A survey of residents of different countries found that 2-10% of adult men will have symptoms at some point in their life that suggest problems with the prostate.
Any urinary tract disease is a wake-up call and self-medication should be ruled out in this case. However, problems are not always associated with prostatitis.
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This is how the prostate works
The prostate, or prostate, is a walnut-like organ that is located just below the bladder. Between the halves of the "nut" runs the urethra - a tube through which urine is removed from the bladder and semen from the testicles.
The main role of the prostateconsists in the production of a secret that is part of the seed. Thanks to this secret, sperm can move. The second job of the prostate is to contract and allow ejaculation, that is, ejaculation.
Next to the prostate are seminal vesicles connected to the vas deferens, through which sperm leave the genitals. The seminal vesicles produce the liquid part of the semen and store the prostate secretion.
The secret of the prostate is a mixture of citric acid and enzymes. This fluid dilutes the semen that flows from the vas deferens of the testicle into the urethra.
Prostate problems don't always lead to erectile problems
In the vast majority of cases, sexual dysfunction is not associated with problems with the prostate, as there is no physical connection between the prostate and the erection mechanism.
But disturbed urination, discomfort from incomplete urination, pain, or discomfort related to inflammation all lead to a person becoming nervous and shy. Because of this, mental problems arise - as a rule, they are the ones that negatively affect the erection.
What is prostatitis
Prostatitis is inflammation of the prostate that is associated with pathogenic microbes or other non-infectious causes. Sometimes inflammation affects the seminal vesicles as well - this is called vesiculitis.
At the same time, inflammation of the prostate does not always lead to pain and problems urinating, and the presence of unpleasant symptoms is not necessarily associated with inflammation of the gland.
To avoid confusion, urologists around the world use the classification proposed by the American National Institute for the Study of Diabetes Mellitus, Digestive and Kidney Diseases (NIDDK).
For convenience, the classification divides prostatitis into bacterial and abacterial, that is, not related to bacteria. This approach helps doctors make one important decision - whether to prescribe antibiotics and additional drugs. It is wrong to give antibiotics to all patients with suspected prostatitis, as non-microbial forms of prostatitis are more common than bacterial. Taking unnecessary antibiotics is bad for your health.
The NIDDK classification identifies five forms of prostatitis.
Acute bacterial prostatitis.A disease that is most commonly caused by typical urinary tract infections: E. coli, Klebsiella and Enterobacter, for example.
As a rule, the disease begins unexpectedly and is accompanied by a general deterioration in well-being. The temperature rises to 38-39 ° C, with some people feeling weakness, severe pain, or burning sensation in the perineum, scrotum, or anus, lower abdomen, and sometimes muscles. Some people experience pain during ejaculation. Sometimes bacterial prostatitis causes frequent, difficult, and painful urination.
Chronic bacterial prostatitis.This disease can also be caused by microbes that are typical of acute prostatitis. The disease is considered chronic if symptoms persist for at least three months.
Symptoms of chronic bacterial prostatitis are similar to acute ones, but they can be less or less severe. Fever and weakness are usually absent, lower abdominal pain is more painful than sharp, but it is difficult to start urinating and empty your bladder completely. In addition, unpleasant symptoms can temporarily go away and reappear after a while.
Any man can get acute and chronic bacterial prostatitis. Most at risk, however, are those who are at a higher risk of bacterial contamination: people who have sex, especially anal intercourse, without a condom, patients with a urinary tract infection, and people who have recently had an operation or a prostate biopsy bio.
Chronic abacterial prostatitis related inflammation.The symptoms of inflammatory non-bacterial prostatitis are very similar to 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 is high - this indicates inflammation of the prostate.
Chronic abacterial prostatitis or chronic pelvic pain syndrome that is not associated with inflammation.The symptoms also mimic acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in the sperm, prostate skeleton and urine - this indicates that the prostate is not inflamed.
With non-bacterial forms of prostatitis, it is far from always possible to find out what cause leads to the development of the disease. Risk groups are also difficult to define.
Asymptomatic inflammatory prostatitis.This form of the disease does not cause any discomfort. Most often, inflammation is discovered accidentally when the patient is being examined for other problems, such as infertility.
How prostatitis differs from prostate adenoma
In about 8% of men after age 40, the prostate begins to grow - this is known as prostate adenoma or benign prostatic hyperplasia. An overgrown prostate narrows the urethra, which can cause urination problems: going to the toilet too often or leaking urine. If there are symptoms of adenoma, some patients can assume that they have developed prostatitis.
While some of the symptoms of prostatic hyperplasia are actually similar to prostatitis, they are not the same. Prostatitis is inflammation of the prostate. And an adenoma is an age-related uncontrolled proliferation of prostate cells that is not associated with inflammation.
An adenoma can cause serious inconvenience. So if you are having trouble urinating, 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 generalized literature data, acute bacterial prostatitis occurs in 5-10% of cases worldwide and chronic bacterial prostatitis in 6-10% of cases. In addition, both variants of chronic abacterial prostatitis account for 80-90% of all disease cases.
If we do a massive microscopic examination of the prostate, after 40 years we will find certain signs of its inflammation in all men without exception. But it has nothing to do with a 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 immediate treatment. Therefore, I recommend that all patients with symptoms resembling prostatitis undergo a closer examination that will 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. Without consulting a urologist and special tests, it is impossible to distinguish one form of prostatitis from another and receive quality treatment. As part of the statutory health insurance, you can get an appointment with the urologist free of charge or make an appointment with a doctor in a private clinic.
The main task of a urologist to whom a patient suspected of having prostatitis came is to rule out other diseases of the prostate, for example, cancer, and to determine what form of the disease a person has. It is very important to differentiate chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen. Here's what a doctor should do to find out.
Ask the patient about symptoms and well-being.For more information, your doctor may suggest answering questions from a questionnaire called the chronic prostatitis symptom index. In some cases it makes sense to print out the questionnaire and fill it out in advance so as not to waste time at the appointment.
Do a physical exam.The doctor will examine the patient, paying special attention to the groin area. If there are swollen, painful lymph nodes in the groin area, it increases the likelihood that the body is actually inflamed. Typically, the exam includes a digital rectal exam, which allows the doctor to assess the size, shape, and condition of the prostate. The study helps understand whether the prostate is enlarged. If the gland is painful to the touch, it is most likely inflamed.
Can a digital rectal examination be dispensed with?
Digital rectal exam and prostate massage are not the most convenient procedures. In the case of acute inflammation, this can be painful. Some patients avoid these interventions so much that they fundamentally refuse to make an appointment with the urologist.
Digital rectal examination is a diagnostic method, but massage of the prostate through the rectum is carried out in order to obtain material for laboratory analysis - the secret of the prostate. If the secret cannot be obtained, the doctor can replace the analysis of the prostate secretion with either the analysis of the first urine portion or a urine sample from two and three glasses. These studies can be used to roughly determine where the problem area is in the urinary tract.
Sometimes, instead of this examination, a semen analysis is prescribed for the same purpose. It helps to understand if prostatitis is part of a male sex gland infection and provides information about the quality of the ejaculate. In addition, counting the number of leukocytes in the ejaculate enables the distinction between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If the patient has concerns about an upcoming digital exam or prostate massage, I recommend discussing it with your doctor. Perhaps the analysis of prostate secretion, which only requires its massage, can be replaced by a urine or semen analysis.
Order blood tests, urine, and prostate secretions.The diagnostic standard includes a microscopic examination of the prostate secretion, a general blood test, a general urinalysis with microscopy of the sediment, and a microbiological examination of urine and secretions of the prostate.
In microbiological examinations, the patient's biological material is placed on a nutrient medium and he can see which bacteria are growing on it - this is how you can clarify the diagnosis. In a private clinic you can take tests for money or free of charge as part of the statutory health insurance.
Other tests and exams - such as total blood prostate specific antigen (PSA) levels and transrectal prostate ultrasound (TRUS) - are usually not done if prostatitis is suspected. In some cases, TRUS of the prostate may show fibrosis, a scar, or foci similar to a malignant tumor, but such studies are not indicated in 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 when bacteria have nothing to do with it, drugs are needed to manage unpleasant symptoms of the disease.
Acute bacterial prostatitisStart treatment without waiting for the test results - this is called empirical antibiotic therapy. In this approach, antibiotics are prescribed based on knowing which germs are most likely to cause prostate infections.
As a rule, patients are prescribed antibacterial drugs that penetrate well into the tissues of the prostate and act on the "most popular" pathogens causing prostatitis and urinary tract infections.
Those who feel more or less normal and are treated at home are usually given antibiotics in pill form. And hospitalized patients with a high fever are more likely to be prescribed injectable antibiotics. With this treatment, most patients with acute prostatitis will have fever and pain relief two to six days after starting medication.
When the patient's temperature returns to normal and the signs of inflammation go away, the doctor may switch the patient from injections to tablets. The total duration of antibiotic treatment is usually around 2-4 weeks.
Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique. It used to be thought that it might help to release excess secretion that has built up in the gland, thereby reducing its swelling. However, today most experts agree that prostate massage should be avoided for bacterial prostatitis. Not only is this painful and useless, but it can also make the disease worse because the massage allows bacteria to get into neighboring, uninfected tissues.
Chronic bacterial prostatitisare also treated with antibiotics that target gram-negative bacteria. Fluoroquinolones are usually used for treatment - these antibiotics are considered to be fairly safe. However, if the doctor suspects that other microorganisms have caused the prostatitis, he can prescribe other antibacterial drugs without waiting for the test results.
With chronic prostatitis, antibiotics must be taken longer than with acute. According to the recommendations of urologists, they are prescribed over the course of 4-6 weeks.
Chronic abacterial prostatitisis not associated with bacteria, so antibiotics are prescribed to patients with this disease only if they have a urinary tract infection in addition to prostatitis.
Since it is not clear what exactly causes bacterial prostatitis, treatment is primarily aimed at relieving painful urination. To do this, doctors prescribe alpha-1 blockers, drugs that help relax the prostate muscles that compress the urethra. If the pain persists, your doctor may prescribe nonsteroidal anti-inflammatory drugs. The dosage for each patient is selected individually.
Some patients with abacterial prostatitis are helped by cognitive behavioral therapy - these are the names of the sessions with a psychologist in which a person learns to deal with pain without medication. At the same time, there is still no scientific evidence of the effectiveness of psychological help with abacterial prostatitis.
Studies trying to prove the effectiveness of other interventions such as acupuncture, electromagnetic stool therapy, prostate massage, or transrectal thermotherapy were poorly planned and took too little time - usually less than 12 weeks. So whether all this will help or not cannot be said.
How to avoid prostatitis: prevention
The main cause of discomfort in the prostate is a sedentary lifestyle and the lack of regular sex life. Doctors believe that the greatest chance of avoiding prostatitis is in men who:
- Have safe sex regularly.
- You do moderate exercise on a regular basis.
- Avoid hypothermia.
- From the age of 40, they are examined urologically every year.
Where is it better to treat prostatitis - in a public or private clinic
The most important thing is that the principles of evidence-based medicine are followed in the diagnosis and treatment of prostatitis. It just depends on the doctor - and it doesn't matter where exactly he works.
Unfortunately, doctors in private clinics do not always adhere to the standards of medical care. This can lead to overdiagnosis and unnecessary treatment, which puts the patient at risk of overpaying. A government medical organization is more likely to meet all diagnostic and treatment standards. However, patients must take into account that a full exam will take longer, sometimes much longer than a private clinic exam.
Notice
- Urinary tract problems in men are common, but not always the case with prostatitis. In order to understand what exactly is happening to a person, it is necessary to undergo a thorough examination.
- Prostate problems rarely lead to erectile dysfunction. Usually, with prostatitis, it weakens due to psychological problems that arise against the background of unpleasant symptoms.
- Not every form of prostatitis is caused by bacteria: in 80-90% they have nothing to do with it. If antibiotics are prescribed to a person with suspected prostatitis without additional testing, it is bad. Before taking it, it makes sense to consult another doctor.
- A person with acute or chronic prostatitis may be prescribed prostate massage to collect a glandular secretion for analysis.
- The best way to prevent prostatitis is safe sex, a healthy lifestyle, and a regular urological check-up by a doctor after 40 years.