What are the signs of chronic prostatitis. Distinctive signs and methods of treatment of prostatitis at different stages. Causes of the disease

Both the penetration of pathogenic microorganisms into its tissues and the wrong lifestyle lead to the development of inflammation of the prostate gland. The latter cause is more common, although there is a relationship between both factors. After all, infectious pathogens attack the body precisely when it is more weakened.

Prostatitis is considered the most common problem in male urology. Sometimes the cause of the disease lies in the organ itself, but often changes occur due to the influence of certain factors. Here is some of them:

General symptoms

A prerequisite for the appearance of the disease is the inflammatory process that occurs in the excretory ducts. As a result, there is an accumulation of mucus and small stones in the channels, which begin to fester. The man is in pain. Sometimes the signs of prostatitis are barely noticeable or insignificant at an early stage.

The course of the disease is different for all men. Some patients in the early stages felt only mild discomfort in the lower abdomen and perineum. In most cases, the symptoms of the disease are characterized by the following manifestations:

• Difficulty urinating as the enlarged prostate presses on the excretory ducts.

Frequent urge, sensation of incomplete release of the bladder.

• Sexual disorder, as a result of which erectile function is impaired.
• Urine contains white flakes and pus.
• Discomfort during defecation.
• Cutting pains when urinating.

Symptoms will differ depending on the form of the disease. Inflammation of the prostate gland can be acute and chronic.

For the acute form, general symptoms are typical. The patient feels weakness and pain in the groin, especially during urination. The urge to go to the toilet is frequent and difficult. Along with this, the temperature rises. Cases of early detection of the disease are very rare, so it quickly acquires a protracted course.

The chronic form often proceeds without pronounced signs. Pathology causes discomfort in the perineum and lower back, and pain during urination is weak and quickly passing. There are problems in sexual life: untimely ejaculation, decreased sexual desire. Such changes in the body seem to be erased, and few people attach importance to them. But if you ignore these symptoms, the disease progresses and leads to complications: cystitis, vesiculitis, infertility, impotence.

As a result of inflammation, nerve endings are irritated, which is why the patient urinates in small portions even at night. Rarely there is complete retention of urine. Such a manifestation should be alarming, it is necessary without delay to consult a doctor. After all, it is he who will be able to correctly diagnose the disease and choose the treatment.

The consequences are irreversible, since the listed symptoms can be caused by diseases such as adenoma or prostate cancer.

Stages of prostatitis and their signs

Sometimes the pathology is very difficult to recognize, because it does not manifest itself in any way. And the transition to different stages makes the disease more or less noticeable. There are three stages of prostatitis in men, which have a peculiar character:

Stages	Characteristic	Symptoms
The first	Inflammation in the prostate gland is just beginning and at the same time regeneration of its tissues occurs.	1. The pressure of the urine stream is weakened. 2. Discharge appears from the urethra. 3. Discomfort in the anus. 4. Pain in the perineum and testicles. 5. Erection decreases.
Second	Symptoms of inflammation become less pronounced than at the beginning. Patients mistakenly conclude that the disease has receded. The structure of the prostate changes as scars appear on it.	1. Erectile function is disturbed. 2. Irritability. 3. Quick fatigue. 4. Concomitant diseases appear: sciatica, vegetative-vascular dystonia, heart failure.
Third	The resulting scars increase, the soft tissues of the prostate gland change or their necrosis occurs. There is pressure on the bladder.	1. Frequent and unbearable urge to urinate due to severe pain. 2. Even after the toilet there is a feeling of a full bladder.

The initial stage of the development of prostatitis has the following symptoms: weak urine pressure, decreased libido, discomfort in the groin and during ejaculation. This stage may continue for several years. The acute course of the disease is characterized by four phases of clinical development:

• Catarrhal. The mucous membrane of the male organ is enlarged, painful and swollen.

Its excretory ducts change.

• Follicular. The walls of the ducts swell, which leads to stagnation of the mucopurulent secretion.

In the prostate follicle, suppuration of the lobules occurs, the ducts become clogged.

• Parenchymal. Small pustules form into an abscess of the prostate gland.

The focus of infection becomes a source of intoxication for the whole organism.

• Abscessing. The resulting abscess spreads, affecting neighboring organs.

There is inflammation of the posterior urethra.

The course of follicular and parenchymal forms is accompanied by modifications of the neck of the bladder and the back of the urethra.

Urologists distinguish only two stages of chronic prostatitis: exacerbations and remissions, but this does not diminish their significance. The appearance of relapses is explained by the fact that the acute form of the pathology was launched, the man did not start treatment on time, or it was incorrectly selected.

During periods of exacerbation, the disease has pronounced symptoms: severe pain in paired organs, fever, discharge from the urethra in the morning, often problematic deurination, increased fatigue and sweating, wrinkling of the unpaired gland. In this case, the control of the attending physician is mandatory.

With the onset of the remission phase, the patient shows improvement. Symptoms either completely disappear, or partially. Usually this stage of the chronic course of the pathology does not require special therapy.

Sometimes patients stop being treated because of the latent course of the disease, since nothing bothers them. But after some time, the problem may return again, so during remission, a regular visit to the doctor and a set of preventive actions are still necessary.

Establishing diagnosis

To correctly establish the diagnosis, the urologist examines the clinical picture. The characteristic signs of pathology simplify the definition of both its acute and chronic forms. With suspicious symptoms, a study of the prostate through the rectum is mandatory. Thanks to palpation, the doctor determines the soreness, consistency of the prostate gland and its symmetry.

The sampling of the secret of the prostatic gland is examined. This helps detect low lecithin levels. A general analysis of urine and blood in an acute form should show a high content of leukocytes.

When there is a need to identify structural changes (tumors, metastases, cysts, adenoma), a transrectal (through the rectum) ultrasound is performed, and in case of pain - transabdominally (through the abdomen). Such an examination helps to confirm the conclusion and see if there is another pathology of the urinary system with similar symptoms. This diagnostic method will show the size of the organ, whether its structure is homogeneous, whether there are stones in the presence. In addition to other research methods, when planning surgical treatment, some doctors consider it appropriate to perform an MRI.

The doctor must find out from the patient how long the pain lasts. If three months or more - the pathology has passed into the chronic stage. Additional studies of changes occurring in the male gland will help an experienced specialist see a clear clinical picture and treat the patient with an effective remedy.

Features of therapy

Good results and prognosis are given by the treatment of the initial stage of prostatitis. The patient has a good chance of recovery. Thanks to a complex of laboratory tests, the cause and degree of development of the disease becomes clear. If inflammation is provoked by an infection, antibiotics are prescribed. For efficiency, first, a culture is made on the sensitivity of the microflora to therapeutic agents.

With a disease of a congestive nature, drugs are recommended that improve blood circulation in the pelvic region of a man. In addition to the main treatment at the initial stage of inflammation, physiotherapy and prostate massages are used to increase the tone of its muscles.

Sometimes therapy includes a complex of painkillers, antispasmodics, diuretics. Their use is recommended based on symptoms. Thanks to the healing actions of soothing herbs, you can quickly achieve the expected results.

Traditional medicines are considered highly effective. To restore men's health, it is recommended to include in the diet a list of the following products: pumpkin seeds, parsley, cabbage, asparagus, propolis.

Treatment of the chronic stage lasts longer and more difficult, especially when the causes of the disease are not so obvious. Often, bacteria from the urinary tract enters the prostate with urethritis. The process does not have an exact picture, it develops hardly noticeably. Therefore, therapy should focus on the primary infection.

In a chronic course, the patient should be treated in close cooperation with the doctor. In most cases, therapy is similar to the initial stage of the disease. The treatment regimen is often complex, which may include: antibacterial, antispasmodic, vasodilator, immunostimulating agents.

Possible consequences

With improper treatment or its long absence, undesirable consequences are inevitable. The function of the prostate is aimed at producing the necessary secret, which is part of the sperm. Due to inflammation, the prostate gland increases in size, the urethra, seminal ducts are clamped, blood flow is disturbed, and the characteristics of spermatozoa deteriorate. The consequences of prostatitis can be: problems in sexual life up to impotence, dysuric syndrome, infertility.

After the acute nature of the course, the risk of a purulent abscess, which is removed by surgery, increases. Chronic disease will also leave its mark on the body. In this situation, the consequence may be a loss of organ functionality, which leads to its sclerosis, the development of cystitis or pyelonephritis, prostate adenoma.

Prevention

As studies progress, scientists conclude that the exact cause of the pathology is unknown. Perhaps heredity and hormonal processes play a role. Fortunately, two risk factors - poor nutrition and lack of physical activity - can be controlled by everyone. Moderate exercise for the body increases blood circulation in the pelvis, which prevents congestion.

A man needs to make lifestyle changes. You should reduce the consumption of spices, smoked meats, alcoholic beverages and foods high in carbohydrates and animal fats. Such food tends not only to irritate the mucous membrane of the genitourinary system, but also to slow down blood circulation in the urinary area. Abstaining from beer leads to a full sexual life, since in its composition the intoxicating drink contains phytoestrogen, which suppresses sexual function. You need to enrich your daily menu with vegetables, fruits, legumes, cereals, pasta, herbal teas.

A routine check-up can sometimes save a life. An annual urological examination helps to identify not only prostate adenoma at an early stage, but also prostatitis, which will allow the use of more gentle methods of therapy. An orderly sex life protects a man from sexually transmitted diseases, which can also cause this disease.

Unfortunately, more and more often young men, and sometimes even teenagers, are diagnosed with chronic.

It is a consequence of frequent inflammation of the prostate gland and the transition to a chronic latent form.

The disease is characterized by a long development with an uncharacteristic, which is usually blurred or virtually absent. Although it is believed that chronic prostatitis inevitably occurs against the background of the acute stage, in practice this form of the disease is often detected by chance during routine examinations.

The symptomatology of the disease depends on the nature of the inflammatory process, the duration of the disease, on the degree of damage to neighboring organs, on. Also, an important role is played by what lifestyle (active or passive) a man leads.

Causes that provoke the occurrence of a chronic form of the disease:

• infection of the genitourinary system and prostate gland (ureaplasmosis, chlamydia, candidiasis, mycoplasmosis, gonococcal and herpesvirus infection);
• violation of blood flow in the pelvis, which leads to;
• decreased immunity of various etiologies;
• hypodynamia and inactive, sedentary work;
• irregular intimate life, interruption of sexual intercourse without orgasm;
• overwork, injury and damage;
• abuse of alcohol and spicy foods;
• retention of urination and violation of the stool ().

All these causes lead to congestion and inflammation. They contribute to the penetration of infections, and this can lead to complications, as well as impotence and complete infertility.

Chronic prostatitis is divided into three main types:

• bacterial, in which an infection is detected;
• when there is no pathogenic microflora in the secret;
• prostatodynia, when symptoms characteristic of the chronic form of prostatitis are present, but pathological changes in the secretion of the prostate are not detected (this is called chronic pelvic pain syndrome).

Symptoms of chronic prostatitis:

• pain and cutting in the rectum during bowel movements;
• and the inability to completely empty the bladder;
• decrease and erections;
• pulling sensations in the sacral and inguinal region;
• dullness of sensations or their complete absence during orgasm.

There is also an asymptomatic form of the disease. Often, it does not manifest itself for a long time and is determined by the results, as well as in laboratory studies of the secretion of the prostate gland.

If at least one of the signs appears, a man should consult a doctor and undergo those examinations that he will prescribe.

How to cure chronic prostatitis?

Treatment of chronic prostatitis is one of the most difficult tasks facing modern medicine.

The disease proceeds in a latent form and is not always detected at the initial stage.

Men go to the doctor when symptoms of exacerbation with complications appear. Therefore, treatment depends on the phase of the disease, the degree of bacterial or viral damage and the nature of the pathological process.

To completely cure the patient, you need to spend a whole. This is the only way to achieve positive results.

Effective drugs and the scheme of their use

For the treatment of bacterial chronic prostatitis, they are used that can suppress pathogenic microflora.

So, antibacterial drugs of such groups as fluoroquinolones (, Moxifloxacin), macrolides (Erythromycin, Spiramycin), tetracyclines (, Oxytetracycline), cephalosporins () can be prescribed.

Tablets Tavanic

In the chronic form of the disease, antibacterial drugs are used for a long time to achieve a good therapeutic effect. The duration of admission depends on many factors, the required duration of therapy can vary from 2 to 6 weeks.

Also, for the treatment of the chronic form of the disease, drugs are needed that improve blood flow, relieve congestion, antispasmodic and painkillers.

Medicines used in the chronic form of the disease include:

• , which has an antiandrogenic, vasoprotective effect. It is used in the treatment of non-bacterial chronic prostatitis and;
• , which improves the condition of the prostate gland and microcirculation, reduces the degree of edema, prevents thrombosis and normalizes the secretory function of epithelial cells;
• , which has a wound healing, anti-inflammatory and regenerating effect;
• , which has a locally irritating and pronounced vasodilating effect.

Only a doctor can prescribe drug therapy; you cannot self-medicate with prostatitis.

Rectal prostate massage

An effective method to cure chronic prostatitis is. It can be done in and even.

The most effective way is a bougie massage. A special device is inserted into the urethra, after which light massaging movements are performed.

A similar procedure should be done by a specialist in stationary conditions. through the anus with a finger when the bladder is full. The prostate is in contact with the anterior wall of the rectum and is located 5 cm from the anus.

Most doctors believe that rectal massage should be done in a hospital to prevent complications and achieve the maximum therapeutic effect.

Therapeutic gymnastics and physiotherapy

Many men find rectal massage unacceptable for themselves, despite its effectiveness. For this category of patients, doctors have developed a special and physiotherapy.

Physiotherapy treatments include:

• hydromassage;
• acupuncture and stimulation of the sacrum and lower back;

Exercises and physiotherapy in each case are selected individually, as there are some contraindications, and only a specialist will help prescribe a safe and effective method.

Nutrition principles

Special attention in the chronic form of the disease deserves therapeutic diet therapy.

The principles and goals of the diet are as follows:

• minimize irritating factors so as not to provoke additional inflammation;
• ensure normal blood supply and prevent the occurrence of atherosclerosis;
• if possible, reduce the frequency of urination;
• normalize the work of the gastrointestinal tract;
• boost immunity.

• alcohol;
• carbonated drinks;
• smoked meats, butter, as well as fatty meats and rich broths;
• spicy, sour and highly salty foods;
• mushrooms, liver, kidneys and semi-finished products;
• products that cause increased gas formation (legumes, cauliflower).

But it is useful to use:

• all types of dairy products, especially homemade cottage cheese, yogurt;
• fresh juices and compotes;
• fish and lean meat;
• cereals;
• products containing (seafood, pumpkin seeds).

The diet should be varied and balanced in terms of nutrients, it is better to consult a nutritionist to select a diet.

How to get rid of the disease with the help of folk remedies?

Not bad proved themselves and chronic prostatitis. They are simple and safe, but still, any method has its own indications and contraindications, which is due to the individual characteristics of the body and the presence of concomitant diseases.

In folk medicine is widely used:

• the use of fresh juices of carrots, beets, cucumbers, elderberries;
• application with coniferous pine concentrate;
• microclysters and suppositories with and other medicinal herbs;
• honey therapy, use.

It is also useful to use pumpkin seeds, which have a stimulating effect on the prostate gland and contain in their composition all the necessary trace elements for its normal functioning.

There are many effective folk methods for getting rid of the chronic form of prostatitis, but first you need to consult a doctor.

Surgical methods of therapy

In cases where drug therapy and other complex conservative methods of treatment do not give the desired result, and at the same time there is a negative dynamics of the pathological process, they resort to surgical intervention.

Types of operations for chronic prostatitis:

• drainage used for purulent inflammation and;
• resection involving the removal of part of the gland. With this option, surgical access is carried out through an incision or punctures on the abdomen, through the urethra;
• when the gland is completely removed. It is used in extreme cases, mainly with malignant adenoma;
• circumcisio- a rare and not always effective method of operation, involving the cutting off of the foreskin.

Surgical intervention for chronic prostatitis is an extreme measure, in order not to bring to such a state, it is necessary to consult a doctor at the first symptoms.

Approximate cost of a course of drug treatment

The treatment of chronic prostatitis is so individual and varied that many factors affect pricing, the cost of therapy can vary in very wide ranges.

It all depends on the ongoing process, the duration of the necessary treatment, the medications and procedures used. Therefore, in each case, the price will be individual.

Possible consequences of re-inflammation

Under adverse conditions, the inflammatory process can recur. Frequent exacerbations of the disease lead to irreversible changes and serious complications.

There are not only pain and discomfort, the entire genitourinary and reproductive systems suffer, potency may decrease, or complete impotence may occur.

And in advanced forms, and, as a result, cancer (adenoma) develops. It must be remembered that any disease is easier to prevent than to treat, especially in a chronic form.

Strengthen immunity;

avoid, if necessary, take sedatives of natural origin (valerian, motherwort, peony).

It is a serious problem even for modern urology, since many questions regarding this disease still remain unclear. There is an opinion that chronic prostatitis is a pathology that implies that a person has a whole range of health problems, including tissue damage, functional disorders of the work of not only the prostate gland and urinary tract, but also other organ systems of a man.

Since there is no single characteristic of the concept of "chronic prostatitis", this negatively affects the diagnosis and treatment of the disease as a whole.

In order to make this diagnosis, a man must have pain in the perineum, in the pelvic area and in the organs of the genitourinary system for at least 3 months (USA, National Institutes of Health). Signs such as urination disorder and detection of bacteria in secret are not prerequisites for making a diagnosis.

In this case, the process of inflammation in the tissues of the prostate gland must be confirmed by the data of histological studies of prostate tissues, or by microbiological analysis of the secret. Ultrasound examination allows you to clarify the nature of changes in the organ.

Epidemiology of chronic prostatitis

Statistics indicate that the disease is extremely common and is in first place among all diseases of the male reproductive system of an inflammatory nature. In addition, this pathology holds a leading position among all diseases that affect young men in general. We are talking about the representatives of the stronger sex up to 50 years. The average age of patients is 43 years, while 30% of men will definitely suffer this pathology until they reach the age of 80.

Up to 35% of all visits to a urologist in the Russian Federation are due to chronic prostatitis. Often the disease occurs with complications - it can be vesiculitis, dysuria, erectile dysfunction, inability to conceive a child, epididymitis. These and other complications occur according to various data in 7-36% of cases.

The causes of chronic prostatitis are varied. The disease occurs under the influence of infectious agents, while patients have neurovegetative, hemodynamic, immunological, hormonal disorders. It affects the reflux of urine into the prostate lobes, biochemical factors (disturbance of metabolic processes, and in particular salt metabolism), as well as disturbances in the functioning of growth factors responsible for the proliferation of living cells.

Experts identify the following provocateur factors that influence the formation of the disease:

Infections of the genitourinary system (non-compliance with the rules of personal hygiene, lack of a permanent sexual partner, refusal to protect, the presence of an infection in a partner);

Surgical interventions on the prostate without prior preparation with antibacterial agents;

Dysrhythmia of sexual life;

Regular hypothermia;

Bladder catheterization on an ongoing basis;

Physical inactivity.

The role of immunological disorders in the development of the disease should not be rejected. If there is an imbalance of immunocompetent factors, namely cytokines, then this directly affects the work of immunity.

Intraprostatic reflux of urine contributes to the development of chronic non-bacterial prostatitis.

Chronic abacterial prostatitis is associated with neurogenic disorders of the pelvic floor muscles, as well as those elements that are responsible for the functioning of the bladder wall, prostate and urethra.

Pelvic pain syndrome may be due to the fact that a man forms myofascial trigger points, which are located next to the prostate gland and the organs of the genitourinary system. Points that are the result of injuries, surgical interventions and some diseases can lead to pain in the perineum, pubis and nearby areas.

Symptoms of chronic prostatitis

The symptoms of chronic prostatitis are diverse, but the pain and discomfort that occurs in the pelvic area and lasts at least 3 months come to the fore.

In addition, men suffer from erectile dysfunction and urination disorders:

As for pain, they occur mainly in close proximity to the prostate gland, that is, in the perineum, but can radiate to the anus, to the inner surface of the thigh, scrotum, lower back, sacrum and inguinal zone. When pain occurs on one side and radiates to the testicle, most likely this is not a symptom of chronic prostatitis.

Libido suffers, erection does not occur at the moment when there are adequate conditions for this, but although certain sexual disorders are present, complete impotence is not observed.

Another symptom of chronic prostatitis is premature ejaculation. This is typical for the initial stages of the development of the disease. As the pathology progresses, ejaculation becomes, on the contrary, slow. Orgasm is often dim, devoid of richness and emotional color. The ejaculate loses its qualitative and quantitative characteristics.

The disease is characterized by irritative symptoms (increased urination at night, urgency, pain and burning sensation during bladder emptying, urinary incontinence). Ifravesical obstruction with bladder occlusion is less common.

The disease has an undulating course, the symptoms either weaken or become stronger, but they clearly indicate the presence of inflammation.

The following stages of development of chronic prostatitis can be distinguished:

exudative stage. A man experiences pain in the scrotum, in the groin, in the pubis. Urination becomes more frequent, there may be a feeling of discomfort at the end of intercourse. Erections can hurt.

Alternative stage. The pains intensify, are localized mainly in the pubic region, in the groin and are given to the sacrum. Emptying the bladder most often goes without any difficulty, although it may occur more often than usual. Erection does not suffer.

proliferative stage. The stream of urine loses its strength, during an exacerbation of the disease, urination becomes more frequent. The erection is intense, but some slowing down of the reaction is possible.

Scar stage. Prostate tissue sclerosis occurs. In the pubic area, in the sacrum there is a feeling of heaviness. Urination becomes more frequent, the urge disturbs the man not only during the day, but also at night. Ejaculation may be completely absent, erection becomes weak.

One should not expect that the symptoms characteristic of a particular stage will be present in a strictly defined order and will arise in full. They may vary depending on the characteristics of the individual course of the disease. But pain, increased urination and functional erectile dysfunction will gradually increase.

At the same time, many men underestimate the severity of the disease until they encounter it. Meanwhile, studies show that the quality of life of people with this problem suffers no less than if they had suffered, Crohn's disease, or.

The classification of prostatitis was proposed in 1995 in the United States, developed by scientists from the National Institutes of Health:

Acute bacterial prostatitis - type 1 (5% of all diagnosed inflammation of the prostate gland).

Chronic bacterial prostatitis - type 2.

Abacterial prostatitis of chronic course - type 3. This prostatitis is also called chronic pelvic pain syndrome.

Inflammatory form (with a leukocyte jump in the discharge from the prostate) of chronic prostatitis - type 3A. Diagnosed among the total mass of chronic prostatitis in 60% of cases.

Non-inflammatory form (without leukocyte surge) of chronic prostatitis - type 3B. Diagnosed among the total mass of chronic prostatitis in 30% of cases.

Asymptomatic prostatitis - type 4.

Diagnosis of chronic prostatitis

Diagnosis of chronic prostatitis is not particularly difficult when there is a complex of symptoms (pain, urination disorders, sexual disorders). However, it happens that the pathology is asymptomatic, which requires additional research methods, in addition to the standard survey and examination of the patient. These are physical, laboratory, and instrumental methods. Be sure to study the immunological status of the patient, a neurological examination.

In addition, questionnaires and questionnaires have been developed that allow you to clarify the subjective feelings of the patient, give more complete information about the state of his health, about the strength of pain, about urinary disorders, erection, ejaculation, about the patient's psycho-emotional moods.

Often practicing urologists use the prostatitis symptom scale questionnaire developed by the American National Institutes of Health - this is the NIH-CPS questionnaire.

Laboratory diagnosis of chronic prostatitis

Laboratory diagnosis of chronic prostatitis allows you to distinguish between abacterial and bacterial forms of the disease, determine the type of pathogen and make the most accurate diagnosis. When the fourth urine sample, or prostate secretion, contains more than 10 leukocytes in the PZ, or bacterial associations, chronic inflammation of the prostate is confirmed in this case. If the number of leukocytes is increased, but the bacteria are not sown, the material should be examined for the detection of chlamydia and other STD pathogens in it.

Discharge from the urethra is sent to the laboratory to detect leukocytes, bacterial, fungal or viral flora, as well as mucus in it.

A scraping taken from the urethra is studied by PCR, which makes it possible to identify pathological sexually transmitted agents.

The secret of the prostate is sent for microscopic examination to count the number of leukocytes, macrophages, amyloid and Trousseau-Lallemand bodies. They also conduct its bacteriological study and immunological study, determine the level of nonspecific antibodies.

10 days after the digital rectal examination, blood is taken to determine the concentration of PSA in it. If the indicator exceeds 4.0 ng / ml, then the patient is recommended to undergo a prostate biopsy to exclude cancer.

Based on the results of the performed studies, a diagnosis is made.

Instrumental diagnosis of chronic prostatitis

Transrectal ultrasound examination of the gland makes it possible to clarify the form of the disease, its stage. With the help of ultrasound, it is possible to weed out other diagnoses, track the effectiveness of the therapy, visualize the size of the prostate, its echostructure (exclude the presence of cysts, stones, sclerotic changes, abscess), the density and uniformity of the seminal vesicles.

Urodynamic studies and myography of the pelvic floor muscles reveal neurogenic disorders and infravesical obstruction, which often accompanies chronic prostatitis.

Tomography, both computed and magnetic resonance, is used to make a differential diagnosis, in particular, with prostate cancer. In addition, these methods make it possible to identify existing disorders in the spinal column, in the pelvic organs.

Differential diagnosis of chronic prostatitis

Differential diagnosis of chronic prostatitis is of no small importance, since there is a risk that a man has a more serious disease.

So, the differential diagnosis is established with diseases such as:

Bladder dysfunction of neurogenic origin, complex regional pain syndrome, functional disorder of the detrusor-sphincter system, pseudodyssynergia;

Prostate adenoma, hypertrophic changes in the neck of the bladder, bladder stricture;

Chronic prostatitis (ICD-10 code. N41.1) is an inflammatory process that has been observed in the tissues of the prostate gland for more than three months. Its peculiarity is that in almost 70% of all cases, it proceeds without any symptoms. And only 15% of patients complain of manifestations of the disease. All other men have symptoms that only partially indicate the development of prostatitis and can often be associated with other diseases. Therefore, it is so important to consult a doctor if any signs appear, who, after the examination, will tell you how to treat chronic prostatitis.

Chronic prostatitis can be diagnosed not only in older people. Young and middle-aged people are also susceptible to the disease. At risk are those who lead a sedentary lifestyle, adhere to sexual abstinence or experience physical activity in the perineum. That is, the likelihood of chronic prostatitis in drivers, athletes is much higher than in everyone else.

Among all diseases of the male reproductive system, chronic prostatitis ranks first in prevalence, followed by BPH (prostate adenoma). Approximately one in three men is faced with inflammation of the prostate, and one in five of them suffer from a chronic form of the disease.

I. A. Izmakin, chief urologist of the Euromedica clinic, talks about the pathology and how it appears:

In most cases, the cause of chronic prostatitis is the transferred diseases of the genitourinary system caused by infections. A little less often, it is caused by inflammatory processes associated with changes in the hormonal background of a man.

Classification

Like other inflammatory diseases, chronic prostatitis can have acute and chronic stages. Its classification is based on the following features:

• The presence of leukocytes in the urine.
• The presence of pathogenic bacteria in the urine, ejaculate or secretion of the gland.

Based on the classification, there are the following types of disease:

1. Asymptomatic inflammatory prostatitis is characterized by the absence of symptoms of chronic prostatitis. It turns out to be revealed by chance when the patient goes to the doctor with some other disease.
2. bacterial nature. The patient has an acute inflammation of the prostate tissues, pathogenic bacteria are present in the urine, which lead to an increase in temperature and the development of intoxication of the body.

1. Chronic bacterial prostatitis. The doctor notes the typical signs of chronic inflammation. And in the analysis of urine and secret, a high content of leukocytes and bacteria is revealed.
2. Chronic pelvic pain syndrome. Such soreness is considered the main symptom, since bacteria are not detected. To make a diagnosis of chronic prostatitis, the syndrome must be observed in a man for at least 3 months.

Causes of the disease

The main cause of chronic prostatitis is the penetration of pathogens into the prostate gland (enterococci, Escherichia or Pseudomonas aeruginosa, etc.). Bacteria can enter the prostate in three ways:

• Through the urethra.
• Through the blood.
• through the lymph.

According to statistics, 90% of cases of chronic prostatitis are a consequence of the development of acute prostatitis or a complication.

In addition to getting bacteria into the prostate, the causes of chronic prostatitis can be:

1. Sexual infections (STIs): herpes, trichomonas, gonococcus, chlamydia, etc.
2. Congestive processes in the pelvic area, which can provoke inflammation of the prostate.
3. Decreased immunity. This can be caused by: vitamin deficiency, imbalance of hormones, hypothermia, allergic reactions, significant physical and emotional stress, untreated infections, etc.
4. Sedentary lifestyle.
5. Big weight.

1. Irregular sexual life or disorders in the intimate sphere.
2. Perineal injury.
3. Wearing tight underwear.
4. Irrational nutrition (the predominance of spicy foods in the diet).
5. Restraint of urination.
6. Chair disorder.

All this can lead to impaired blood circulation in the pelvic region, contribute to congestion and the development of the inflammatory process. The consequences of the lack of therapy are infertility and impotence.

Symptoms of the disease

Signs of chronic prostatitis can be very different. Most often, the patient complains about:

• Decreased performance.
• Rapid fatigue.
• Increased irritability.
• Anxiety.

• Sleep disturbance.
• Lethargy.
• Loss of appetite.
• Increased sweating.

Candidate of Medical Sciences, urologist Guk Andrey Valerievich answers questions about symptoms:

Local symptoms include:

1. Urination disorder. The patient feels frequent urges, pain at the beginning and end of urination.
2. Aching pain that may radiate to the groin, sacrum, scrotum, subpubic bone, or rectum.
3. Pain during sex.
4. Discharge during tension of the pelvic muscles.

In contrast to the acute phase, in a chronic disease, sexual dysfunction often occurs. This is due to the fact that stagnant and inflammatory processes affect the nerve endings that ensure the transmission of impulses to the brain. As a result, erectile dysfunction is possible, which weakens or ejaculation (premature ejaculation), sensations during orgasm are dulled. Such symptoms of chronic prostatitis in men lead to fear of intimacy, irritability and, as a result, sexual neurosis develops.

Treating chronic prostatitis can be difficult. How long you have to take medication depends on the degree of pathology and the duration of the development of the disease. It is important to remember that if they have disappeared, this does not mean a final cure. The severe consequences of chronic prostatitis include scarring of the gland. This process can pass to the urethra.

Diagnosis of the disease

When contacting a doctor, he will ask the patient about the symptoms. Particular attention is paid to the frequency and nature of pain, urination disorders, sexual dysfunction. But due to the fact that chronic prostatitis can occur without any manifestations, it is necessary to conduct certain studies:

• Clinical and bacterial analysis of urine, which determines the number of leukocytes and the presence of pathogenic microorganisms.
• Analysis of the secret, which may contain bacteria.
• Scraping from the mucous membrane, in which the number of leukocytes, the presence of macrophages and amyloid bodies are determined.
• Transurethral ultrasound makes it possible to identify the echo sign of chronic prostatitis and determine the condition of the prostate.

On the issues of diagnosis and treatment, listen to the report of the specialists of the Federal State Budgetary Institution "Research Institute of Urology" of the Ministry of Health of the Russian Federation:

Qualitative diagnosis is a significant part, as it makes it possible to distinguish chronic prostatitis from other pathologies with similar symptoms.

Treatment

This disease should have an integrated approach to therapy. In this case, the patient needs to tune in to long-term treatment. The treatment regimen for chronic prostatitis will be individual for each patient. Usually, the patient does not need hospitalization and can be treated. It is quite another matter when the acute phase of the disease or its exacerbation against the background of chronic inflammation of the prostate is subject to treatment. In a hospital setting, antibiotic therapy is used and detoxification is carried out. If necessary, surgery is needed.

Medical therapy

For the complex treatment of chronic prostatitis in men, drugs are prescribed, the action of which is aimed at eliminating the infection, normalizing blood circulation and hormone levels. For this use:

1. Antibiotics.
2. Anti-inflammatory nonsteroidal drugs.
3. Anticholinergics.

List of antibiotics for the treatment of CP

1. Immunomodulators.
2. Angioprotectors.
3. Vasodilator drugs.

Before making an appointment, the doctor will conduct an analysis to determine the pathogen. If the disease is not of bacterial origin, then the course of antibiotic therapy will be short. In the case when it is not possible to determine the type of pathological microflora by laboratory methods, a histological analysis of prostate tissue is used.

In case of recurrence of the disease, antibiotic therapy is prescribed for the purpose of prevention. For this, a drug is used that has already been used during treatment, but at a lower dosage.

Knowing what chronic prostatitis is and what can cause it to develop, the specialist will pay attention to the pressure inside the prostate gland and its ability to contract. If this function is reduced, then congestion and inflammation of the prostate can occur in the pelvic area. To normalize intraurethral pressure, alpha-blockers are prescribed ("Alfuzosin", "Terazosin", etc.).

For complaints of frequent and painful urination, non-steroidal anti-inflammatory drugs are used in conjunction with alpha-blockers.

Vladimir Viktorovich Borisov, Doctor of Medical Sciences, Professor, will talk about the treatment of this unpleasant disease:

In the case when it turned out to be ineffective and symptoms such as soreness and dysuria persist, the treatment is adjusted so that it is directed to:

• Elimination of pain. For this, tricyclic antidepressants (Imipramine, Amitriptyline) are used.

• Normalization of urination. Treatment is prescribed after a urinodynamic analysis. With hyperactivity of the sphincter, antihistamines, Amitriptyline and washing the bladder with antiseptic solutions are indicated. With the ineffectiveness of such treatment, neuromodulation and physiotherapy are used.

Non-drug methods

To be more effective, the doctor may recommend physiotherapy (electrophoresis, phonophoresis, laser therapy, mud treatment) and transrectal hyperthermia, which is carried out taking into account existing changes in the prostate tissue and concomitant diseases. When exposed to a temperature of 40 degrees, cellular immunity is activated. When exposed to a temperature of 45 degrees, nerve endings are inhibited, which helps to relieve pain. The use of laser therapy has a biostimulating effect.

In the absence of contraindications, the patient undergoes a prostate massage. Often, patients are prescribed a course of psychotherapy and can strengthen the muscles of the perineum.

Treatment with folk remedies

Along with the use of medications, the manifestations of chronic prostatitis are treated. This treatment improves immunity and reduces pain. For this, in addition to herbal remedies ("Prostamol", etc.), infusions and decoctions of herbs, baths, etc. are used.

The course of treatment with herbal remedies is at least 1 month and should be prescribed by a doctor, as some of them may have contraindications for use. Treatment with folk methods involves:

1. Plentiful drink (teas with linden, rose hips, raspberries).
2. Every day before meals you need to drink 1 glass of freshly squeezed juice of carrots, pears, cucumbers.
3. If the patient is tormented by pain, coniferous baths are used, with a temperature of 37 degrees. The duration of the procedure is 20 minutes.

To prepare suppositories with propolis, take a mixture of glycerin, gelatin and water in proportions of 5:1:2. Add propolis there and spread the mixture on parchment. Put everything in the refrigerator where the suppositories are completely frozen.

1. If the patient is not allergic to honey, he is recommended to eat up to 100 grams of the product daily.
2. At home, you can make your own suppositories based on propolis or honey. They need to be installed within 1 month.
3. Before going to bed, it is recommended to do an enema with wormwood. To do this, 1 teaspoon of a dry plant is brewed in 1 liter of boiling water.

Treatment with pumpkin seeds, aloe juice, parsley, chestnut and celandine is also considered effective. Parsley has an anti-inflammatory effect and is able to restore sexual function. Herbalists recommend this treatment with this plant:

• Drink 1 tablespoon of parsley juice daily before meals.
• 4 teaspoons of plant seeds are poured into 250 ml of boiling water and infused in a thermos overnight. The next day, drink an infusion of 1 tablespoon every hour.
• 100 g of the crushed root of the plant is poured with 1 liter of water, put on a slow fire and boiled for 10 minutes. The decoction is drunk during the day.

Pumpkin seeds are an effective remedy. About 30 of these seeds contain a daily dose of zinc, which is essential for men's health. For treatment, you can make such a remedy. 500 g of pumpkin seeds are ground in a meat grinder and mixed with 200 grams of natural honey. From the resulting mass, balls are made, the size of a walnut. Every day you need to eat 2 of these balls.

Propolis helps to strengthen the body's defenses and relieve inflammation. You can buy its tincture in a pharmacy. For treatment, you need to drink a glass of milk daily with 1 teaspoon of this tincture.

Dear readers, we have collected a large video selection of traditional medicine recipes. We are sure that out of 106 videos you will be able to choose the treatment you need (to view the list of videos, click on the playlist icon):

In addition, decoctions of licorice, St. John's wort, echinacea are used for treatment, which are also used in cases where the disease occurs without obvious symptoms.

Surgery

Often, chronic prostatitis does not give symptoms, and patients seek medical help already when there have been serious changes in the prostate gland and chronic prostatitis drugs are already powerless. In addition, such complications can pose a threat to the health of the patient. An example of a complication is prostate sclerosis.

Due to the fact that such complications are often detected in young men, doctors use minimally invasive surgery. Indications for its use are: involuntary excretion of urine or, conversely, its retention, prostate abscess, a significant increase in the size of the gland, blockade of the urethra or bleeding. There are such types of surgery that are indicated for chronic inflammation:

1. Circumcision - is used when the patient has phimosis. During the operation, the foreskin is cut.
2. Prostatectomy is a radical operation during which the prostate is completely removed. It is carried out in case of suspicion of the presence of a malignant tumor.
3. Resection of the prostate is a partial removal of the gland, in case of its sclerotic change.

1. Elimination of adhesions.
2. Drainage of a cyst or abscess. Produced by endoscopy. For drainage, a special tube with a camera at the end is used. Such a device is inserted into the lumen of the urethra and makes it possible to control the progress of the operation.
3. In case of complaints of various sexual disorders (orgasm disorder, painful ejaculation, etc.), the patient undergoes an incision in the vas deferens.

The result of surgery will depend on the timeliness of the diagnosis. In cases where there is an adenoma of the prostate, then the manifestations of chronic prostatitis can be blurred. This is observed in 70% of cases. 25% of men learn about the development of chronic prostatitis during an examination for adenoma. And only 5% of patients - during a preventive examination.

The condition for the operation is the lack of effect in the conservative treatment of the disease. Therefore, surgery is needed to prevent complications and improve the quality of life.

However, it should be borne in mind that even after the operation, the return of prostatitis is possible. This happens in almost half of those operated on. A contraindication to any operation is:

• Diabetes.
• Pathology of the liver.
• Diseases of the respiratory system.
• Mental disorders.
• Heart diseases.

Disease prognosis

Everyone who is faced with such a diagnosis is interested in whether chronic prostatitis can be cured? The disease is considered cured if the symptoms do not appear for a significant period of time, the level of leukocytes in the urine is within the normal range, there are no pathogenic bacteria in the secretion of the prostate, urination and sexual function are restored.

Most often, the prognosis is favorable in cases where the disease has not led to irreversible processes, and the patient complies with the prescribed treatment.

Disease prevention

Every middle-aged man should be engaged in the prevention of diseases of the genitourinary system, which will also help reduce the likelihood of chronic prostatitis. For this it is enough:

1. Adhere to the basics of a healthy lifestyle, play sports.
2. Eat properly. It is important to eat plenty of protein foods (low-fat meat and fish, dairy products, eggs) and limit animal fats. At the same time, canned food, spicy, salty dishes, alcohol should be excluded from the menu.
3. Regular sex life. It is important to avoid unprotected sex.

In order to prevent prostate disease, every man, especially after 35 years old, should take care of his health and lead an active life. It is not necessary to ignore the medical examination, which always helps to identify prostatitis in time and start its treatment. At the same time, it is important to remember that it is curable if it is detected at the initial stage, and the patient complies with all the doctor's prescriptions.