A survey of residents in different countries found that 2-10% of adult men experience symptoms that suggest prostate problems in their lifetime.
Any urinary disorder is waking up, in which case self-medication should be ruled out. However, problems are not always associated with prostatitis.
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How the prostate works
The prostate or prostate gland is a nut-like organ located just below the bladder. Between half of the "nut" passes the urethra - a tube through which urine is excreted from the bladder and sperm from the testicles.
The most important function of the prostateit consists in the production of a secret which forms part of the semen. Thanks to this secret, sperm are able to move. The second function of the prostate is to allow contraction, ejaculation, or ejaculation.
In addition to the prostate, there are seminal vesicles connected to the iron deferens, through which sperm leaves the genitals. The nuclei produce the liquid part of the sperm and store the secretion of the prostate.
The secret of the prostate is a mixture of citric acid and enzymes. This fluid dilutes the sperm that flows from the iron deferents of the testes into 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 mechanism of the erection.
But upset urine, discomfort from incomplete bladder emptying, pain or discomfort with inflammation lead to a person feeling nervous and shy. This causes psychological problems - usually the ones that negatively affect erections.
What is prostatitis
Prostatitis is an inflammation of the prostate gland that is associated with pathogenic microbes or other non-infectious causes. Inflammation also affects the bladders of the nucleus - this is called vesiculitis.
However, inflammation of the prostate gland does not always lead to pain and urination problems, and the presence of unpleasant symptoms is not necessarily associated with inflammation of the gland.
To avoid misunderstandings, urologists around the world use the classification recommended by the American National Institute for the Study of Diabetes Mellitus, Gastrointestinal and Kidney Diseases, or the NIDDK.
To put it a little simpler: the classification divides prostatitis into bacterial and abstract, that is, it is not associated with bacteria. This approach helps doctors make an important decision - whether to prescribe antibiotics and additional medications. The administration of antibiotics to all patients with suspected prostate suspicion is incorrect because non-microbial forms of prostatitis are more common than bacterial ones. Taking unnecessary antibiotics is harmful to health.
The NIDDK classification identifies five forms of prostatitis.
Acute bacterial prostatitis.A disease most commonly caused by typical pathogens of urinary tract infections, such as E. coli, Klebsiella, and Enterobacter.
As a general rule, the disease begins unexpectedly and is associated with a general deterioration in well-being. The temperature rises to 38-39 ° C, some people feel weakness, severe pain or burns 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 characterize acute prostatitis. The disease is considered chronic if the symptoms last for at least three months.
The symptoms of chronic bacterial prostatitis are similar to those of acute, but may be less severe or less severe. Fever and weakness are usually absent, lower abdominal pain hurts rather than sharp, but it is difficult to start urinating and empty the bladder completely. Moreover, the unpleasant symptoms may temporarily disappear and reappear after a while.
Any person can get acute and chronic bacterial prostatitis. But those most at risk are those who are at higher risk for exposure to germs: those who have sex, especially anal sex, do not use condoms, patients with urinary tract infections, and have recently undergone surgery or prostate biopsy.
Chronic inflammatory prostatitis with inflammation.The symptoms of inflammatory, non-bacterial prostatitis are very similar to acute and chronic bacterial prostatitis. However, 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 bacterial prostatitis or chronic pelvic pain syndrome that is not associated with inflammation.Symptoms mimic both acute and chronic bacterial prostatitis. However, there are no pathogenic bacteria and high levels of leukocytes in the semen, prostate skeleton, and urine - indicating that the prostate is not inflamed.
For non-bacterial forms of prostatitis, it is by no means always possible to figure out what is causing the disease. Risk groups are also difficult to define.
Asymptomatic inflammatory prostatitis.This form of the disease does not cause discomfort. Inflammation is most often accidentally discovered when a patient is examined for other problems, such as infertility.
How is prostatitis different from prostate adenoma
Men are approx. In 8% of people over the age of 40, the prostate grows - this is called prostate adenoma or benign prostatic hyperplasia. An overgrown prostate constricts the urethra, which can cause urinary problems: too frequent cravings to use the toilet or leaking urine. Faced with the symptoms of adenoma, some patients may assume that they have developed prostatitis.
While some of the symptoms of prostatic hyperplasia may indeed resemble prostatitis, they are not the same. Prostatitis is an inflammation of the prostate gland. And adenoma is an age-related, uncontrolled proliferation of prostate cells that is not accompanied by inflammation.
Adenoma can cause severe discomfort, so if you have problems urinating, it is important to see a urologist as soon as possible. However, adenoma is still not as dangerous as prostatitis because it does not increase the risk of cancer.
How often are chronic bacterial prostatitis diagnosed?
According to generalized literature data, acute bacterial prostatitis occurs in 5-10% of cases and chronic bacterial prostatitis in 6-10% of cases worldwide. Moreover, 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, after 40 years we will find certain signs of inflammation in all men without exception. However, this has nothing to do with the diagnosis of chronic bacterial prostatitis.
Many urological diseases can be hidden behind the mask of chronic prostatitis, some of which require quite severe and immediate treatment. Therefore, I recommend that all patients with symptoms similar to prostatitis have a more detailed examination that clarifies 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 consultation with a urologist and special tests, it is impossible to differentiate one form of prostatitis from another and receive quality treatment. Under the compulsory health insurance policy, you can get an appointment with a urologist for free or make an appointment with a doctor at a private clinic.
The main task of a urologist who is approached by a patient with a suspected prostate is to rule out other diseases of the prostate, such as cancer, and to determine what disease the person is suffering from. It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis, the pathogen of which has been confirmed or suspected. The doctor has to do it to figure it out.
Ask the patient about symptoms and well-being.To gather more information, your doctor may suggest answering the questions in a questionnaire called Symptoms of Chronic Prostatitis. In some cases, in order not to waste time in the meeting, it makes sense to print out the questionnaire and fill it out in advance.
Perform a physical examination.The doctor examines the patient, paying particular 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 exam includes a digital rectal examination that allows the physician to assess the size, shape, and condition of the prostate. The study will help you understand if your prostate is enlarged. If touching the gland is painful, it is probably inflamed.
Can it be done without digital rectal examination
Digital rectal examination and prostate massage are not the most pleasant procedures. This can be painful in acute inflammation. Some patients are so reluctant to avoid these procedures that they are in principle unwilling to make an appointment with a urologist.
Digital rectal examination is a diagnostic method, but we perform a rectal massage of the prostate gland in order 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 prostate secretions with either an analysis of the first part of the urine or a two- and three-glass urine sample. These studies make it possible to roughly determine where the problem area of the urinary tract is located.
Sometimes, instead of this test, sperm analysis is prescribed for the same purpose. It helps to understand whether prostatitis is part of a male gonadal infection and provides information about the quality of the ejaculate. In addition, the counting of leukocytes in the ejaculate makes it possible to distinguish between the inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If a patient is concerned about an upcoming digital examination or prostate massage, I advise you to discuss this with your doctor. Perhaps the analysis of prostate secretion, which requires only massage to obtain it, can be replaced by urine or sperm analysis.
Order blood tests, urine and prostate secretions.The diagnostic standard includes microscopic examination of prostate gland secretions, general blood tests, general analysis of urine with sediment microscopy, and microbiological examination of urine and prostate gland secretions.
In microbiological tests, the patient's biological material is placed on a medium and they see what bacteria are growing on it - this allows the diagnosis to be clarified. You can take tests at a private clinic for money or for free under compulsory health insurance.
Other tests and examinations, such as total blood levels of prostate-specific antigen (PSA) and transrectal ultrasound of the prostate (TRUS), are not usually performed if prostatitis is suspected. In some cases, prostate TRUS may detect fibrosis, a scar or foci similar to a malignancy, but such tests are not recommended for all patients without exception.
How is prostatitis treated?
Treatment depends on the type of prostatitis. If the inflammation is provoked by bacteria, the doctor will choose antibiotics. And if the bacteria have nothing to do with it, you will need medications to help you cope with the unpleasant symptoms of the disease.
Acute bacterial prostatitiswithout waiting for the test results, they start treatment - this is called empirical antibiotic therapy. With this approach, antibiotics are identified based on which germ causes the most 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 pathogens of prostatitis and urinary tract infections.
People who feel more or less normal and are treated at home usually receive tablets in antibiotics. Patients with high fever who are treated in hospital are more likely to be prescribed antibiotics by injection. With this treatment, most patients with acute prostatitis relieve fever and pain on the second to sixth day after starting the drug.
When the patient's temperature returns to normal and the signs of inflammation disappear, the doctor can transfer the patient from the injections to the tablets. 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 this could help release excess mucus that had accumulated in the gland and thus reduce its swelling. Today, however, most experts have agreed that prostate massage should be avoided in cases of bacterial prostatitis. This is not only painful and useless, but can also worsen the course of the disease because as a result of the massage, bacteria can enter adjacent, uninfected tissues.
Chronic bacterial prostatitisGram-negative bacteria are also treated with targeting antibiotics. Fluoroquinolones are commonly used for treatment - these antibiotics are considered quite safe. But if your doctor suspects that other microorganisms have caused prostatitis, you can prescribe additional antibacterial medications without waiting for the test results.
In case of chronic prostatitis, antibiotics should be taken for a longer time than in acute cases. They are prescribed for 4-6 weeks according to the recommendations of urologists.
Chronic bacterial prostatitisit is not related to bacteria, so patients with this disease are only prescribed antibiotics if they have a urinary tract infection in addition to prostatitis.
Because it is not clear what exactly causes abdominal prostatitis, treatment is primarily aimed at relieving pain during urination. To do this, doctors prescribe alpha-1-blockers, which prescribe drugs that help relax the prostate muscles that compress the urethra. If the pain persists, your doctor may prescribe non-steroidal anti-inflammatory drugs. The dosage of each patient is chosen individually.
For some patients with abstraction prostatitis, cognitive behavioral therapy helps - this is the name of a session with a psychologist during which a person learns to cope with pain without medication. However, there is still no scientific evidence for the effectiveness of psychological help in bacterial prostatitis.
Studies in which researchers tried to demonstrate the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal heat therapy, were poorly designed and required too little time — usually less than 12 weeks. So it’s impossible to tell if it all helps or not.
How to avoid prostatitis: prevention
The main reasons for prostate discomfort are a sedentary lifestyle and a lack of regular sex life. Doctors believe that the greatest chance of avoiding prostatitis is in men who:
- Have safe sex regularly.
- They exercise regularly in moderation.
- Avoid hypothermia.
- After reaching the age of 40, they undergo a urological examination every year.
Where is better to treat prostatitis - in a public or private clinic
Most importantly, the principles of evidence-based medicine should be followed in the diagnosis and treatment of prostatitis. It just depends on the doctor - and it doesn’t matter exactly where you work.
Unfortunately, doctors in private clinics do not always adhere to standards of medical care. This can lead to overdiagnosis and unnecessary treatment, so the patient is at risk of overpaying. A public medical organization is more likely to adhere to all norms of diagnosis and treatment. But patients need to keep in mind that a full study takes more time, sometimes much more than a study in a private clinic.
Remember
- Urinary problems in men are common, but not always in prostatitis. To understand exactly what is happening to a person, you need to go through a thorough investigation.
- Prostate problems rarely lead to erectile dysfunction. Usually, prostatitis is weakened by the psychological problems that underlie the unpleasant symptoms.
- Not all forms of prostatitis are caused by bacteria: 80-90% have nothing to do with it. If antibiotics are prescribed without further investigation if prostatitis is suspected, this is bad. It is advisable to consult another doctor before taking them.
- A person with acute or chronic prostatitis may be prescribed a prostate massage to collect glandular secretions for analysis.
- The best way to prevent prostatitis is the protected sex, a healthy lifestyle, and after 40 years - a regular urological examination by a doctor.