A survey of residents of different countries showed that 2-10% of adult men experience symptoms that indicate prostate problems during their lifetime.
Any urinary disturbance is a wake-up call and in this case self-employment should be ruled out. However, problems are not always related to prostatitis.
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How the prostate works
The prostate, or prostate gland, is a walnut-like organ located below the bladder. Between the middle parts of the "walnut" passes the urethra - the tube through which urine is excreted from the bladder, and semen from the testicles.
The main task of the prostateConsists in the production of secretions that are part of the sperm. Thanks to this secret, sperm can move. The second task of the prostate is to compress, to ejaculate, or to ejaculate.
Next to the prostate are the seminal vesicles, which connect to the vas deferens, through which sperm leave the genitals. The seminal vesicles form 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 sperm that flows into the urethra from the testicles.
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 erection.
But urinary incontinence, discomfort from incomplete emptying of the bladder, inflammation-related pain or discomfort lead to the fact that the person feels 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 associated with pathogenic microbes or other non-infectious causes. Sometimes inflammation also affects the testicles - 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 related to inflammation of the gland.
To avoid confusion, urologists around the world use a classification by the American National Institute for Diabetes, Digestive and Kidney Diseases, or NIDDK.
For the sake of simplicity, the classification separates prostatitis into bacterial and non-bacterial, i. e. not related to bacteria. This approach helps doctors make important decisions - whether to prescribe antibiotics and additional medications. Giving antibiotics with suspected prostatitis is wrong for all patients because non-microbial forms of prostatitis are more common than bacterial ones. Taking too many antibiotics is bad for your health.
The NIDDK classification defines five forms of prostatitis.
Acute bacterial prostatitis.A disease most commonly caused by typical pathogens of urinary tract infections: e. g. , E. coli, Klebsiella, and Enterobacter.
Usually the disease starts suddenly and is accompanied by a general deterioration in well-being. The temperature rises to 38-39 ° C, some people have weakness, severe pain or burning in the perineum, scrotum or anus, lower abdomen and sometimes muscles. Some people experience pain during ejaculation. Frequent, difficult, and painful urination occurs sometimes during bacterial prostatitis.
Chronic bacterial prostatitis.This disease can also be caused by microbes characteristic of acute prostatitis. The disease is considered chronic if the symptoms last for at least three months.
The symptoms of chronic bacterial prostatitis are acute but may be less severe 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 the bladder completely. Moreover, the unpleasant symptoms may disappear temporarily and reappear after a while.
Any man can get acute and chronic bacterial prostatitis. But those who are most at risk are those who are at high risk for microbial exposure: those who have sex, especially anal sex, without a condom, patients with a urinary tract infection, and people who have recently had surgery or a prostate biopsy. .
Chronic bacterial prostatitis is associated with inflammation.The symptoms of inflammatory nonbacterial prostatitis are very similar to those of acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria in semen, 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 also include acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in semen, prostate skeleton and urine - this indicates that the prostate gland is not inflamed.
In the case of non-bacterial forms of prostatitis, it is always possible to find out the cause of the disease. Defining risk groups is also difficult.
Asymptomatic inflammatory prostatitis.This form of the disease does not cause discomfort. Most often, inflammation is discovered accidentally when a patient investigates other problems, such as infertility.
How is prostatitis different from prostate adenoma?
After about 40 years, prostate size increases in about 8% of men - this is called prostate adenoma or benign prostatic hyperplasia. The adult prostate muscle contracts and this can lead to urinary problems: a very frequent urge to use a toilet or urine leak. In the face of adenoma symptoms, some patients may assume that they have developed prostatitis.
While some of the symptoms of prostate hyperplasia may indeed 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.
An adenoma can cause serious discomfort, so if you have urinary problems, it is important to see a urologist as soon as possible. However, an adenoma is not yet as dangerous as prostatitis because it does not increase the risk of cancer.
How often is chronic bacterial prostatitis diagnosed?
According to the generalized literature data, acute bacterial prostatitis is found in 5-10% of cases in the world, and chronic bacterial prostatitis - in 6-10% of cases. Moreover, both variants of chronic bacterial prostatitis account for 80-90% of all cases of the disease.
If we conduct a massive microscopic examination of the prostate gland, after 40 years without exception we will find some signs of its inflammation in all men. But it has nothing to do with the diagnosis of chronic bacterial prostatitis.
There are many urological diseases that are hidden behind the mask of chronic prostatitis, some of them are quite serious and require immediate treatment. It is therefore recommended that all patients with prostatitis-like symptoms undergo a more detailed examination to clarify the diagnosis.
How is prostatitis diagnosed?
From the patient’s point of view, the symptoms of bacterial and non-bacterial prostatitis are very similar to each other. Without consulting a urologist and special tests it is impossible to distinguish one form of prostatitis from another and get quality treatment. You can make an appointment with a urologist for free with a compulsory health insurance policy or make an appointment with a doctor at a private clinic.
The main task of the urologist, which was seen by a patient with suspected prostatitis, is to rule out other diseases of the prostate, such as cancer, and to determine what form of the disease a person has. It is very important to distinguish chronic pelvic pain syndrome from confirmed or suspected pathogenic bacterial prostatitis. Here is 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 on a questionnaire called the Chronic Prostatitis Symptoms Index. In some cases, in order not to waste time on a date, it makes sense to print out a questionnaire and fill it out in advance.
Conduct a physical examination.The doctor will examine the patient, paying particular attention to the uterine area. If there are swollen, painful lymph nodes in the abdomen, this increases the likelihood of the body actually becoming inflamed. Typically, the test involves a digital examination of the rectum, which allows the doctor to assess the size, shape, and condition of the prostate. Research helps to understand whether there is an enlarged prostate. If the gland is painful to the touch, it is likely to be inflammatory.
It is possible to do this without a digital rectal examination
Digital examination of the rectum and prostate massage are not the most enjoyable procedures. In acute inflammation, it can be painful. Some patients are so eager to avoid these procedures that, in principle, they refuse to make an appointment with a urologist.
Digital rectal examination is a diagnostic method, but prostate massage is done through the rectum to obtain material for laboratory analysis - the secret of the prostate gland. If secretions cannot be obtained, the doctor may replace the prostate gland secretion analysis with either an analysis of the first part of the urine, or a two- and three-glass urine sample. These tests allow you to roughly determine where the urinary tract problem is.
Sometimes, instead of this test, a sperm test is prescribed for the same purpose. This helps to understand whether prostatitis is part of a male genital infection and provides information about the quality of the ejaculate. In addition, the count of leukocytes in the ejaculate allows us to distinguish between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If the patient is concerned about a future digital examination or prostate massage, I recommend that you discuss this with your doctor. Prostate secretion analysis, which requires only massage, may be replaced by urine or semen analysis.
Order blood tests, urine and prostate secretions.The diagnostic standard includes microscopic examination of prostate secretion, general blood test, general analysis of urine by sediment microscopy, as well as microbiological examination of urine and prostate secretion.
During microbiological examinations, the patient's biological material is placed in a nutrient medium and they see what bacteria are growing on it - this allows you to confirm the diagnosis. You can take the tests at a private clinic with cash or free compulsory medical insurance.
Other tests and examinations - for example, the concentration of total prostate specific antigen (PSA) in the blood and prostate transrectal ultrasound (TRUS) - are not usually done when prostatitis is suspected. In some cases, prostate TRUS may reveal fibrosis, or scar-like or malignant tumor-like foci, but such examinations 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, your doctor will prescribe antibiotics. If the bacteria have nothing to do with it, medications are required to deal with the unpleasant symptoms of the disease.
Acute bacterial prostatitisStart treatment without waiting for test results - this is called empirical antibiotic therapy. With this approach, antibiotics are prescribed to know which microbes are causing the prostate infections.
Patients are usually prescribed antibacterial drugs that penetrate well into the tissues of the prostate gland and act on the most "popular" causes of prostatitis and urinary tract infections.
People who feel more or less normal and treated at home usually take antibiotics in pills. And patients with high fevers who are treated in hospital are more often prescribed antibiotics by injection. In most patients with acute prostatitis during this treatment, the fever and pain will subside on the second to sixth day after starting the medication.
When the patient's temperature returns and the signs of inflammation disappear, the doctor can move the patient from the injections to the pill. The total duration of treatment with antibiotics is usually about 2-4 weeks.
Sometimes prostate massage is used not only as a diagnostic method but also as a therapeutic technique. It was once thought that it could help secrete excess secretion accumulated in the gland and thus reduce its swelling. However, today most experts have reached a consensus that prostate massage should be avoided during bacterial prostatitis. Not only is it painful and useless, but it can also worsen the course of the disease because as a result of the massage, bacteria can get into neighboring, uninfected tissues.
Chronic bacterial prostatitisThey are also treated with antibiotics aimed at Gram-negative bacteria. Fluoroquinolones are commonly used for treatment - these antibiotics are considered quite safe. But if your doctor suspects that other microorganisms have caused prostatitis, he or she may prescribe additional antibacterial drugs without waiting for the test results.
Chronic prostatitis requires taking antibiotics longer than acute. According to the recommendations of urologists, they are prescribed for 4-6 weeks.
Chronic bacterial 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 unclear what causes bacterial prostatitis, treatment is mainly aimed at relieving pain during urination. To do this, doctors prescribe alpha-1-blockers, medications that help relax the prostate muscles, which compress the urethra. If pain persists, your doctor may prescribe nonsteroidal anti-inflammatory drugs. The dose for each patient is selected individually.
Some patients with bacterial prostatitis are helped by cognitive-behavioral therapy - so-called sessions with a psychologist, during which a person learns pain without medication. At the same time, there is still no scientific evidence on the effectiveness of psychological help for bacterial prostatitis.
Studies in which researchers have tried to prove the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage or transrectal thermotherapy, were poorly planned and took very little time - usually less than 12 weeks. It is therefore impossible to say whether all this helps.
How to prevent prostatitis: prevention
The main cause of discomfort in the prostate gland is a sedentary lifestyle and lack of regular sex life. Doctors believe that men who: have the best chance of preventing prostatitis.
- Have safe sex regularly.
- They regularly exercise in moderation.
- Avoid hypothermia.
- Reaching the age of 40, they undergo annual urological examination.
Where is the best treatment for prostatitis - in a public or private clinic
Most importantly, the principles of evidence-based medicine are adhered to in the diagnosis and treatment of prostatitis. It just depends on the doctor - and it does not matter where exactly he works.
Unfortunately, doctors in private clinics do not always adhere to medical care standards. This can lead to over-diagnosis and over-treatment, so the patient will be overpaid. The probability of meeting all standards of diagnosis and treatment in a state medical organization is higher. But patients should be aware that a full examination will take more time, sometimes much longer than during a private clinic examination.
remember
- Urinary tract problems are common in men, but they do not always occur during prostatitis. To understand what is really happening to a person, you need to undergo a thorough investigation.
- Prostate problems rarely cause erection difficulties. Usually with prostatitis, it weakens due to psychological problems that arise against the background of unpleasant symptoms.
- Not all forms of prostatitis are caused by bacteria: in 80-90% they have nothing in common. If a person with suspected prostatitis is prescribed antibiotics without additional tests, it is bad. It makes sense 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 to maintain a healthy sex, lifestyle and after 40 years - regular urological examination by a doctor.