A survey of residents of different countries found that 2-10% of adult men experience symptoms that indicate a problem with the prostate during their lifetime.
Any urinary disorder should be a wake-up call, and self-medication in this case should be ruled out. However, the problems are not always related to prostatitis.
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Our articles are written with a passion for evidence-based medicine. We consult reputable sources and consult with reputable doctors. But remember: the responsibility for your health lies with you and your doctor. We do not write prescriptions, we make recommendations. Based on our opinion or not is up to you.
How does the prostate gland work?
The prostate gland, also known as the prostate gland, is a walnut-like organ located just below the bladder. Between the two halves of the "seed" passes through the urethra - a tube that carries urine from the bladder and sperm from the testicles.
The important function of the prostate glandinvolves the production of a secret that is part of the semen. Thanks to this secret, sperm is able to move. The second job of the prostate gland is to contract, allowing ejaculation, i. e. ejaculation.
Next to the prostate are seminal vesicles that connect to the vas deferens, through which sperm exits the genitals. The seminal vesicles produce the liquid portion of semen and store secretions of the prostate gland.
The secret of the prostate is a mixture of citric acid and enzymes. This fluid dilutes semen, which flows into the urethra from the vas deferens of the testicles.
Prostate problems don't always lead to erection problems
In the vast majority of cases, sexual dysfunction is not related to problems with the prostate gland, because there is no physical connection between the prostate gland and the erection mechanism.
But discomfort when urinating, discomfort caused by incomplete emptying of the bladder, pain or discomfort associated with inflammation, leads a person to begin to feel anxious and shy. Because of this, psychological problems arise - as a rule, they are the ones that negatively affect an erection.
What is prostatic disease
Prostatitis is an inflammation of the prostate gland that is associated with pathogenic bacteria or other non-infectious causes. Sometimes inflammation also affects the seminal vesicles - this is called seminal vesicles.
At the same time, prostatitis does not always lead to pain and difficulty urinating, and unpleasant symptoms are not necessarily related to urethritis.
To avoid confusion, urologists around the world use the classification recommended by the National Institutes of Diabetes and Digestive and Kidney Diseases, or NIDDK.
To simplify things a bit, the classification divides prostatitis into bacterial and bacterial, i. e. not associated with bacteria. This approach helps doctors make important decisions – whether to prescribe antibiotics and complementary medicines. It is wrong to give all patients with suspected prostatitis antibiotics because nonmicrobial forms of prostatitis are more common than bacterial prostatitis. Taking unnecessary antibiotics is bad for your health.
The NIDDK classification identifies five forms of prostatitis.
Acute bacterial prostatitis.A disease usually caused by pathogens typical of urinary tract infections: for example, E. coli, Klebsiella and Enterobacter.
As a rule, the disease begins suddenly and is accompanied by a general deterioration of health. The temperature rises to 38-39°C, some people feel weakness, severe pain or burning in the perineum, scrotum or anus, in the lower abdomen, and sometimes in the muscles. Some people experience pain during ejaculation. Sometimes with bacterial prostatitis, you may have frequent, difficult, and painful urination.
Chronic bacterial prostatitis.It can also be caused by bacteria typical of acute prostatitis. The disease is considered chronic if symptoms persist for at least three months.
Symptoms of chronic bacterial prostatitis are similar to acute, but may be less or less severe. Usually without fever and weakness, lower abdominal pain rather than sharp pain, but difficulty initiating urination and emptying bladder completely. Furthermore, unpleasant symptoms may temporarily disappear and then reappear after a while.
Any man can develop acute and chronic bacterial prostatitis. But the people most at risk are those at higher risk of exposure to the pathogen: people who have sex, especially anal sex, who don't use condoms, patientsurinary tract infections and those who have recently had prostate surgery or biopsy. .
Chronic prostatitis involves inflammation.The symptoms of 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 white blood cell levels will be high - this indicates an inflamed prostate.
Chronic bacterial prostatitis or chronic pelvic pain syndrome, unrelated to inflammation.Symptoms also mimic acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria and a high concentration of white blood cells in the semen, prostate skeleton and urine - this indicates that the prostate is not inflamed.
For nonbacterial forms of prostatitis, it is far from possible to find out what causes the development of the disease. Risk groups are also difficult to identify.
Asymptomatic inflammatory prostatitis.This form of disease does not cause discomfort. Often, inflammation is discovered by accident when a patient is being examined for other problems, such as infertility.
How is prostatitis different from prostate cancer?
In about 8% of men after the age of 40, the prostate gland begins to increase in size - this is called a prostatic tumor or benign prostatic hyperplasia. An overgrown prostate constricts the urethra and, as a result, urination problems can begin: going to the bathroom too often or leaking urine. When faced with the symptoms of an adenoma, some patients may assume they have prostatitis.
Although some symptoms of prostatic hyperplasia can indeed resemble prostatitis, they are not the same. Prostatitis is an inflammation of the prostate gland. And adenomas are age-related uncontrolled proliferation of prostate cells that are not related to inflammation.
Adenomas can cause serious inconvenience, so if you have problems urinating, it's important to see a urologist as soon as possible. However, adenoma is still not as dangerous as prostatitis, as it does not increase the risk of cancer.
How often is chronic prostatitis diagnosed?
According to the general literature, worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis - in 6-10% of cases. . Furthermore, both variants of chronic bacterial prostatitis account for 80-90% of all cases.
If we were to conduct a large microscopic examination of the prostate, we would find some signs of its inflammation in all men, without exception after 40 years. But it has nothing to do with the diagnosis of chronic bacterial prostatitis.
There are many urinary conditions that can hide behind the mask of chronic prostatitis, some of which are quite serious and require immediate treatment. Therefore, I recommend that all patients with prostatitis-like symptoms undergo a more detailed examination, which will clarify the diagnosis.
How to diagnose prostatitis?
From the patient's perspective, the symptoms of bacterial and nonbacterial prostatitis are very similar. Without consulting a urologist and special tests, it is not possible to distinguish one form of prostatitis from another and receive quality treatment. You can book a free urologist appointment under your mandatory health insurance policy or book an appointment with a doctor at a private clinic.
The primary duties of a urologist, to whom a patient suspects prostatitis, visit, is to rule out other diseases of the prostate gland, for example, cancer, and to determine what a person has. . It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected causative agent. Here's what your doctor should do to figure it out.
Ask the patient about symptoms and health status.To gather more information, your doctor may suggest answering questions from a questionnaire called the Chronic Prostatitis Symptom Index. In some cases, to save time at the appointment, it is advisable to print out the questionnaire and fill it out in advance.
Conduct a health check.The doctor will examine the patient, paying particular attention to the groin area. If there are swollen and painful lymph nodes in the groin, this increases the possibility that the body is actually inflamed. Usually, the exam includes a digital rectal exam, which allows the doctor to assess the size, shape, and condition of the prostate gland. Research helps find out if the prostate gland is enlarged. If it feels painful to the touch, it's most likely inflamed.
Can anything be done without a digital rectal exam
Digital rectal examination and prostate massage are not the most pleasant procedures. In acute inflammation, this can be painful. Some patients want to avoid these procedures, in principle they refuse to make an appointment with a urologist.
A digital rectal exam is a diagnostic method, but transrectal prostatectomy is performed for laboratory analysis - the secret of the prostate. If bile cannot be obtained, the doctor may substitute an analysis of the prostate secretions with an analysis of the first urinalysis, or two and three cup urine samples. These studies allow you to preliminary locate the problem area in the urinary tract.
Sometimes, instead of this test, a semen analysis is prescribed for the same purpose. It helps to understand if prostatitis is part of an infection of the male gonads and provides information about the quality of the ejaculation. In addition, leukocyte counting in ejaculate helps differentiate between 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 recommend discussing this with your doctor. Perhaps the analysis of the secretion of the prostate gland, to achieve this only by her massage, could be replaced by the analysis of urine or semen.
Order blood, urine, and prostate secretions tests.Diagnostic criteria include microscopic examination of prostate secretions, general blood tests, general urinalysis with microscopic sedimentation, as well as microbiological examination ofurine and secretions of the prostate gland.
During microbiology, the patient's biomaterial is placed on a nutrient medium and they watch the bacteria grow on it - this allows you to clarify the diagnosis. You can get the tests done at a private clinic for money or for free under the required health insurance.
Other tests and examinations — such as total prostate-specific antigen (PSA) blood levels and transrectal prostate ultrasound (TRUS) — are usually not done if prostatitis is suspected. paralysis. In some cases, TRUS of the prostate may reveal fibrosis, that is, a scar or foci resembling a malignancy, but such studies are not indicated for all patients. patient, no exception.
How is prostatitis treated?
Treatment depends on the type of prostatitis. If the inflammation is caused by bacteria, your doctor will choose an antibiotic. And if bacteria has nothing to do with it, medication will be required to help deal with the unpleasant symptoms of the disease.
Acute bacterial prostatitisstart treatment without waiting for test results - this is called empiric antibiotic therapy. With this approach, antibiotics are prescribed based on knowledge of which bacteria are most likely to cause a prostate infection.
As a rule, patients are prescribed antibacterial drugs that penetrate well into the tissues of the prostate gland and act on the most "common" agents of prostatitis and urinary infections.
People who feel more or less normal and are treated at home usually receive antibiotics in pill form. As for patients with high fever who are being treated at the hospital, they are more likely to be prescribed intravenous antibiotics. With this treatment, in most patients with acute prostatitis, fever and pain are relieved by the second to sixth day after starting the drug.
Once the patient's temperature returns to normal, and signs of inflammation disappear, the doctor can switch the patient from the injection form to the tablet form. The total duration of antibiotic treatment 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 release excess secretions that had accumulated in the gland and thus reduce swelling. Today, however, most experts have come to a consensus that prostate massage should be avoided for bacterial prostatitis. Not only is this painful and unhelpful, but it can also worsen the course of the disease, because as a result of the massage, bacteria can get into adjacent tissues, leaving no infection.
Chronic bacterial prostatitisare also treated with antibiotics that target gram-negative bacteria. For treatment, fluoroquinolones are often used - these antibiotics are considered quite safe. But if the doctor suspects that other microorganisms have caused the prostatitis, he or she may prescribe additional antibacterial drugs without waiting for the test results.
With chronic prostatitis, antibiotics are needed longer than in acute. In accordance with the recommendations of urologists, they are prescribed for a course of treatment from 4-6 weeks.
Chronic bacterial prostatitisNo bacteria is involved, so patients with this condition are prescribed antibiotics only if, in addition to prostatitis, they have a urinary tract infection.
Since the exact cause of bacterial prostatitis is unknown, treatment is primarily aimed at relieving pain during urination. To do this, doctors prescribe alpha-1 blockers, drugs that help relax the prostate muscles that compress the urethra. If the pain persists, your doctor may prescribe a non-steroidal anti-inflammatory drug. Dosage for each patient is selected individually.
Some patients with prostatitis receive help with cognitive behavioral therapy - this is the name of the sessions with a psychologist, in which a person learns to cope with pain without medication. At the same time, there is still no scientific evidence on the effectiveness of psychological support for bacterial prostatitis.
Studies in which researchers try to demonstrate the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal heat therapy, are established. sketchy planning and taking too little time - usually less than 12 weeksSo it's impossible to say whether all of this is helpful or not.
How to avoid prostatitis: prevention
The main cause of prostate discomfort is a sedentary lifestyle and lack of regular sex. Doctors believe the best chance of avoiding prostatitis is in men who:
- Practice safe sex often.
- They regularly exercise moderately.
- Avoid hypothermia.
- After reaching the age of 40, they have an annual urological exam.
Where is it better to treat prostatitis - in a public or private clinic
The most important thing is to follow the principles of evidence-based medicine in the diagnosis and treatment of prostatitis. It just depends on the doctor - and exactly where he works doesn't matter.
Unfortunately, doctors at private clinics do not always adhere to standards of medical care. This can lead to overdiagnosis and unnecessary treatment, thus putting the patient at risk of overpaying. In a public health institution, the likelihood of compliance with all diagnostic and therapeutic standards is higher. But patients need to be aware that the general examination will take longer, sometimes more than when examining in a private clinic.
Remember
- Urinary tract problems in men are common, but not every case with prostatitis. To understand exactly what is going on with a person, you need to undergo a thorough examination.
- Prostate problems rarely lead to difficulty getting an erection. Often, with prostatitis, it is weakened by psychological problems that arise against the background of unpleasant symptoms.
- Not every form of prostatitis is caused by bacteria: 80-90% of them have nothing to do with it. If a person suspected of having prostatitis is prescribed antibiotics without additional tests, this is bad. Before taking them, you should consult another doctor.
- A person with acute or chronic prostatitis may be prescribed prostate massage to collect gland secretions for analysis.
- The best way to prevent prostatitis is through protective sex, a healthy lifestyle, and after age 40 - regular urological exams by a doctor.