A survey of residents of various countries has shown that 2-10% of adult men have symptoms indicating problems with the prostate during their lifetime.
Any urination disorder is an alarm bell, and self-medication in this case should be ruled out.However, problems are not always related exclusively to prostatitis.
Go to the doctor
Our articles are written with love for evidence-based medicine.We refer to reputable sources and seek comments from reputable doctors.But remember: the responsibility for your health lies with you and your doctor.We do not write prescriptions, we give recommendations.It is up to you whether to rely on 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 "nut" passes the urethra, the tube through which urine is removed from the bladder and sperm from the testicles.
The key task of the prostateconsists of the production of a secretion that is part of the seminal fluid.Thanks to this secretion, spermatozoa are able to move.Another task of the prostate is contraction, ensuring ejaculation, or ejaculation.
Next to the prostate are the seminal vesicles, which are connected to the vas deferens, through which the sperm leaves the genitals.The testicles produce the liquid part of the sperm and store prostate secretions.
Prostate secretion is a mixture of citric acid and enzymes.This fluid dilutes the sperm, which enters the urethra from the vas deferens of the testicles.
Prostate problems do not always lead to erectile problems
In the vast majority of cases, sexual dysfunction is not related to prostate problems, because there is no physical connection between the prostate and the erection mechanism.
But voiding disorder, discomfort due to incomplete emptying of the bladder, pain or discomfort associated with inflammation cause a person to become nervous and embarrassed.Because of this, psychological problems arise - as a rule, they have a negative effect on erection.
What is prostatitis?
Prostatitis is an inflammation of the prostate that is associated with pathogenic microbes or other non-infectious causes.Sometimes the inflammation also affects the seminal vesicles - this is called vesiculitis.
At the same time, inflammation of the prostate does not always lead to pain and problems with urination, and the presence of unpleasant symptoms is not necessarily related to inflammation of the gland.
To avoid confusion, urologists around the world use the classification proposed by the US National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK.
To simplify a little, the classification divides prostatitis into bacterial and abacterial, that is, it is not related to bacteria.This approach helps doctors make an important decision about whether to prescribe antibiotics and additional drugs.It is incorrect to give antibiotics to all patients with suspected prostatitis because non-microbial forms of prostatitis are more common than bacterial ones.Taking unnecessary antibiotics is harmful to your health.
The NIDDK classification identifies five forms of prostatitis.
Acute bacterial prostatitis.Disease most often caused by typical pathogens 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 of health.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 feel pain during ejaculation.Sometimes bacterial prostatitis causes frequent, difficult and painful urination.
Chronic bacterial prostatitis.Microbes typical of acute prostatitis can also cause this disease.The disease is considered chronic if the symptoms last for at least three months.
Symptoms of chronic bacterial prostatitis are similar to symptoms of acute prostatitis, but may not be as severe or less severe.There is usually no fever or weakness, the pain in the lower abdomen is more painful than sharp, but it is difficult to start urinating and empty the bladder completely.Moreover, unpleasant symptoms may disappear temporarily and reappear after some time.
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 urinary tract infections, and people who have recently had surgery or a prostate biopsy.
Chronic abacterial prostatitis associated with inflammation.The symptoms of inflammatory non-bacterial prostatitis are very similar to acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in semen, prostate and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate.
Chronic abacterial prostatitis, or chronic pelvic pain syndrome, is not associated with inflammation.Symptoms also resemble acute and chronic bacterial prostatitis.At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in semen, prostate and urine - this indicates that the prostate is not inflamed.
In the case of non-bacterial forms of prostatitis, it is not always possible to find out which cause leads to the development of the disease.Risk groups are also difficult to define.
Asymptomatic inflammatory prostatitis.This form of the disease does not cause discomfort.Most often, the inflammation is discovered accidentally when the patient is examined for other problems, such as infertility.
How does prostatitis differ 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.An enlarged prostate compresses the urethra, which can cause problems with urination: frequent urges to go to the toilet or leakage of urine.Faced with adenoma symptoms, some patients may assume they have prostatitis.
Although some symptoms of prostatic hyperplasia may indeed resemble prostatitis, they are not the same thing.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.
Adenoma can cause serious problems, so if you have problems urinating, it is important to consult 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 generalized literature data, worldwide acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis in 6-10% of cases.Moreover, both variants of chronic abacterial prostatitis account for 80-90% of all cases of the disease.
If we perform an extensive microscopic examination of the prostate, we will find certain signs of inflammation in all men over 40 without exception.But it has nothing to do with the diagnosis of "chronic bacterial prostatitis".
There are numerous urological diseases that can be hidden behind the mask of chronic prostatitis, and some of them are quite serious and require urgent 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 consultation with 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 as part of your mandatory health insurance policy or make an appointment with a doctor in a private clinic.
The main task of a urologist who examines 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.Here's what a doctor needs to do to find out.
Ask the patient about symptoms and health.To gather more information, your doctor may suggest answering questions from a questionnaire called the Chronic Prostatitis Symptom Index.In some cases, in order not to waste time on the appointment, it makes sense to print the questionnaire and fill it in advance.
Do a physical exam.The doctor will examine the patient, paying special attention to the groin area.If there are swollen, painful lymph nodes in the groin, this increases the likelihood that there is actually an inflammatory process in the body.Usually, the exam includes a digital rectal exam, which allows the doctor to assess the size, shape and condition of the prostate.The study helps to understand whether the prostate is enlarged.If the touch of the gland is painful, it is most likely inflamed.
Can it be done without a digital rectal examination?
Digital rectal examination and prostate massage are not the most pleasant procedures.In acute inflammation, this can cause pain.Some patients want to avoid these procedures so much that they completely refuse to make an appointment with a urologist.
Digital rectal examination is a diagnostic method, but massage of the prostate through the rectum is done in order to obtain material for laboratory analysis - prostate secretion.If the secretion cannot be obtained, the doctor can replace the analysis of the prostate secretion with either the analysis of the first portion of urine, or the two- and three-cup urine test.These tests can roughly determine where the problem area is in the urinary tract.
Sometimes, instead of this examination, a spermogram analysis is prescribed for the same purpose.It helps to understand if prostatitis is part of male reproductive gland infections and provides information about ejaculate quality.In addition, by counting leukocytes in the ejaculate, it is possible to distinguish 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 suggest they discuss this with their healthcare provider.Perhaps the analysis of prostate secretions, which requires massage, can be replaced by urine or semen analysis.
Prescribe blood, urine and prostate secretion tests.The diagnostic standard includes a microscopic examination of prostate secretions, a general blood test, a general urine test with sediment microscopy, as well as a microbiological examination of urine and prostate secretions.
During microbiological studies, the patient's biological material is placed on a nutrient medium and it is observed which bacteria grow on it - this allows the diagnosis to be clarified.You can be tested in a private clinic for money or for free with mandatory health insurance.
Other tests and examinations - for example, a test for the concentration of total prostate-specific antigen (PSA) in the blood and a transrectal ultrasound of the prostate (TRUS) - are usually not done if prostatitis is suspected.In some cases, TRUS of the prostate can reveal fibrosis, that is, scarring or foci similar to a malignant tumor, but such 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 has nothing to do with it, you'll need medication to help you deal with the unpleasant symptoms of the disease.
Acute bacterial prostatitisthey start treatment without waiting for test results - this is called empiric antibacterial therapy.In this approach, antibiotics are prescribed based on knowledge of which microbes most commonly 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 are treated at home usually receive 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, the temperature and pain decrease from the second to the sixth day after starting to take the medicine.
When the patient's temperature returns to normal and signs of inflammation disappear, the doctor can switch the patient from injections to tablets.The total duration of antibiotic therapy 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 this might 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.It is not only painful and useless, but can also worsen the course of the disease, because as a result of the massage, bacteria can enter the adjacent, non-infected tissues.
Chronic bacterial prostatitisit is also treated with antibiotics that work against gram-negative bacteria.Fluoroquinolones are commonly used to treat;these antibiotics are considered fairly safe.But if the doctor suspects that prostatitis is caused by other microorganisms, he can prescribe additional antibacterial drugs without waiting for the test results.
In chronic prostatitis, antibiotics need to be taken longer than in acute prostatitis.In accordance with the urologist's recommendations, they are prescribed in a course of 4-6 weeks.
Chronic abacterial prostatitisit is not related to bacteria, so antibiotics are prescribed to patients with this disease only if they also have a urinary tract infection in addition to prostatitis.
Since it is not clear what exactly causes abacterial prostatitis, treatment is mainly aimed at relieving pain during urination.To achieve this, doctors prescribe alpha-1 blockers - drugs that help relax the prostate muscles that compress the urethra.If the pain persists, the doctor may prescribe non-steroidal anti-inflammatory drugs.The dosage 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 drugs.However, there is no scientific evidence on the effectiveness of psychological help for abacterial prostatitis.
Studies in which researchers tried to prove the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal thermotherapy, were poorly designed and too short in duration—usually less than 12 weeks.So it's impossible to say whether all this helps or not.
How to avoid prostatitis: prevention
The main cause of discomfort in the prostate is a sedentary lifestyle and lack of regular sex life.Doctors believe that the greatest chance of avoiding prostatitis is in men who:
- Practice safe sex regularly.
- Do moderate exercise regularly.
- Avoid hypothermia.
- After reaching the age of 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 to follow the principles of evidence-based medicine when diagnosing and treating prostatitis.It just depends on the doctor - and it doesn't matter where exactly he works.
Unfortunately, doctors in private clinics do not always respect health care standards.This can lead to overdiagnosis and unnecessary treatment, leaving the patient at risk of overpayment.In a public medical organization, it is more likely that all diagnostic and treatment standards will be met.But patients must take into account that a complete examination will take longer - sometimes significantly longer than during an examination in a private clinic.
Remember
- Problems with the urinary tract in men are common, but not always the result of prostatitis.To understand what exactly is happening with a person, you need to undergo a thorough examination.
- Prostate problems rarely lead to erectile difficulties.Usually, with prostatitis, it weakens due to psychological problems that arise against the background of unpleasant symptoms.
- Not every form of prostatitis is caused by bacteria: in 80-90% they have nothing to do with it.If a person with suspected prostatitis is prescribed antibiotics without additional tests, it is bad.Before taking them, it makes sense to consult with another doctor.
- People with acute or chronic prostatitis may be prescribed prostate massage to collect secretions from the gland for analysis.
- The best way to prevent prostatitis is protected sex, a healthy lifestyle, and after the age of 40, regular urological examinations by a doctor.