The first signs, symptoms of prostatitis in men and its treatment. Chronic prostatitis and its consequences for men Classification of chronic inflammation of the prostate

is a prolonged inflammation of the prostate gland, leading to disruption of the morphology and functioning of the prostate. It manifests itself as a prostatic triad: pain in the pelvis and genitals, urinary disorders, sexual disorders. Diagnostics includes palpation of the gland, examination of prostate secretions, ultrasound, uroflowmetry, urethroscopy, and puncture biopsy of the prostate gland. Complex medication and physiotherapeutic treatment, prostate massage, and instillation of the posterior urethra are indicated. Surgical intervention is advisable for complicated forms of chronic prostatitis.

ICD-10

N41.1

General information

Chronic prostatitis is the most common male disease: about 50% of men suffer from some form of prostate inflammation. Chronic prostatitis most often affects men aged 20 to 40 years, who are in the period of greatest sexual, reproductive and labor activity. In this regard, the identification and treatment of chronic prostatitis in modern andrology acquires not only a medical, but also a socially significant aspect.

Causes

However, for the development of chronic prostatitis, it is not so much the presence and activity of microorganisms that is important, but the state of the pelvic organs and blood circulation in them, the presence of concomitant diseases, and the level of protective mechanisms. Therefore, a number of factors can contribute to the occurrence of chronic prostatitis. First of all, these are urological diseases - pyelonephritis, cystitis, urethritis, urethral stricture, uncured acute prostatitis, orchitis, epididymitis, etc.

A microbial etioagent can enter the prostate from distant foci of infection, for example, in the presence of sinusitis, tonsillitis, caries, chronic bronchitis, pneumonia, pyoderma, etc. Local and general hypothermia, overheating, exposure to a humid environment, fatigue, and poor nutrition predispose to chronic inflammation. , rare urination, etc.

Non-bacterial chronic prostatitis is usually associated with congestive (congestive) phenomena in the prostate gland, caused by stasis of the venous circulation in the pelvic organs and impaired drainage of the prostate acini. Local congestion leads to overflow of the prostate vessels with blood, swelling, incomplete emptying of secretions, disruption of the barrier, secretory, motor, and contractile functions of the gland.

Stagnant changes are usually caused by behavioral factors: prolonged sexual deprivation, the practice of interrupted or prolonged sexual intercourse, excessive sexual activity, physical inactivity, chronic intoxication, occupational hazards (vibration). The development of non-bacterial inflammation is predisposed by pathology of the pelvic organs and the nervous structures that innervate them (for example, spinal cord injuries), prostate adenoma, hemorrhoids, constipation, androgen deficiency, and other causes.

Classification

According to modern classification Prostatitis, developed in 1995, distinguishes three categories of disease:

• II. Chronic prostatitis of bacterial origin.
• III. Inflammation of non-bacterial origin / pelvic pain syndrome is a symptom complex that is not associated with obvious signs of infection and lasts for 3 or more months.
• III A. Chronic process with the presence of an inflammatory component (detection of leukocytes and infectious agents in the prostate secretion);
• III B. Chronic pathology with the absence of an inflammatory component (leukocytes and pathogens in the prostate secretion).
• IV. Asymptomatic chronic prostatitis (no complaints when leukocytes are detected in prostatic secretions).

In the presence of an infectious component, they speak of bacterial (infectious) chronic prostatitis; in the absence of microbial pathogens – non-bacterial (non-infectious). It is believed that in 90-95% of all cases there is non-bacterial inflammation and only in 10-5% - bacterial inflammation.

Symptoms of chronic prostatitis

The disease manifests itself with local and general symptoms. Local manifestations include the prostatic triad, characterized by pain, dysuria and sexual dysfunction. The pain is constant, aching in nature, localized in the perineum, genitals, above the pubis, in the groin. The pain syndrome intensifies at the beginning and end of urination, with pain radiating to the head of the penis, scrotum, sacrum, and rectum.

Pain may increase after sexual intercourse or due to prolonged abstinence; weaken or intensify after orgasm, become more intense immediately at the moment of ejaculation. The intensity of the pain syndrome varies from sensations of discomfort to severe manifestations that disrupt sleep and performance. Pain with limited localization in the sacrum is often regarded as osteochondrosis or radiculitis, and therefore the patient can be treated independently for a long time, without resorting to the help of a doctor.

Urination is frequent and painful. In this case, there may be difficulty in starting voiding, weakening or intermittency of the urine stream, and a feeling of incomplete emptying. Bladder, frequent night urges, burning in the urethra. The presence of floating threads can be detected in the urine. After defecation or physical activity, discharge (prostatorrhea) appears from the urethra, caused by a decrease in prostate tone. There may be itching, a feeling of cold or increased sweating in the perineum, local changes in skin color associated with stagnation of blood circulation.

Chronic prostatitis is accompanied by severe sexual dysfunction. The phenomena of dyspotence can be expressed in deterioration, painful erection, prolonged and frequent nocturnal erections, difficulty or early ejaculation, loss of sexual desire (decreased libido), erased orgasms, hemospermia, infertility. Sexual disorders are always difficult for a man to experience and lead to psycho-emotional disorders, including neurosis and depression, which further worsen sexual function.

Exacerbations are accompanied by a slight increase in body temperature and deterioration in well-being. The general condition is characterized by increased irritability, lethargy, anxiety, fatigue, loss of appetite, sleep disturbance, decreased ability to work, creative and physical activity. Almost a quarter of patients have no symptoms of the disease for a long time, which leads to a late visit to an andrologist.

Complications

Diagnostics

The information necessary for the diagnosis of chronic prostatitis is obtained through a comprehensive laboratory and instrumental examination. The primary examination includes clarifying the anamnesis and complaints, conducting an external examination of the genitals for discharge, rashes, irritations, and a digital rectal examination of the prostate in order to determine the contours, boundaries, consistency, and soreness of the gland.

To determine structural and functional changes in the prostate gland, prostate ultrasound (TRUS) is indicated. Important methods in the diagnosis of chronic prostatitis are the study of prostate secretions, general urine analysis, bacteriological examination of a smear from the urethra and urine, a 3-glass urine sample, PCR and RIF examination of scrapings for pathogens of sexually transmitted infections, determination of prostate-specific antigen (PSA). Clinically significant is the detection of causative agents of chlamydia, mycoplasmosis, herpes, cytomegalovirus, trichomoniasis, gonorrhea, candidiasis, as well as nonspecific bacterial flora.

Collection of prostate secretions for examination is carried out after urination and massage of the prostate gland. Signs of the disease are an increase in the number of leukocytes in the field of view, a decrease in the number of lecithin grains, and the presence of pathogenic microflora. A general urine test may reveal leukocyturia, pyuria, and erythrocyturia. Bacteriological culture of urine allows us to identify the degree and nature of bacteriuria. In case of reproductive disorders, a spermogram and MAR test are indicated.

The degree and causes of urination disorders can be determined by urodynamic studies (uroflowmetry, cystometry, profilometry, electromyography). With the help of these studies, chronic prostatitis can be differentiated from stress urinary incontinence, neurogenic bladder, etc. For hematuria, hemospermia, and obstructive urination, endoscopic examination is indicated - urethroscopy, cystoscopy. To exclude adenoma and prostate cancer, a PSA determination is required, in some cases a prostate biopsy with morphological examination of tissue is required.

Treatment of chronic prostatitis

The disease is not easy to cure, but it should be remembered that recovery is still possible and largely depends on the patient’s mood, the timeliness of his contact with a specialist, and the strict adherence to all the urologist’s instructions. The basis for the treatment of a bacterial inflammatory process is antimicrobial therapy in accordance with an antibiogram lasting at least 2 weeks. To reduce pain and inflammation, NSAIDs (diclofenac, ibuprofen, naproxen, piroxicam) are prescribed; To relax the muscles of the prostate, restore urodynamics and outflow of prostatic secretions, the use of a-blockers (tamsulosin, alfuzosin) is indicated.

In order to improve drainage of the prostate gland, local microcirculation and muscle tone, a course of therapeutic prostate massage is carried out. A prostate massage session should end with the release of at least 4 drops of prostate secretion. Prostate massage is contraindicated in acute bacterial prostatitis, prostate abscess, hemorrhoids, prostate stones, rectal fissures, prostate hyperplasia and prostate cancer.

To relieve pain, paraprostatic blockades and acupuncture may be recommended. Important importance in treatment is given to physiotherapy with the prescription of medicinal electrophoresis, ultrasound, ultraphonophoresis, magnetic therapy, laser magnetic therapy, inductometry, mud therapy, SMT, hot sitz baths at a temperature of 40 - 45 ° C, enemas with hydrogen sulfide and mineral waters, instillations into the urethra.

If complications develop, surgical treatment is indicated: elimination of urethral strictures; TUR of the prostate or prostatectomy for prostate sclerosis; transurethral resection of the bladder for sclerosis of its neck, puncture and drainage of prostate cysts and abscesses; circumcision for phimosis caused by recurrent urinary tract infections, etc.

Prognosis and prevention

The prognosis is determined by the timeliness and adequacy of treatment, the patient’s age, and the presence of concomitant pathologies. Prevention of the disease requires compliance with sexual hygiene, timely treatment of urogenital and extragenital infections, normalization of the regularity of sexual life, sufficient physical activity, prevention of constipation, and timely emptying of the bladder. To exclude relapses, dynamic examinations by an andrologist (urologist) are necessary; preventive courses of physiotherapy, multivitamins, immunomodulators; exclusion of hypothermia, overheating, stress, bad habits.

Chronic prostatitis is a long-term inflammation of the prostate gland, with often no symptoms, which is why most of the male population is not aware of the disease.

The development of a chronic form of prostatitis is a consequence of an acute process, although in practice this is quite rare. As a rule, inflammatory chronic prostatitis begins gradually, without any unpleasant symptoms and sensations, the course of the disease is often discovered in a patient by chance during an ultrasound examination.

Both young men and middle-aged and elderly people are susceptible to the chronic form. Prostatitis also threatens those who, by the nature of their work, lead an inactive lifestyle and feel excessive physical exercise on the perineum, observes sexual abstinence.

Classification

According to the modern classification of prostatitis, developed in 1995, there are several categories of the disease:

1. Acute bacterial prostatitis(OPP) is the most common and easily diagnosed type of prostatitis. It is usually caused by a bacterial infection and is easily diagnosed due to its typical symptoms. Acute bacterial prostatitis can occur at any age. Symptoms include inability to completely empty the bladder, back, or pelvic area. There may be a fever accompanied by chills.
2. Chronic bacterial prostatitis– disease with typical symptoms chronic inflammation and an increased number of bacteria and leukocytes in the urine and secretions of the prostate after its massage.
3. (CP) is the most common form of prostatitis. In most cases, it is a consequence of acute bacterial prostatitis (untreated or poorly treated). If there are symptoms, they occur in the form of pain in the genitals or pelvic area, difficulty urinating or painful urination and ejaculation.
4. Asymptomatic inflammatory prostatitis– with this form of the disease, the classic symptoms of prostatitis are absent, and the disease itself is detected by chance, when visiting the clinic for another reason.

In the presence of an infectious component, they speak of bacterial (infectious) chronic prostatitis; in the absence of microbial pathogens - non-bacterial (non-infectious) prostatitis. It is believed that in 90-95% of all cases non-bacterial chronic prostatitis occurs and only in 10-5% - bacterial.

Causes

A number of factors can contribute to the occurrence of chronic prostatitis. First of all, this:

1. STIs: Trichomonas, Candida fungus, Escherichia coli can infect the urethra and be detected in prostate tissue;
2. Poor circulation in the pelvic organs (congestion in the prostate leads to its inflammation);
3. Sedentary lifestyle (drivers, office workers, officials);
4. Prolonged sexual abstinence, interrupted sexual intercourse or artificial prolongation of sexual intercourse;
5. Regular hypothermia (fans of extreme recreation: diving, surfing, kayaking and skiing);
6. Stress: mental and physical overload.

For the development of chronic prostatitis, it is not so much the presence and activity of pathogenic microorganisms that is important, but the state of the pelvic organs and blood circulation in them, the presence of concomitant diseases, and the level of protective mechanisms.

Symptoms of chronic prostatitis

Most often, with the development of a chronic form of prostatitis, the symptoms practically do not bother the man. In this case, all the signs of acute prostatitis will not manifest themselves at all or will manifest themselves to a much lesser extent.

The most common symptoms of chronic prostatitis in men are:

• periodic pain and discomfort in the perineum;
• discomfort during bowel movements and urination;
• irradiation to the anus, thigh, testicles;
• discharge from the urethra.

Changes in the course of the disease, which is already not very bright, can be so insignificant that patients with chronic prostatitis do not pay special attention to them.

Exacerbation of chronic prostatitis

An exacerbation of the disease is usually accompanied by the following symptoms:

• pain and burning in the urethra;
• increased urge to urinate;
• pain in the lower abdomen, perineum and rectum;
• signs of decreased sexual activity in men;
• pain during defecation.

According to some doctors, psychological symptoms of chronic prostatitis can also be identified, which include increased irritability, anxiety, fatigue, short temper, sleep disturbances, obsession and depression.

It is almost impossible to determine all the symptoms in a patient at once, since a man usually exhibits only 2-3 signs of the disease. For example, the most common are erectile dysfunction and pain in the lower abdomen.

Why can prostatitis cause infertility?

The fact is that the prostate gland produces a special secretion that ensures the viability of sperm. With inflammation, the secretory function of the prostate gland deteriorates, which inevitably affects the quality of sperm.

In addition, the prostate gland is actively involved in the regulation of testosterone production and the erection process. This is why chronic prostatitis causes decreased erectile function, even impotence. However, these scenarios for the development of the disease can be avoided if timely and competent treatment is carried out.

Diagnostics

The following procedures are necessary to help establish/refute the diagnosis:

• rectal examination;
• microscopy of prostate secretion;
• culture of prostate secretion for sensitivity to antibiotics;
• tests for sexually transmitted diseases;
• transrectal ultrasound.

Sometimes additional endoscopic and urodynamic studies are performed.

How to treat chronic prostatitis

If a man is diagnosed with chronic prostatitis, treatment is always long and difficult. Its duration directly depends on the stage of the disease at which the patient consulted a specialist. Therapy involves an integrated approach, that is combination of several methods simultaneously:

• antibacterial therapy;
• prostate massage;
• physiotherapeutic procedures;
• correction of diet and lifestyle;
• application folk remedies;
• surgery.

Additionally, anti-inflammatory and antispasmodic agents are used in the treatment of chronic forms of the disease.

Drug treatment

Choice medicines depends on the cause and symptoms of the disease. To cure chronic prostatitis of infectious etiology antibacterial drugs are used:

• fluoroquinolones;
• macrolides;
• tetracyclines.

To eliminate inflammation and pain, analgesics and non-hormonal anti-inflammatory drugs are used.

also in last years treatment of chronic prostatitis is carried out using drugs that have not previously been used for this purpose: alpha1-blockers (terazosin), 5-a-reductase inhibitors (finasteride), cytokine inhibitors, immunosuppressants (cyclosporine), drugs affecting urate metabolism (allopurinol) and citrates.

Physiotherapy

Certain physiotherapeutic procedures, such as laser therapy, electrophoresis, transrectal microwave hyperthermia, ultrasound phonophoresis and others, also help improve the trophism of prostate tissue and speed up the healing process.

Also, for chronic prostatitis, therapeutic warm baths, mud therapy, and special enemas can be prescribed.

Prostate massage

Improves drainage of prostate secretions and microcirculation at the level of this organ, which in turn contributes to a speedy recovery of the patient.

Prostate massage cannot be performed in case of acute prostatitis, hemorrhoids, or rectal fissures. Prostate massage is usually combined with antibiotic therapy. Numerous clinical studies have shown the high effectiveness of this treatment.

Operation

Surgery is possible to remove areas of the prostate gland affected by bacteria.

• Transurethral resection is an operation that is performed under epidural or intravenous barbiturate anesthesia. The postoperative recovery period lasts no more than a week.

The methods required for the treatment of chronic prostatitis are determined by the urologist based on diagnostic information and his practical experience. Carrying out self-therapy at home based on reviews on the Internet is fraught with consequences.

Inflammation of the prostate gland is a dangerous disease, but not all men are aware of the possible risks and complications. The inflammatory process must be treated. The consequences of prostatitis, if the disease is left to chance, are reflected in the functioning of the entire organism as a whole.

Symptoms of prostatitis are pain, difficulty urinating, weakened erection. These manifestations of the disease are directly related to changes in the prostate gland that occur against the background of the inflammatory process.

With prostatitis, the prostate gland becomes irritated and swollen. An increase in the size of the organ causes specific symptoms due to compression of the urethra and irritation of pain receptors located nearby tissues.

In addition to severe symptoms, which significantly worsen a man’s quality of life, the inflammatory process is dangerous due to structural changes in the tissues of the organ. They occur with low-grade inflammation and are characterized by scar formation. Replacement of the muscle and glandular tissues of the organ with connective tissue leads to disruption of the functionality of the gland. This disease is known as prostate sclerosis, and is diagnosed during a long course of chronic prostatitis without qualified treatment.

The consequences of prostatitis in this case are irreversible without surgical intervention. Symptoms of sclerotic changes in prostate tissue:

• inability to fully empty the bladder;
• inflammation of the bladder and seminal vesicles;
• sharp and cutting pain in the perineum;
• erectile disfunction.

The only treatment for prostate sclerosis is surgery.

The disease is difficult to treat. One of the dangerous consequences of glandular sclerosis is the formation of residual urine, which enters the kidneys and provokes their infection. In addition to discomfort and lack of erection, the pathology can cause the development of acute renal failure. Such complications of prostatitis are observed 5-10 years after the onset of the disease. Factors predisposing to prostate scarring due to prostatitis are older age, vascular atherosclerosis, circulatory disorders, and hypertension.

To treat this pathology, minimally invasive surgical methods are used, for example, laser vaporization of connective tissue. During the procedure, the changed areas of the organ literally evaporate due to laser exposure.

Chronic prostatitis

Acute inflammation of the prostate is characterized by specific symptoms. The disease is successfully treated with antibiotics, but after symptoms have resolved, patients are required to undergo long-term maintenance therapy to restore prostate function.

Many people are interested in: what will happen if prostatitis is not treated, and what are the dangers of this disease?

An incomplete course of treatment for prostate inflammation eventually results in the development of chronic, sluggish prostatitis. The symptoms of this form of the disease are mild, and most often manifest themselves as an increased urge to go to the toilet. Chronic prostatitis may not manifest itself for a long time and may not bother a man, but changes will occur in the prostate gland. Over time, the disease always makes itself felt with a sudden exacerbation of symptoms. This is manifested by acute pain, stagnation of urine, and increased body temperature. During the examination, changes in the organ are usually noted - scars in the tissues, irritation, enlargement of the prostate. Prostatitis and its consequences may not appear immediately, but make themselves felt many years after the onset of the disease.

Chronic prostatitis leads to dysfunction of the organ. This negatively affects a man’s hormonal levels and well-being. First of all, reproductive function suffers. It is very difficult to treat this form of the disease; therapy boils down to preventing an exacerbation of symptoms.

Prostatitis worsens well-being and sex life

Adenoma and malignant neoplasms

The consequences of prostatitis are not always manifested by the development of prostate adenoma - this disease can be considered as an independent pathology. First of all, the development of adenoma is caused by increased production of dihydrotestosterone with a simultaneous decrease in the rate of testosterone synthesis. Predisposing factors are also genetic predisposition and natural aging of the body.

Nevertheless, the relationship between chronic prostatitis and the development of adenoma is clearly visible. A sluggish inflammatory process leads to prostate dysfunction. The prostate is a hormone-dependent organ, therefore, if its functioning is disrupted, there is a disruption in the production and absorption of sex hormones. At the same time, there is an increase in androgen synthesis. Dihydrotestestron serves as a kind of fuel for the functioning of the prostate gland, so its excess is absorbed by the gland tissue. Against this background, there is a rapid enlargement of the prostate and structural changes in the tissues of the organ, known as benign hyperplasia or adenoma.

Symptoms of adenoma are primarily associated with impaired urine outflow and bladder function. Quite often, men are faced with the inability to urinate. The development of acute urinary retention requires hospitalization and catheter placement.

Prostate adenoma cannot be treated. Even surgical intervention does not guarantee the absence of relapse in the future, except for radical prostatectomy. Even after laser prostate surgery, men must take pills that block androgen production for life to prevent recurrence of prostate hyperplasia.

The relationship between prostate cancer and prostatitis is controversial. On the one hand, oncopathology occurs in men who have never encountered prostatitis in their lives, but on the other hand, the percentage of cancer among patients who have had prostate inflammation is much higher. Thus, doctors agree that prostatitis is not a guarantee of the development of cancer, but is a serious prerequisite for malignant neoplasm in the prostate. Such consequences of prostatitis are very dangerous; they significantly shorten a man’s life and in some cases lead to death.

Prostatitis is considered a provoking factor for tumors in the prostate

Disorders of the urinary system

The consequences of chronic prostatitis for men often result in disruption of the urinary system. Constant compression of the urethra by the swollen prostate leads to a narrowing of its lumen. This prevents the bladder from emptying normally. Symptoms of this condition:

• constant urge to urinate;
• feeling of incomplete emptying of the bladder;
• the need to strain the groin muscles when urinating;
• weak stream of urine;
• burning and pain in the urethra.

With prostatitis, complications lie in the risk of kidney dysfunction. This is due to stagnation of residual urine in the bladder due to its dysfunction, which provides a favorable environment for the proliferation of pathogenic microorganisms. With infected urine, pathogenic agents are thrown into the kidneys, causing them to become infected. Inflammation of the kidneys can lead to serious impairment of their function, including the development of failure.

To eliminate a condition in which the bladder does not empty completely, an operation is performed during which a valve is installed that allows stable work urinary system. This is a last resort; a catheter is usually used to empty the bladder.

Reproductive system dysfunction

The most common complication of prostatitis, which makes itself felt quite quickly, is disruption of the reproductive system, a gradual decrease in fertility with further infertility.

First of all, potency suffers. This is usually not due to physiological changes, but psychological stress due to specific symptoms of prostatitis. Over time, due to the thickening of prostate juice and a decrease in the lumen of the urethra, problems with ejaculation appear - the patient either ejaculates too quickly or cannot achieve orgasm during sex. All this ultimately leads to erectile dysfunction, up to complete sexual impotence.

Decreased fertility is due to changes in the composition of prostate juice. The first thing that chronic prostatitis leads to is a violation of sperm motility. This is due to a reduction in the number of lecithin grains in the prostate secretion. As the disease progresses, these protein compounds completely disappear, so over time the man loses the ability to fertilize and is diagnosed with infertility.

Prostatitis reduces the ability to conceive

The only way to prevent such consequences is a timely course of comprehensive treatment of prostatitis. If, after treatment of the underlying disease, a man still has problems with erection, additional therapy is indicated to restore sexual function. It is important to remember: almost any complication can be prevented if you do not let the disease take its course. Any signs of erectile dysfunction, decreased desire for the opposite sex, or other consequences of prostatitis in men should be discussed with your doctor in a timely manner.

Complications from the nervous system

In addition to functional disorders in the functioning of organs genitourinary system, as a result of untreated prostatitis, problems with the nervous system remain. These complications include:

• depression;
• apathy;
• asthenic syndrome;
• neuroses.

Such disturbances in the functioning of the nervous system always entail a decrease in cognitive functions - memory, attention, mental abilities. In this case, performance always suffers, which negatively affects the patient’s quality of life.

Disorders of the nervous system are caused by constant stress and psycho-emotional stress that accompany the symptoms of prostatitis. Due to the constant urge to go to the toilet, a man does not get enough sleep, and this becomes the first alarm signal indicating the imminent appearance of nervous disorders.

A psychotherapist and neurologist can help cure such complications. To do this, it is necessary to take medications that normalize the activity of the nervous system and allow you to fight stress and increased mental stress. Special attention it is necessary to pay attention to the depression remaining after an exacerbation of prostatitis. This is a dangerous condition that has a destructive effect on nervous system and the human psyche.

If you are depressed, you cannot do without the help of a specialist.

Complications of acute bacterial inflammation

Complications that are difficult to treat and radically change the patient’s life are observed with chronic prostatitis. As a rule, such consequences develop over years, but do not appear overnight. At the same time, acute infectious prostatitis can lead to serious complications that require urgent hospitalization. We are talking about a prostate abscess - a dangerous pathology in which a cavity filled with pus forms in the prostate gland and necrotic changes in the tissue begin. This condition can lead to infection of the entire body. Abscess rupture, without timely hospitalization, can cause death.

Prostatitis is a dangerous pathology that leads to serious consequences that affect the entire body as a whole. Complications can be prevented only by timely treatment of this disease.

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03.05.2018

The signs of chronic prostatitis in men may be familiar to many members of the stronger sex due to the widespread prevalence of the disease. The inflammatory process can occur either unnoticed by the patient or with pronounced symptoms. This may depend on the characteristics of the body, the reasons that caused the pathology, and the age of the person. Most manifestations occur at the acute rather than chronic stage, and prostatitis is more often diagnosed at this stage.

Along with it, diseases such as prostate adenoma or urethritis, vesiculitis can be detected. They all have the same sources of origin and can flow from one to another. Therefore, during treatment it is necessary to be very careful and try to prevent the appearance of concomitant ailments from the very first days. You should consult a doctor at the slightest symptoms, because... Chronic prostatitis manifests itself exactly like this - little by little, almost imperceptibly.

Main symptoms of prostatitis

Prostatitis is inflammatory disease, affecting the prostate gland located in the pelvis of men. According to the nature of its development, it is divided into 2 stages: acute and chronic. Usually the acute form appears first, and without treatment it becomes chronic. In this case, most of the symptoms disappear and the patient begins to think that he has recovered, while the inflammatory process continues to develop in the prostate.

According to the international classification, prostatitis is a long-term disease; in some patients it is not possible to overcome it at all and the man is left to maintain the disease in remission.

The chronic form makes little difference, so many simply do not pay attention to their health or relieve minor pain with pills. But the very first provoking factor can bring the signs of chronic prostatitis into the active phase, when all the main symptoms manifest themselves simultaneously - pain, potency disorder and dysuria. Taken together, they accurately indicate that a man has this particular illness; doctors can accurately diagnose it even without tests or examination.

Pain syndrome

With chronic prostatitis, pain can occur in various areas of the pelvis and even beyond. At the same time, the pain itself can be of a different nature - cutting, aching, dull, short-term and long-lasting. They can reach such strength that the patient has a psychological barrier to going to the toilet or having sexual intercourse. But still, with inflammation at the chronic stage, they are not strong and almost do not interfere Everyday life. They can intensify when:

• Increased physical activity
• Severe stress
• Intimacy, especially during ejaculation
• Long abstinence from sex
• Hypothermia
• After drinking alcohol

Most often, pain is present in the genital area, but you can feel it in the lower back, buttocks, anus, inner thighs, legs. This happens because it passes through the prostate gland. big number nerve endings in various organs of the genitourinary system, but it itself never hurts. The pain does not depend on the time of day, it can last a couple of minutes one day, and not disappear for hours on another.

The worst thing is when it is felt in the kidney area, because... this means a disruption in their functioning (usually due to the accumulation of urine in the bladder and poisoning of the body with the poisons that it forms as it accumulates). When pain is felt in the legs, this means that inflammation is already present on the entire surface of the prostate, but this is dangerous only when the prostatitis is of a bacterial nature due to the likelihood of reactive arthritis.

Weak potency, a flaccid penis, lack of a long-term erection are not a death sentence for a man’s sex life, but a signal that the body needs help and male strength is weakening. There are a large number of drugs that help a man gain a stable erection for sex, but they all have their own disadvantages and contraindications, especially if the man is already 30-40 years old. “M16” drops for potency help not only to get an erection HERE AND NOW, but act as a preventive measure and accumulation of male power, allowing a man to remain sexually active for many years!...

Weakening of potency

Erectile dysfunction due to prostatitis is also one of the most common phenomena and it is because of this that men try to get rid of the disease as quickly as possible. Problems in bed can also lead to a doctor faster than others, because to get rid of sexual impotence or improve hormonal levels, you need drugs that are sold only with a doctor’s prescription. Signs of exacerbation of chronic prostatitis in this case manifest themselves in the form of pain during sex, premature or delayed ejaculation, and discomfort in the groin after sexual intercourse. Sometimes the erection is not strong enough for intercourse, sometimes it is completely absent.

There may also be signs such as loss of orgasm, its absence, and disruption of the reproductive system. With prostatitis, men often have the problem of being unable to conceive a child, because... sperm at this time has a small amount of sperm, and those that exist are inactive due to the abnormal composition of the seminal fluid. This is due to the fact that prostate secretions are a source of fructose, which gives sperm energy. Some influence goes to psychological condition patient, because hormonal balance is disrupted. A man becomes aggressive and irritable, easily becomes depressed due to sexual failure.

Urination disorder

Impaired urination may be a sign of chronic prostatitis and BPH (benign prostatic hyperplasia), as well as some other ailments. This symptom appears due to the enlarged gland squeezing the bladder and urinary tract that pass through its tissue. What manifestations are typical for the disease:

1. Private urge to go to the toilet
2. Difficulty in urinating, manifested in a thin stream, urine coming out drop by drop, and the need to strain very hard to do so.
3. Pain during bowel movements
4. Feeling of incomplete emptying of the bladder
5. Presence of blood or pus in urine

Add here a change in the color or smell of urine, which may indicate various infections or oncology. Dysuria does not appear immediately; for this it is necessary that the inflammatory processes spread throughout the prostate. If you do not cope with this symptom, there is a high probability of urinary incontinence or acute retention.

Other symptoms

In addition to the above symptoms, clinical picture prostatitis may contain other manifestations. These include high fever and weakness, increased sweating. At the chronic stage, the temperature usually does not rise above 37 degrees, but during an exacerbation it reaches 40. Headaches, nausea and vomiting, and body aches may be present.

Causes of pathology

The causes of chronic prostatitis in more than 50% of cases are congestion in the pelvis. They can arise due to excess weight or low mobility of the patient, as a result of which blood begins to be retained in the pelvis. Sooner or later this leads to inflammation. A long absence of intimate relationships also affects, because... Because of this, seminal fluid stagnates in the prostate itself. It becomes an excellent place for the proliferation of pathogenic microflora, which quickly causes inflammation.

El Macho for potency

The risk group for the disease includes men with sedentary work, those suffering from diseases of the circulatory system, smokers and alcohol abusers. Inflammation of the prostate gland can be affected by:

• Pelvic injuries and operations performed on it
• Weakened immunity
• Frequent constipation
• The presence of foci of infection in any organ (even caries can cause prostatitis)
• Poor nutrition

Before starting treatment, it is necessary to find out exactly what is causing the inflammatory reactions in order to get rid of them forever. Read more about diagnosing the disease below.

Diagnosis of the disease

To confirm the presence of prostatitis and find out what caused it, doctors perform quite a few different tests and examinations. You can see signs of chronic prostatitis using an ultrasound or blood and urine tests. Seminal fluid tests will be informative. But first of all, the urologist does a digital examination to assess the condition of the prostate - whether touching causes pain, what size it is, what texture it is. How different diagnostic methods help:

1. Blood and urine tests. Helps to see the presence of an inflammatory process, the presence of pathogenic microorganisms
2. Analysis of prostate secretions. Determines the condition of the organ, whether there are pathogenic agents in it, and how to deal with them. Can detect the presence of cancer
3. Ultrasound. Evaluates the condition of the prostate, the degree of urethral constriction, and pressure on the bladder
4. Tomography. It is done if malignant neoplasms are suspected; it helps to determine chronic inflammation if it is caused by stagnation, because it may not be detected by analysis

After receiving all the necessary information, a course of treatment is developed, which will be individual for each patient.

Treatment of prostate inflammation

Treatment of signs of chronic prostatitis in men can take quite a long period of time, because... inflammation at this stage usually has time to spread over the entire surface of the gland. Some changes in the organ (scarring of tissue or the formation of cavities due to an abscess) cannot be corrected, so the patient will only have to live with impaired prostate activity. Therapy for prostatitis includes the following points: taking medications, attending physical procedures, following proper nutrition and classes physical exercise. With the permission of the doctor, various non-standard techniques can be added to them:

• Apitherapy
• Mud therapy
• Folk remedies
• Hot baths
• Hirudotherapy, etc.

The use of drugs is one of the most effective ways fight the signs of prostatitis. They cope within a couple of hours, the variety of medications allows you to choose them for any patient. However, they also have a negative side in the form side effects. Antibiotics, alpha-blockers, NSAIDs, vasodilators, vitamins, herbal preparations, etc. are used to eliminate the disease. The first group - antibacterial agents - can only be used for those patients in whom tests have determined the presence of pathogenic microflora in the prostate gland.

For others, they will only harm the immune system and can cause infection to enter the prostate more easily. Antibiotics are used strictly in the quantities specified by the doctor; the course of treatment lasts no more than 2 weeks. After this, the analysis is repeated and, if pathogens are present in the tissues of the organ, the drug can be changed to a more powerful one. Nonsteroidal anti-inflammatory drugs act directly on the site of inflammation, regardless of what caused it. They are very effective, but cause many unwanted reactions.

To help the body cope with the disease faster, you should spend more time in the fresh air, avoid stress, and get a good night's sleep.

Other medications are mostly designed to treat only one symptom. For example, analgesics eliminate pain, and alpha-blockers and muscle relaxants eliminate urinary disorders. Treatment of signs of chronic prostatitis is not complete without physiotherapeutic procedures. They help improve the absorption of active substances from tablets, improve the metabolism of affected tissues, and help restore prostate function. The doctor may refer a man to galvanization, electrophoresis, magnetic therapy or prostate massage.

It is mandatory to follow for the treatment of prostatitis balanced diet, because Many products can harm or worsen the patient's situation. You should give up coffee, smoked meats, processed foods, fast food, legumes, spicy and salty foods. Physical activities necessary to prevent stagnation of blood and lymph, as well as improve blood circulation.

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Prostatitis - inflammation of the prostate gland - can manifest itself in acute and chronic forms.

It is difficult to ignore acute inflammation: its signs are clearly expressed, which cannot be said about the chronic manifestation of the disease. It asymptomatic, but it does its job “excellently”, damaging the tissues of the organ, reducing its functions.

About chronic prostatitis: types and features

Inflammation of the prostate is considered chronic, if its indolent symptoms persist for more than 3 months.

According to statistics, only 5% of cases are acute, the remaining 95% are chronic prostatitis. It affects men of reproductive age, and even young men aged 18-20 years are susceptible to this disease.

There can be two reasons for the development of chronic prostatitis: infection and blood stagnation in the pelvis.

Infection gets into the prostate in several ways:

• with blood flow from infectious foci in the body - carious teeth, pneumonia, inflamed maxillary sinuses, pustular formations;
• with the flow of lymph from nearby organs, for example, from the intestines with hemorrhoids, dysbacteriosis;
• sexually;
• descending or ascending from the infected urinary tract - the bladder or urethra.

Prostate inflammation caused by a sexually transmitted pathogen, such as gonococcus, chlamydia, and treponema pallidum, requires special attention. The symptoms of such prostatitis and genital infections are similar to each other, and they can “hide” behind the signs of these diseases. This kind of prostatitis is easy to trigger.

Reduced immunity and hormonal imbalances especially stimulate the development and spread of infection.

Non-infectious or congestive prostatitis appears as a result of a violation of the outflow of blood and lymph from the pelvis, as well as stagnation of prostate juice in the ducts of the gland.

Provoke such phenomena the following factors:

• disturbances in sexual life - prolonged abstinence, interrupted acts, unfulfilled desire;
• smoking - nicotine spasms blood vessels and interferes with normal blood circulation;
• sedentary lifestyle;
• tight clothes;
• alcohol abuse. Alcoholic drinks irritate the walls of the gland ducts, causing their inflammation;
• constipation

Congestive prostatitis occurs 8 times more often than infectious prostatitis and very rarely develops as a complication of acute inflammation of the prostate.

Abacterial prostatitis

This type of disease is also called chronic pelvic pain syndrome (CPPS). The main symptom is pain in the pelvic area, but the absence of pathogenic microorganisms in microbiological examination of urine and prostate secretions.

Painful sensations acquire different severity and localization. They spread to the perineum or bladder, genitals. The process of ejaculation is also painful. Problems with urine excretion and in the sexual sphere are also present, but they are secondary.

The diagnosis is made if the pain persists for 3 months or more.

There are 2 types of CPPS:

1. Inflammatory CPPS- an increased number of leukocytes is detected in the urine and secretions of the prostate, which indicates inflammation. Microorganisms are not detected. There are several reasons for the appearance of this type of inflammation. On the one hand, this is possible with reflux (reflux) of clean urine from the urethra into the gland. This is facilitated by anatomical defects or impaired muscle contractions of the bladder, prostate organ, and perineum. Urine, or rather the urates in it, cause inflammation of the prostate. On the other hand, it is believed that the culprit of this process is still bacteria that are not determined by the classical method. To identify them, molecular diagnostics should be used. The 3rd reason is autoimmune processes in the body.

1. Non-inflammatory CPPS— the analyzes do not contain leukocytosis and microorganisms. To establish a diagnosis, use instrumental diagnostics. It allows you to identify innervation problems or muscle changes in the prostate and other organs:
   • cervical part of the bladder - stenosis or proliferation;
   • pelvic area – myalgia, muscle tension, disruption of the passage of nerve impulses;
   • urethra - narrowing, increased pressure;
   • prostate – reflux of urine, increased pressure.

Often Nervous disorders are observed in patients with CPPS: anxiety, irritability, depressive tendencies.

Bacterial prostatitis

Chronic inflammation of the prostate of bacterial etiology begins to manifest itself with slight discomfort when urinating. This includes minor pain, itching or burning, and a decrease in the flow of the stream. The color of the urine changes and it acquires an unpleasant odor. Unpleasant sensations May also cause discomfort during bowel movements. A weak, dull pain appears in the perineum.

arise problems in sex life. At the beginning of the disease, they are situational: weakening of erection or increased frequency of its occurrence at night, acceleration of ejaculation, disturbances in orgasmic sensations.

A characteristic symptom for this stage– the appearance of discharge from the urethra during defecation.

Such sluggish symptoms can persist for quite a long time. A man may not pay attention to them, attributing everything to other reasons. If there is no treatment, they progress and an exacerbation of the chronic process occurs. the intensity of sensations increases.

Urination becomes sharply painful, the urge to go to the toilet becomes more frequent. At a certain point, these manifestations weaken due to compensatory growth of the bladder muscles, and then resume again, with greater force.

The pain in the perineum also intensifies. It radiates to the lower back, pubis, leg, scrotum. The nature of the pain also changes: it becomes stronger and sharper, and bothers you at night.

Growing sexual dysfunction, which becomes constant. Ejaculation is accompanied by pain, erection and libido decrease.

Patients are also accompanied by increased sweating, including in the perineum. Body temperature is slightly elevated – 37-37.5°.

Against the background of sexual disorders in men mental disorders develop. They become irritable, nervous, and may become depressed.

Treatment of the disease at this stage reduces the intensity of symptoms, and the exacerbation stage goes into remission.

Other types of chronic prostatitis

There is a concept calculous prostatitis. This disease is extremely rare and affects older men. It is characterized by the formation of stones consisting of prostatic juice, inflammatory effusion, as well as phosphates and calcium.

Signs of this type of disease are pain, which has a localization typical for prostatitis. They intensify with movement, after sexual intercourse. Blood appears in the ejaculate. There are other signs of inflammation of the gland.

Stones are a consequence of long-term prostatitis or adenoma.

Congestive prostatitis There are bacterial and non-bacterial. Its peculiarity is mild symptoms:

• low-grade fever;
• uncomfortable sensations in the groin;
• problems with urination;
• irritability;
• sexual disorders.

There are also such types of chronic prostatitis:

• autoimmune– develops with immune diseases, for example, rheumatoid arthritis, systemic lupus erythematosus;
• hormonal-dystrophic– appears due to hormonal imbalances, with hormonal diseases ( diabetes), as a result of physiological aging of the body;
• vegetovascular– formed against the background of vegetative-vascular dystonia. Causes problems with blood circulation.

How is the disease detected: diagnosis

Chronic prostatitis is diagnosed the same methods as acute.

First thing the doctor interviews and examines the patient. The examination is carried out using a digital rectal examination of the prostate. It may be enlarged, painful, asymmetrical and hardened. In rare cases (non-inflammatory CPPS) it is not changed.

Next doctor will order tests. From laboratory methods A general blood and urine test and analysis of prostate secretions are used. They will show an increased white blood cell count. Bacteriological examination of urine and prostate juice reveals the pathogen. Sometimes these indicators may be normal, but the process is still present.

To confirm the fact of the disease, the blood is tested for PSA. Instrumental methods will also help: ultrasound, TRUS, urofluometry.

Very often it turns out that a man does not suspect that he has such a disease, ignoring the symptoms. It is detected by chance, during systematic examinations. Therefore, it is recommended not to disturb the system and not to neglect scheduled inspections.

Pharmacological treatment

First of all, for the treatment of chronic prostatitis antibiotics are prescribed. The course is long - 1-1.5 months. Before prescribing antibacterial agents, the type of pathogen and its sensitivity to the drugs are determined.

Necessarily use immunocorrective drugs, because reduced immunity is a common cause of inflammation. Help from an immunologist is possible.

Therapy for chronic inflammation of the prostate Can't do without anti-inflammatory drugs. To begin with, non-steroidal drugs are prescribed: Diclofenac, Ibuprofen, Meloxicam. They are used in the form of tablets or injections. If they fail to achieve the desired result, hormones are used: Prednisolone, Dexamethasone.

Alpha blockers will help relieve muscle tension from the bladder and perineum. They act symptomatically, reducing pain and improving urination.

If unbearable pain occurs, painkillers are relevant.

It’s worth mentioning separately about the use of a dosage form such as suppositories. They are perfect for treating chronic prostatic processes. Most often, its symptoms are mild, and the mild action of suppositories is quite enough to relieve them.

They are inserted into the rectum. Its close location to the prostate gland allows you to quickly and effectively achieve results. In addition, the harmful effects of tablets on the gastrointestinal tract and difficulties with injections are eliminated. Suppositories have an anti-inflammatory and analgesic effect on the organ.

Physiotherapy and other methods

In addition to medications, other methods of treating chronic prostatitis are used:

• rectal prostate massage– carried out through the rectum. The procedure eliminates stagnation of prostate juice and also enhances the effect of medications. Contraindicated in case of exacerbation of the disease and in the presence of stones in the prostate;
• physiotherapy improves blood circulation in the affected organ and improves its nutrition. Methods used UHF, electrophoresis, darsonvalization and others. They are indicated only in the remission stage;
• Prostatitis involves not only the organs, but also the psyche of a man. He might need help from a psychologist or psychotherapist;
• acupuncture is a common method of treating chronic prostatitis. The procedure affects the organ indirectly, through acupuncture points;
• exercises, such as squats, walking, jumping will increase blood circulation in the pelvis and eliminate congestion;
• actively used balneotherapy– treatment with mineral waters.

Medications are an integral part of the treatment of chronic prostatitis. But they can cause a number of complications. And since the treatment of this type of disease is long-term, people have found ways to partially replace such drugs. Came to the rescue ethnoscience.

The leader among folk remedies for the treatment of prostatitis are pumpkin seeds . They contain a lot of zinc, which is essential for men's health. The seeds can be consumed separately: 30g will replenish daily norm essential microelement. You can also grind them in a meat grinder and mix with honey, making balls from the resulting mixture. They need to be stored in the refrigerator and consumed 1 piece before meals.

It is very useful for inflammation of the prostate to drink freshly squeezed juices of beets, carrots, cucumbers and asparagus. The volume per day should be at least 0.5 liters.

Blueberry Perfect for restoring the prostate gland. It contains a lot useful substances, microelements and vitamins.

In rare cases, in the treatment of prostatitis have to resort to surgery. Indications for it include the lack of improvement from conservative treatment, as well as acute processes: abscess and other purulent inflammation of the prostate, acute urinary retention, proliferation of glandular tissue, as well as benign and malignant formations.

Surgical treatment is carried out using several methods: This can be partial resection of an organ, opening of ulcers, excision of the foreskin or removal of the entire gland.

How to prevent the development of chronic prostatitis

Prevention of this disease can be primary or secondary.

Primary prevention is to prevent the occurrence of the disease, and comes down to the following measures:

• maintaining immunity;
• regularity of sexual activity;
• physical exercises and moderate loads. This is especially important for those who lead a sedentary lifestyle;
• avoid hypothermia;
• stopping infectious foci in the body;
• timely treatment of urogenital infections;
• be sure to undergo routine medical examinations;
• do not abuse alcohol and smoking.

Secondary prevention includes measures to prevent relapse of the disease. In the first year after suffering from prostatitis, a man is required to visit a urologist once every 3 months. Then – once every 6 months. If an exacerbation of the disease does not occur, the patient is removed from dispensary observation.

Excellent for the prevention of prostatitis sanatorium-resort treatment is suitable. Modern sanatoriums offer complexes of procedures from physiotherapy and balneotherapy, and other natural resources.

Important monitor your diet as well. Include more vegetables and fruits and a variety of cereals in the menu. You should also enrich your diet with fermented milk products. Eating seafood will compensate for the lack of zinc.

You should avoid salty, spicy and smoked foods, and do not overuse spices. Legumes, fatty foods and flour products should be excluded.

Chronic prostatitis is a sluggish but long-term process. He is insidious with complications:

• cystitis, pyelonephritis - urolithiasis;
• vesiculitis - an inflammatory process in the seminal vesicles;
• epididymo-orchitis is an inflammatory process of the testicles;
• gland hypotrophy;
• infertility and impotence.

Treatment of the disease - quite a long process. But it’s worth following this path to the end in order to preserve your health and preserve the chance of having healthy offspring.