questionnaire in advance so as not to waste time at the meeting.

Perform a physical examination.The doctor will examine the patient, paying special attention to the groin area. If there are swollen, painful lymph nodes in the groin, this increases the likelihood that the body is actually inflamed. Typically, the examination consists of a digital rectal examination that allows the doctor to assess the size, shape, and condition of the prostate. Research helps to understand prostate enlargement. If the condition is painful to the touch, it is most likely inflamed.

Is it possible to do without a digital rectal examination?

Digital rectal examination and prostate massage are not the most pleasant procedures. In acute inflammation, this can be painful. Some patients are so eager to avoid these procedures that they refuse to see a urologist in principle.

Digital rectal examination is a diagnostic method, but the massage of the prostate gland from the rectum is done to obtain material for laboratory analysis - the secret of the prostate gland. If the secretion is not available, the doctor may replace the prostate secretion test with either the first part of the urine test or two or three cups of urine sample. These studies allow us to approximate the location of the problem area in the urinary tract.

Sometimes this test is replaced by a sperm test for the same purpose. Helps to understand whether prostatitis is part of male genital infections and provides information on the quality of ejaculation. In addition, the count of leukocytes in the discharge allows to distinguish between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If the patient is interested in an upcoming digital examination or prostate massage, I would recommend that you discuss this with your doctor. Perhaps the analysis of prostate secretion can be replaced by an analysis of urine or sperm, which requires only his massage.

Order blood tests, urine and prostate secretions.The diagnostic standard includes microscopic examination of prostate secretion, general blood test, general analysis of urine by sediment microscopy, as well as microbiological examination of urine and prostate secretions.

During microbiological studies, the patient's biological substance is placed in a nutrient medium and they see which bacteria have grown on it - this allows to confirm the diagnosis. Under compulsory health insurance, you can take tests at a private clinic for money or for free.

Other tests and examinations - such as total prostate-specific antigen (PSA) concentrations in the blood and transrectal ultrasound of the prostate (TRUS) - are generally not performed if prostatitis is suspected. In some cases, prostate TRUS may detect fibrosis, a lesion or a malignant tumor-like lesion, but such studies are not indicated for all patients without exception.

How is prostatitis treated?

Treatment depends on the type of prostatitis. If the inflammation is caused by bacteria, the doctor will choose antibiotics. And if the bacteria have nothing to do with it, medication will be needed to help cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisstart treatment without waiting for test results - this is called empirical antibiotic therapy. With this approach, antibiotics are prescribed based on the information that germs are most likely to cause prostate infection.

As a rule, patients are prescribed antibacterial drugs that penetrate well into the tissues of the prostate gland and affect the most "popular" agents of prostatitis and urinary tract infections.

People who feel more or less normal and receive treatment at home usually take antibiotics in pill form. And patients with high fever treated in the hospital are more likely to be prescribed antibiotics by injection. With this treatment, the majority of patients with acute prostatitis relieve fever and pain from the second to the sixth day after taking the drug.

When the patient's temperature normalizes and there are no signs of inflammation, the doctor may transfer the patient from needles to tablets. The total duration of antibiotic treatment is usually about 2-4 weeks.

Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique. It was once thought that it could help to release excess secretions accumulated in the pancreas and thus reduce swelling. Today, however, most experts agree that prostate massage should be avoided for bacterial prostatitis. This is not only painful and useless, but can also worsen the course of the disease, as the massage can spread bacteria to neighboring, uninfected tissues.

Chronic bacterial prostatitisgram-negative bacteria are also treated with antibiotics. Fluoroquinolones are generally used for treatment - these antibiotics are considered very safe. However, if a doctor suspects that other microorganisms are causing prostatitis, he or she may prescribe additional antibacterial drugs without waiting for the test results.

In chronic prostatitis, antibiotics need to be taken longer than acute. According to the recommendations of urologists, they are prescribed for 4-6 weeks.

Chronic abacterial prostatitisIt is not associated with bacteria, so antibiotics are prescribed to patients with this disease only in the presence of urinary tract infections in addition to prostatitis.

Since the exact cause of abacterial prostatitis is not clear, treatment is mainly aimed at relieving pain during urination. To do this, doctors prescribe alpha-1-blockers, drugs that help relax the prostate muscles that tighten the urethra. If the pain persists, your doctor may prescribe non-steroidal anti-inflammatory drugs. Dosage is selected separately for each patient.

Some patients with abacterial prostatitis are helped by cognitive behavioral therapy - this is the name of a meeting with a psychologist where a person learns to cope with pain without medication. At the same time, there is still no scientific evidence on the effectiveness of psychological help for bacterial prostatitis.

The researchers' efforts to prove the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal thermotherapy, were poorly planned and took very little time - generally less than 12 weeks. That is, it is impossible to say whether all this helped.

How to prevent prostatitis: prevention

The main cause of prostate problems is a sedentary lifestyle and lack of regular sex life. Doctors believe that men have the highest chance of escaping prostatitis:

1. Have safe sex regularly.
2. They regularly engage in moderate sports.
3. Avoid hypothermia.
4. After reaching the age of 40, they undergo an annual urological examination.

Where it is better to treat prostatitis - in a public or private clinic

The most important thing is to follow the principles of evidence-based medicine in the diagnosis and treatment of prostatitis. It just depends on the doctor - and it doesn't matter exactly where he works.

Unfortunately, doctors in private clinics do not always follow the standards of medical care. This can lead to overdiagnosis and unnecessary treatment, which puts the patient at risk of overpayment. The state medical institution is more likely to meet all diagnostic and treatment standards. However, patients should be aware that a full examination will take longer, sometimes longer than an examination at a particular clinic.

Don't forget

1. Urinary tract problems are common in men, but not always in prostatitis. You need to go through a thorough examination to understand exactly what a person is.
2. Prostate problems rarely cause erection problems. In general, prostatitis is weakened due to psychological problems that occur against the background of unpleasant symptoms.
3. Not all types of prostatitis are caused by bacteria: 80-90% have nothing to do with it. It is bad if a person with suspected prostatitis is prescribed an antibiotic without additional tests. It makes sense to consult another doctor before taking them.
4. A person with acute or chronic prostatitis may be prescribed prostate massage to collect glandular secretions for analysis.
5. The best way to prevent prostatitis is a protected sex, a healthy lifestyle, and after 40 years - regular urological examinations by a doctor.