A survey of residents of several countries showed that 2 to 10% of adult men experience symptoms that suggest problems with the prostate during their lifetime.
Any urinary disorder is a wake-up call, and in this case self-medication should be ruled out. However, problems are not always associated with prostatitis.
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How does the prostate work?
The prostate, or prostate gland, is a walnut-like organ located just below the bladder. Between the halves of the "nut" passes the urethra, a tube through which urine from the bladder and sperm from the testicles are excreted.
The key task of the prostateIt consists of the production of a secret that is part of the semen. Thanks to this secret, sperm can move. The second task of the prostate is to contract, allowing ejaculation, that is, ejaculation.
Next to the prostate there are seminal vesicles connected to the vas deferens, through which sperm leave the genitals. The seminal vesicles produce the liquid portion of semen and store the prostate secretion.
The secret of the prostate is a mixture of citric acid and enzymes. This fluid dilutes the semen, which flows into the urethra from the testicular vas deferens.
Prostate problems don't 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.
But discomfort when urinating, discomfort from incomplete emptying of the bladder, pain or discomfort associated with inflammation, lead to the fact that a person begins to feel nervous and shy. Because of this, psychological problems arise; as a rule, they are the ones that negatively affect the erection.
What is prostatitis
Prostatitis is an inflammation of the prostate gland that is associated with pathogenic microbes or other non-infectious causes. Sometimes the 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 urination problems, 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, or NIDDK.
To simplify a bit, the classification divides prostatitis into bacterial and abacterial, that is, not associated with bacteria. This approach helps doctors make an important decision: whether to prescribe additional antibiotics and medications. Giving antibiotics to all patients with suspected prostatitis is wrong because 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 most often caused by pathogens typical of urinary tract infections: for example, E. coli, Klebsiella, and Enterobacter.
As a rule, the disease begins unexpectedly and is accompanied by a general deterioration in well-being. The temperature rises to 38-39 ° C, and some people experience weakness, severe pain, or burning in the perineum, scrotum, or anus, in the lower abdomen, and sometimes in the muscles. Some people experience pain during ejaculation. Sometimes with bacterial prostatitis, urination is frequent, difficult, and painful.
Chronic bacterial prostatitis.This disease can also be caused by microbes typical of acute prostatitis. The disease is considered chronic if the symptoms last at least three months.
The symptoms of chronic bacterial prostatitis are similar to those of acute, but they can be less severe or less severe. Fever and weakness are usually absent, pain in the lower abdomen is more painful than sharp, but it is difficult to start urinating and completely empty the bladder. Also, unpleasant symptoms may temporarily disappear and, after a while, reappear.
Any man can get both acute and chronic bacterial prostatitis. But those most at risk are those at the highest risk of exposure to germs: those who have sex, especially anal sex, without a condom, patients with a urinary tract infection, and people who have recently undergoneto surgery or a prostate biopsy. .
Chronic abacterial prostatitis associated with inflammation.The symptoms of non-bacterial inflammatory prostatitis are very similar to those of acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria in the semen, prostate skeleton and urine, but the concentration of leukocytes will be high, indicating inflammation of the prostate gland.
Chronic abacterial prostatitis or chronic pelvic pain syndrome, 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 semen, the skeleton of the prostate and urine, indicating that the prostate gland is not inflamed.
In the case of non-bacterial forms of prostatitis, it is not 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 of the time, inflammation is discovered by chance when the patient is examined for other problems, such as infertility.
How is prostatitis different from prostate adenoma?
In about 8% of men after age 40, the prostate begins to enlarge; This is called a prostate adenoma or benign prostatic hyperplasia. An overly large prostate constricts the urethra and, because of this, problems urinating can begin: too frequent a need to use the bathroom or leakage of urine. When faced with adenoma symptoms, some patients may assume that they have developed prostatitis.
While some of the symptoms of prostatic hyperplasia may resemble prostatitis, they are not the same. Prostatitis is an inflammation of the prostate gland. And an adenoma is an age-related uncontrolled proliferation of prostate cells that is not associated with inflammation.
Adenoma can cause serious inconvenience, so if you have 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 data from the generalized literature, worldwide, acute bacterial prostatitis occurs in 5-10% of cases and chronic bacterial prostatitis - in 6-10% of cases. Furthermore, both variants of chronic abacterial prostatitis account for 80-90% of all cases of the disease.
If we perform a massive microscopic examination of the prostate gland, we will find certain signs of its inflammation in all men without exception after 40 years. But 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 them are quite serious and require immediate treatment. Therefore, I recommend that all patients with prostatitis-like symptoms undergo a more detailed examination, which 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 with a urologist and special tests, it is impossible to distinguish one form of prostatitis from another and receive quality treatment. You can make an appointment with a urologist for free under the compulsory health insurance policy or make an appointment with a doctor in a private clinic.
The main task of a urologist, to whom a patient with suspected prostatitis came, is to exclude other diseases of the prostate, for example, cancer, and to determine what form of the disease a person has. It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen. This is what a doctor must do to solve it.
Ask the patient about symptoms and well-being.To gather more information, your doctor may suggest answering questions from a questionnaire called the Chronic Prostatitis Symptom Index. In some cases, in order not to waste time on the appointment, it makes sense to print the questionnaire and complete it in advance.
Perform a physical exam.The doctor will examine the patient, paying particular attention to the groin area. If there are swollen and painful lymph nodes in the groin, this increases the likelihood that the body is actually inflammatory. The exam usually includes a digital rectal exam, which allows the doctor to assess the size, shape, and condition of the prostate. The study helps to understand if the prostate is enlarged. If the gland hurts to touch, it is most likely inflamed.
Is it possible to do without a digital rectal exam?
Digital rectal exam 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 initially refuse to make an appointment with a urologist.
The digital rectal examination is a diagnostic method, but a massage of the prostate gland is performed through the rectum to obtain material for laboratory analysis - the secret of the prostate gland. If the secret cannot be obtained, the doctor may replace the analysis of the secretion of the prostate gland with the analysis of the first portion of urine or a urine sample of two and three glasses. These studies allow you to determine roughly where the problem area is in the urinary tract.
Sometimes, instead of this test, a semen analysis is prescribed for the same purpose. It helps to understand if prostatitis is part of male genital gland infections and provides information on the quality of ejaculation. In addition, the leukocyte count in the ejaculate makes it possible to differentiate between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If the patient is concerned about an upcoming digital exam or prostate massage, I advise you to discuss it with your doctor. Perhaps the analysis of the secretion of the prostate, to obtain what only its massage requires, can be replaced by a urine or semen analysis.
Request tests of blood, urine, and prostate secretions.The diagnostic standard includes a microscopic examination of the secretion of the prostate gland, a general blood test, a general analysis of urine with sediment microscopy, as well as a microbiological examination of the urine and secretions of the prostate gland.
During microbiological studies, the patient's biological material is placed in a nutrient medium and they see which bacteria grow on it; this allows you to clarify the diagnosis. You can take the tests in a private clinic for money or free of charge under the mandatory health insurance.
Other tests and examinations, such as total prostate-specific antigen (PSA) concentration in the blood and transrectal ultrasound of the prostate (TRUS), are usually not done if prostatitis is suspected. In some cases, TRUS of the prostate may reveal fibrosis, that is, a scar or foci similar to a malignant tumor, 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 select antibiotics. And if bacteria have nothing to do with it, medications will be needed to help cope with the unpleasant symptoms of the disease.
Acute bacterial prostatitisstart treating without waiting for test results; this is called empirical antibiotic therapy. With this approach, antibiotics are prescribed based on knowing which germs are most likely to cause prostate infections.
As a general rule, patients are prescribed antibacterial drugs that penetrate well into the tissues of the prostate gland and act on the most "popular" causative agents of prostatitis and urinary tract infections.
Those who feel more or less normal and are treated at home usually receive antibiotics in pill form. And patients with high fever who are treated in the hospital are more likely to be prescribed antibiotics by injection. With this treatment, in most patients with acute prostatitis, fever and pain are relieved between the second and sixth day after starting the medication.
When the patient's temperature returns to normal and the signs of inflammation disappear, the doctor can transfer the patient from injections to pills. The total duration of antibiotic treatment is usually about 2 to 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 release excess secretions accumulated in the gland and thus reduce its swelling. However, today most experts have reached a consensus that prostate massage should be avoided for bacterial prostatitis. This is not only painful and useless, but it can also worsen the course of the disease, because as a result of massage, bacteria can enter neighboring uninfected tissues.
Chronic bacterial prostatitisthey are also treated with antibiotics that attack gram-negative bacteria. For treatment, fluoroquinolones are generally used; these antibiotics are considered quite safe. But if the doctor suspects that other microorganisms have caused the prostatitis, he can prescribe additional antibacterial drugs without waiting for the test results.
With chronic prostatitis, antibiotics must be taken longer than with acute prostatitis. According to the recommendations of urologists, they are prescribed in a 4-6 week course.
Chronic abacterial prostatitisIt is not associated with bacteria, so patients with this disease are prescribed antibiotics only if, in addition to prostatitis, they have a urinary tract infection.
Since it is not clear what exactly causes bacterial prostatitis, treatment is primarily aimed at relieving pain when urinating. To do this, doctors prescribe alpha-1 blockers, drugs that help relax the muscles of the prostate that compress the urethra. If the pain persists, your doctor may prescribe nonsteroidal anti-inflammatory drugs. The dose for each patient is selected individually.
Some patients with bacterial prostatitis receive help from cognitive-behavioral therapy - this is the name of sessions with a psychologist, during which a person learns to cope with pain without medication. At the same time, there is still no scientific evidence of the effectiveness of counseling for bacterial prostatitis.
Studies in which researchers tried to demonstrate the efficacy of other interventions, such as acupuncture, chair electromagnetic therapy, prostate massage, or transrectal thermotherapy, were poorly planned and took very little time, usually less than 12 weeks. So it's impossible to say whether or not all of this helps.
How to avoid prostatitis: prevention
The main reason for discomfort in the prostate gland is a sedentary lifestyle and the lack of a regular sexual life. Doctors believe that the best chances of avoiding prostatitis are found in men who:
- Have safe sex regularly.
- They get regular moderate exercise.
- Avoid hypothermia.
- Having turned 40, they undergo a urological examination every year.
Where is it better to treat prostatitis, in a public or private clinic?
Most importantly, 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 meet health care standards. This can lead to overdiagnosis and unnecessary treatment, putting the patient at risk of overpaying. In a state medical organization, the probability of meeting all diagnostic and treatment standards is higher. But patients should be aware that a full exam will take longer, sometimes much longer than during an exam in a private clinic.
Remember
- Problems with the urinary tract in men are common, but this is not always the case with prostatitis. To understand what exactly is happening to a person, you need to undergo a thorough examination.
- Prostate problems rarely lead to erection difficulties. Usually with prostatitis, it is weakened due to psychological problems that arise against the background of unpleasant symptoms.
- Not all forms of prostatitis are caused by bacteria: 80-90% have nothing to do with them. If a person with suspected prostatitis is prescribed antibiotics without further testing, this is bad. Before taking them, it makes sense to consult with another doctor.
- A person with acute or chronic prostatitis may be prescribed a prostate massage to collect a glandular discharge for analysis.
- The best way to prevent prostatitis is to have safe sex, a healthy lifestyle, and after 40 years, a regular urological exam by a doctor.