A survey of residents of several countries showed that between 2% and 10% of adult men experience symptoms suggestive of prostate problems during their lifetime.
Any urinary disorder is an alarm and in this case self-medication should be excluded.However, problems are not always specifically associated with prostatitis.
go to the doctor
Our articles are written with love for evidence-based medicine.We cite reputable sources and seek comments from reputable doctors.But remember: the responsibility for your health lies with you and your doctor.We don't make recipes, we give recommendations.It is up to you to trust our point of view or not.
How does the prostate work?
The prostate, or prostate gland, is a walnut-shaped organ located just below the bladder.Between the halves of the “walnut” passes the urethra, a tube through which urine is extracted from the bladder and sperm from the testicles.
Prostate key taskIt consists of producing a secretion that is part of the seminal fluid.Thanks to this secretion, the sperm can move.The second task of the prostate is to contract, ensuring ejaculation, that is, ejaculation.
Next to the prostate are the seminal vesicles, which are connected to the vas deferens, through which sperm leave the genitals.The seminal vesicles produce the liquid part of the sperm and store prostate secretions.
Prostate secretion is a mixture of citric acid and enzymes.This liquid liquefies the sperm, which enter the urethra from the vas deferens of the testicles.
Prostate problems do not always cause 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 urinary disorders, discomfort caused by incomplete emptying of the bladder, pain or discomfort associated with inflammation make the person nervous and embarrassed.Because of this, psychological problems arise, which, as a rule, negatively affect the erection.
What is prostatitis like?
Prostatitis is an inflammation of the prostate gland associated with pathogenic microbes or other non-infectious causes.Sometimes inflammation also affects the seminal vesicles;This is called vesiculitis.
At the same time, inflammation of the prostate does not always cause pain and problems with urination, 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 of Diabetes and 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 the important decision to prescribe antibiotics and additional medications.It is incorrect to give antibiotics to all patients with suspected prostatitis because nonmicrobial forms of prostatitis are more common than bacterial forms.Taking unnecessary antibiotics is harmful to 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 feel weakness, severe pain or burning in the perineum, scrotum or anus, lower abdomen and sometimes in the muscles.Some people experience pain during ejaculation.Sometimes with bacterial prostatitis, frequent, difficult and painful urination occurs.
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 resemble those of acute prostatitis, but may not be as severe or less severe.Usually there is no fever or weakness, the pain in the lower abdomen is more painful than sharp, but it is difficult to start urinating and completely empty the bladder.In addition, unpleasant symptoms may disappear temporarily and reappear after a while.
Any man can get acute and chronic bacterial prostatitis.But the people most at risk are those who have a higher 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 had surgery or a prostate biopsy.
Chronic abacterial prostatitis associated with inflammation.The symptoms of nonbacterial inflammatory prostatitis are very similar to those of acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in the semen, prostate and urine, but the concentration of leukocytes will be high, which indicates inflammation of the prostate.
Chronic abacterial prostatitis or chronic pelvic pain syndrome, not associated with inflammation.The symptoms also resemble acute and chronic bacterial prostatitis.At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in the semen, prostate and urine, which indicates that the prostate is not inflamed.
In the case of non-bacterial forms of prostatitis, it is not always possible to determine what cause leads to the development of the disease.Risk groups are also difficult to determine.
Asymptomatic inflammatory prostatitis.This form of the disease does not cause any discomfort.Most of the time, inflammation is discovered incidentally when the patient is being examined for other problems, such as infertility.
How is prostatitis different from prostate adenoma?
In about 8% of men after the age of 40, the prostate begins to increase in size;This is called prostate adenoma or benign prostatic hyperplasia.The enlarged prostate compresses the urethra and this can cause problems with urination: too frequent need to go to the bathroom or leaking urine.Given the symptoms of an adenoma, some patients may assume that they suffer from prostatitis.
While some symptoms of prostatic hyperplasia may resemble prostatitis, they are not the same.Prostatitis is inflammation of the prostate gland.And an adenoma is an uncontrolled, age-related proliferation of prostate cells that is not associated with inflammation.
An adenoma can cause serious 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 developing cancer.
How often is chronic bacterial prostatitis diagnosed?
According to widespread literature, worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis - in 6-10% of cases.In addition, 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, we will find certain signs of inflammation in all men over 40 years of age without exception.But this 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, and some of them are quite serious and require immediate treatment.Therefore, I recommend that all patients with symptoms reminiscent of prostatitis 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 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 your compulsory health insurance policy or make an appointment with a doctor in a private clinic.
The primary task of a urologist caring for a patient with suspected prostatitis is to rule out other prostate diseases, such as cancer, and determine which form of the disease the 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 should do to solve it.
Ask the patient about symptoms and health.To gather more information, your doctor may suggest you answer questions on a questionnaire called the Chronic Prostatitis Symptom Index.In some cases, in order not to waste time at the appointment, it makes sense to print the questionnaire and fill it out in advance.
Perform a physical examination.The doctor will examine the patient, paying special attention to the groin area.If there are swollen and painful lymph nodes in the groin, this increases the likelihood that there really is an inflammatory process in the body.Typically, the exam includes a digital rectal examination, which allows the doctor to evaluate the size, shape, and condition of the prostate.The study helps to understand if the prostate increases in size.If touching the gland is painful, it is most likely inflamed.
Is it possible to do without rectal examination?
Rectal examination and prostate massage are not the most pleasant procedures.In acute inflammation, this can cause pain.Some patients are so eager to avoid these procedures that they refuse to make an appointment with a urologist altogether.
Rectal examination is a diagnostic method, but a massage of the prostate is performed through the rectum to obtain material for laboratory analysis: prostate secretion.If discharge cannot be obtained, the doctor can replace the analysis of prostate discharge with an analysis of the first portion of urine or with a two- and three-glass urine test.These tests can determine approximately where the problem area is located in the urinary tract.
Sometimes, instead of this examination, a spermogram analysis is prescribed for the same purpose.It helps to understand whether prostatitis is part of infections of the male reproductive glands and provides information about the quality of ejaculation.Furthermore, the leukocyte count in the ejaculate allows differentiation of inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If a patient is concerned about an upcoming digital exam or prostate massage, I would suggest discussing this with their healthcare provider.Perhaps the analysis of prostate secretions, which requires massage, can be replaced by a urine or semen analysis.
Prescribe blood, urine and prostate secretion tests.The diagnostic standard includes a microscopic examination of prostate secretion, a general blood test, a general urine analysis with sediment microscopy, as well as a microbiological examination of urine and prostate secretion.
During microbiological studies, the patient's biological material is placed in a nutrient medium and it is observed which bacteria grow on it, which makes it possible to clarify the diagnosis.You can get tested in a private clinic for money or for free with compulsory health insurance.
Other tests and examinations, for example, a test to determine the concentration of total prostate-specific antigen (PSA) in the blood and a transrectal ultrasound of the prostate (TRUS), are usually not performed if prostatitis is suspected.In some cases, TRUS of the prostate can reveal fibrosis, that is, a scar or foci similar to a malignant tumor, but these 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 prescribe antibiotics.And if bacteria have nothing to do with this, you will need medications to help you cope with the unpleasant symptoms of the disease.
Acute bacterial prostatitisthey begin to treat without waiting for test results;This is called empiric antibacterial therapy.In this approach, antibiotics are prescribed based on knowledge of which microbes most often cause prostate infection.
As a rule, patients are prescribed antibacterial drugs that penetrate well into the prostate tissue and act on the most "popular" pathogens of prostatitis and genitourinary infections.
Those people who feel more or less normal and receive treatment at home are usually given antibiotic tablets.And patients with high fever who are treated in the hospital are more often prescribed antibiotic injections.With this treatment, in most patients with acute prostatitis, fever and pain decrease between the second and sixth day after starting the medication.
When the patient's temperature returns to normal and signs of inflammation disappear, the doctor may switch from injections to pills.The total duration of antibiotic treatment is usually 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 secretions accumulated in the gland and thus reduce its swelling.However, today most experts have reached a consensus that prostate massage should be avoided in 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 penetrate into neighboring uninfected tissues.
Chronic bacterial prostatitisIt is also treated with antibiotics that act on gram-negative bacteria.Fluoroquinolones are commonly used for treatment;These antibiotics are considered quite safe.But if your doctor suspects that prostatitis is caused by other microorganisms, he or she may prescribe additional antibacterial medications without waiting for test results.
In chronic prostatitis, antibiotics should be taken for a longer time than in acute prostatitis.According to the recommendations of urologists, they are prescribed in a course lasting 4 to 6 weeks.
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 unclear what exactly causes abacterial prostatitis, treatment is primarily aimed at relieving pain when urinating.To achieve this, doctors prescribe alpha-1 blockers, medications that help relax the prostate muscles that compress the urethra.If the pain persists, your doctor may prescribe nonsteroidal anti-inflammatory medications.The dose is selected individually for each patient.
Some patients with abacterial prostatitis benefit from cognitive behavioral therapy, which is the name given to sessions with a psychologist during which a person learns to cope with pain without medication.However, there is no scientific evidence of the effectiveness of psychological assistance for abacterial prostatitis.
Studies in which researchers have attempted to demonstrate the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal thermotherapy, have been poorly designed and of too short duration (typically less than 12 weeks).Therefore, it is impossible to say whether all this helps or not.
How to avoid prostatitis: prevention
The main cause of prostate discomfort is a sedentary lifestyle and lack of regular sexual life.Doctors believe that the best chances of avoiding prostatitis are in men who:
- Practice safe sex regularly.
- Get moderate exercise regularly.
- Avoid hypothermia.
- When they turn 40, they undergo an annual urological examination.
Where is it better to treat prostatitis: in a public or private clinic?
The most important thing is that the principles of evidence-based medicine be followed when diagnosing and treating prostatitis.It depends solely on the doctor, and it doesn't matter where exactly he works.
Unfortunately, doctors in private clinics do not always meet the standards of medical care.This can lead to overdiagnosis and unnecessary treatment, leaving the patient at risk of overpaying.In a public medical organization, the probability of meeting all diagnostic and treatment standards is higher.But patients should keep in mind that a complete examination will take longer, sometimes much longer than an examination in a private clinic.
remember
- Problems with the urinary tract in men are common, but they are not always due to prostatitis.To understand what exactly is happening to a person, it is necessary to undergo a comprehensive examination.
- Prostate problems rarely cause 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 additional 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 glandular secretions for analysis.
- The best way to prevent prostatitis is to have protected sexual relations, a healthy lifestyle and, after 40 years, regular urological examinations by a doctor.