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Prostatitis

pain in a man with prostatitis

Prostatitis is a disease in which the prostate gland becomes inflamed.Prostatitis, the symptoms of which occur most frequently in men of reproductive age (20 to 40 years), is diagnosed on average in 35% of the population.

Depending on the origin, prostatitis can be bacterial or non-bacterial, depending on the nature of the course: acute or chronic.

When the first signs of prostatitis are detected, the choice of treatment method depends on the form of the disease.As a rule, specific and symptomatic treatment is carried out.

Prostatitis is not a disease that can be diagnosed from a photograph, since the disease does not present visible manifestations.To notice the first symptoms in a timely manner, you need to listen to your own health.

Overview

The prostate, which is affected by the disease in question, is an exclusively male organ;Consequently, prostatitis can develop exclusively in men.If we consider a similar area in women, and this is the distal third of the urethra, or urethra, then here are Skene's glands.These glands are essentially analogous to the prostate and, if inflamed, the symptoms can resemble those of prostatitis.

The prostate itself looks like a glandular-muscular organ located near the bladder.Thanks to this, the urination process is controlled, in addition, it is due to the presence of the prostate that a certain secret is released that makes the sperm liquid.

Most often, prostatitis occurs in combination with diseases such as vesiculitis or urethritis, in elderly patients, in combination with benign prostatic hyperplasia.

Prostatitis: causes

Bacterial prostatitis, as the name suggests, develops when exposed to relevant pathogens.Basically, these are pathological agents that constantly reside on the surface of the skin or in the environment of the digestive tract.In this case, a certain combination of factors can provoke the development of prostatitis.

The causes of prostatitis include a variety of factors.Therefore, this may be premature emptying of the bladder, the presence of diseases of the genitourinary system, constant hypothermia, irregular sexual life, sedentary lifestyle, bad habits, etc.The relevance of this type of factor causes the possibility of microbial agents entering the prostate gland, or causes a disruption of the blood supply to the organs located in the pelvis, or leads to the development of stagnant processes.All this leads to the proliferation of microorganisms, as well as the development and progression of pathological inflammation.

If an infectious pathogen is not detected in prostatitis, a nonbacterial form of prostatitis is diagnosed.Several reasons may explain this form of pathology, although none of them have been proven at the moment.For example, some experts believe that in this way the disease can develop against the background of real neurogenic disorders, while others, on the contrary, focus on the immune nature of the disease in this way.This is only part of the existing theories about prostatitis.

Let us dwell on the acute and chronic forms of the disease.Acute prostatitis is based on the influence of a bacterial factor.As for chronic prostatitis, here this factor is not the main one, acting rather as a secondary factor and important in its impact only at the beginning of the disease.Over time, the pathogenic mechanism can be complemented by a neurogenic, autoimmune or allergic factor, due to whose influence the chronic form of inflammation is maintained even when there is no possibility of bacterial invasion.

Prostatitis: symptoms

Inflammation is accompanied by pain in prostatitis, in particular, this is caused by damage to the excretory ducts of the acini, from the walls of which the epithelium is detached, which gradually accumulates with mucus in the tubules.In addition, microliths are also formed;They look like small pebbles.Mixing with epithelium and mucus, they cause the appearance of peculiar plug formations, which, in turn, cause obstruction of the excretory ducts.Over time, these plugs turn into suppuration (or microabscesses), the lobes are no longer subject to drainage, they simply stop functioning.

Meanwhile, before the onset of such a stage as obstruction of the excretory ducts, as a rule, a lot of time passes;In some cases, this time is calculated in months, in others even in years.The process progresses gradually, the patient may not notice anything special, especially since the production of secretion by the prostate does not stop.Another thing is that when these microabscesses form, this is already accompanied by the appearance of not very pleasant symptoms, which manifest themselves in different degrees of intensity.

As the first of these symptoms, patients notice some difficulty urinating.Due to the fact that the prostate increases in size against the background of the inflammatory process, the urethra is compressed to a certain extent.Further progression of the inflammatory process provokes the development of sclerosis of the bladder neck;in an even more severe form of the pathological process, complete closure of the ureter occurs.

The next symptom is sexual dysfunction.Due to the pathological processes that occur during the disease, the erection mechanism is subject to disturbances and the orgasm is weakened.

There are also other signs of prostatitis, in particular these include:

  • the appearance of a burning sensation in the urethra and perineum;
  • persistent and frequent need to urinate;
  • the appearance of discomfort during bowel movements;
  • “floating threads” in the urine;
  • the appearance of discharge from urethral stretching during defecation;
  • the appearance of prolonged nocturnal erections;
  • intermittent and difficult urination;
  • too rapid ejaculation;
  • increased general fatigue;
  • decreased power;
  • manifestation of orgasm in erased form;
  • expectation of the development of other forms of complications in the considered area, against the background of which anxiety and general mental depression appear.

I would like to add separately that the listed signs (symptoms) do not necessarily appear overnight.The disease is characterized by a highly variable pattern of manifestation, this applies to different variants in each individual patient, and to different time periods during its course.

When considering the symptoms, it would be helpful to return to the causes.Naturally, the inflammatory process will not appear "out of nowhere."We are talking mainly about pathogens, which have already been mentioned above.Meanwhile, it was this factor that caused the formation of a misconception about the presence of certain causative agents of prostatitis, which is still supported by many specialists today.However, there is no specific type of causative agent for this disease.At the same time, any chronic infectious disease can provoke the development of prostatitis;It can be of any type, be it sinusitis, tonsillitis, cholecystitis or any other disease.In this case, the pathogen can enter the prostate through the bloodstream, which is characterized by a rather powerful blood supply (otherwise its functionality would be in doubt).

There is a certain risk group for suffering from prostatitis, in particular the following people fall into it:

  • people whose professional activity falls within the "sedentary" work criterion;
  • people with a sedentary lifestyle;
  • people who have previously been diagnosed with a certain genitourinary infection;
  • people for whom the problem of chronic constipation is relevant;
  • promiscuous people;
  • people whose family relationships do not fit the criteria of order;
  • people who abuse alcohol.

Often men are diagnosed with "abacterial prostatitis", "prostatitis in the prostatosis stage."If a man is diagnosed with prostatosis, we can say that at this stage there is nothing to particularly worry about.In the meantime, you will have to make certain adjustments to your lifestyle.In other words, we are talking here that the stagnation phenomena discussed above are already occurring, but there is still no inflammation as such, it is prostatosis.If such an option as abacterial prostatitis is considered, then here we are already talking about the beginning stage of the development of the inflammatory process in a man, but so far without an accompanying infection.

A distinctive feature of prostatitis is that it practically does not manifest itself acutely.In other words, when it manifests itself, it is already a chronic process, which is explained by its often long and gradual development.Complete recovery due to treatment of the disease or spontaneous disappearance of the pathological process is estimated in isolated cases during the initial acute phase.The disease is characterized, as already noted, by its extremely slow course, the manifestations of symptoms are usually mild.

Prostatitis: consequences

Acute prostatitis, if its manifestations are ignored and seeking medical help is excluded, can lead to the development of an abscess in the prostate gland, that is, the cause of the development of focal purulent inflammation in it.This is accompanied by an increase in temperature (between 39 and 40 degrees), which at the same time becomes hectic, that is, their differences exceed one degree.Patients also experience high fever, which periodically gives way to chills.The pain in the perineum becomes so intense that it makes it difficult to urinate, while defecation becomes almost impossible due to the pain.After some time, swelling develops in the prostate gland, which, in turn, causes acute urinary retention.Meanwhile, it is rarely acute prostatitis, which manifests itself against the background of a chronic spread of the pathological process, unless, at his own risk, a man "holds out and endures."

Returning to chronic prostatitis, we can say that it is characterized by the undulation of its own course, that is, periodically the symptoms of the chronic form of prostatitis appear with greater intensity, and periodically they are practically not felt.Because of this type of change, many patients choose a wait-and-see approach.Meanwhile, as noted above, the inflammatory process may worsen and spread further and further.When it spreads, even pyelonephritis may develop.Meanwhile, complications of prostatitis in most cases are due to diseases such as vesiculitis, in which the inflammatory process affects the seminal vesicles, as well as epididymoorchitis, in which the testicles and appendages become inflamed.As a result of the transmission of the disease in a similar form of spread, the development of infertility in a man may be indicated.Treating infertility is a long and complex process and, in some cases, completely impossible.The listed features mainly refer to the development of a chronic form of prostatitis, due to the specific etiology of its occurrence (in particular, we are talking about STDs).

Diagnosis

Screening patients to identify their specific type of prostate pathology can be performed in several ways.Meanwhile, in each specific case an individual approach to the problem in question is important, on the basis of which it is already possible to determine the diagnostic option in order to obtain sufficient information about the disease.

To begin with, the doctor examines the patient's complaints, studies the medical history, if any, and on the basis of this subsequently makes a preliminary conclusion and determines the principles of an individual diagnostic algorithm.We would like to add that the first consultation with a urologist (that is, this is the specialist you should go to if disturbing symptoms of prostatitis appear) is neither definitive nor reliable in making a diagnosis, because the first examination is only an opportunity for the doctor to determine what additional diagnostic measures are necessary.

Given the sensitivity of the problem, men are interested in what questions a urologist asks if they suspect prostatitis.In particular, it will ask about current problems associated with urination, as well as how the patient himself evaluates his own sexual function (i.e., if there are any changes, what exactly has changed, since what period).Additionally, the doctor will ask you what diseases you currently suffer from, etc.

This is followed by an examination, in particular an external examination, a digital rectal examination, a laboratory examination and an instrumental examination.During an external examination, the doctor examines the man's genitals and determines if there are rashes, irritation, discharge, etc.

Then, after an external examination, the doctor moves to the next stage, which is a rectal examination.A rectal examination allows us to determine the general contours of the prostate, its consistency, limits, etc.

After this, you will need to obtain the results of instrumental and laboratory diagnostics.Instrumental diagnosis is called TRUS, which in expanded form means transrectal ultrasound.This is the most accurate method of identifying diseases in a man compared to standard ultrasound.

As for laboratory tests, these include swabs, urinalysis, prostate secretion test, PCR (a laboratory test to detect sexually transmitted infections).

According to the current classification of methods for diagnosing prostatitis, only microscopic examination of the secretion obtained from the prostate gland, as well as any of the topical diagnostic options that can detect the presence of an inflammatory process in the lower genital tract, can be considered a necessary option.Other types of diagnostic methods act only as clarifying methods;They are necessary for differential diagnosis and to identify existing complications of the underlying disease.Additionally, it is important to remember that with overdiagnosis, this stage itself becomes longer and the symptoms only worsen.That is, here, as in any matter, the principle of the “golden mean” is appropriate.

Prostatitis treatment

Treatment of prostatitis today is a serious problem, although this does not mean that the doctor cannot help and the disease should be left to chance.In fact, it is not always possible to completely recover from prostatitis, but it is possible to eliminate the symptoms of the disease, as well as achieve long-term and sustainable remission.Depending on how seriously a man takes the doctor's recommendations, the duration of the periods of remission will be for him.

In essence, the treatment of prostatitis may contain a number of measures, in particular, methods of antibacterial therapy, prostate massage, immunotherapy, physiotherapy and general correction of the patient's lifestyle.Only on the basis of a set of these measures can the desired result be achieved;In general, the disease is difficult to treat, so it cannot be ignored.

Antibacterial therapy

This type of therapy is considered the basis of conservative treatment.The basis for the choice of antibacterial drugs are several factors, in particular these:

  • the ability of the components of the proposed drug to enter the secretion and tissue of the prostate to create a concentration that exceeds the MIC values of the pathogens;
  • characteristics of the spectrum of antimicrobial activity (for example, the use of macrolide antibiotics determines the possibility of good penetration into the prostate tissue, while they do not have any activity against gram-negative bacteria, that is, they are the main etiological agents when considering the acute form of prostatitis).

What is noteworthy is that acute prostatitis, in comparison with the chronic form of the disease, is characterized by the fact that it allows the possibility of accumulation of aminoglycosides and beta-lactam antibiotics in the tissues of the gland, and in concentrations sufficient to suppress the activity of most types of pathogens.This is due to greater perfusion of the prostate, as well as a greater degree of permeability characteristic of the hemoprostatic barrier.Another characteristic of the drugs in this group is that as the inflammation subsides, the degree of penetration into the prostate decreases.For this reason, it is recommended to switch to another type of oral medication.

prostate massage

For the most part, experts consider this method of influence as a fairly effective solution in the treatment of prostatitis.The basic principles to achieve a therapeutic effect in this case are as follows:

  • restoration of duct patency;
  • improvement of muscle tone and blood circulation in the prostate;
  • greater penetration of the antibiotics used into the gland tissue;
  • the possibility of activating microorganisms that are in an inactive state, thus improving the results of the sale of antibacterial drugs.

How is prostate massage performed?To begin with, of course, it is important to establish a certain contact of trust between the doctor and the patient;This will ensure greater relaxation of the patient, which, in turn, will allow the necessary manipulations to be carried out with minimal pain and maximum effectiveness.When preparing for a massage, the patient leans forward, spreading his legs about 60 cm and leaning on the examination table with his elbows.The doctor puts on gloves and applies a gel to the index finger (sometimes this gel has an analgesic effect).Then, with your free hand, spread your buttocks to a width that allows you to palpate the anal sphincter with your index finger.The natural reaction to such contact is muscle contraction.Then, after relaxing them, the index finger is inserted into the ampulla of the rectum.

In some cases, patients experience dizziness and even fainting during these manipulations (on average, in 10% of cases).These manifestations are mainly caused by excess fear, shame and anxiety, and if the massage is performed correctly they do not accompany it at all.A massage can be considered successful when it is possible to obtain at least 4 drops of secretion secreted by the prostate.

The most popular recognized method used in the treatment of chronic prostatitis is massage according to the Manila Protocol.In this case, the massage is performed three times a week, a dynamic microbiological study is also carried out and antibiotics are taken.

Immunotherapy

This direction in the treatment of prostatitis is usually extremely necessary, because with prolonged manifestation of inflammation in combination with previously incorrect antibacterial treatment, the possibility of a negative impact on the general state of the immune system cannot be ruled out.Treatment of prostatitis requires not only eliminating the infection of the gland and, in fact, inflammation, but also preventing the recurrence of inflammation in it.However, like other areas of treatment, immunotherapy should not be reduced to self-medication or treatment based on the recommendations of a pharmacist in a pharmacy;Here you will need to consult an immunologist and, most likely, do some tests.

Physiotherapy

For prostatitis, this treatment direction can be implemented in a wide variety of impact options;However, regardless of the specific solution, the impact is focused on improving blood circulation in the pelvic organs, thereby increasing the overall effectiveness of implementing antibiotic therapy measures.Physiotherapy can use ultrasonic waves, electromagnetic waves, laser therapy, increasing temperature directly in the rectum, etc.If there are no possibilities for physiotherapy, the doctor may recommend microenemas with warm water and certain medications.

Lifestyle correction

This type of effect is aimed at both the treatment of prostatitis and its prevention.It should be treated in the same way as the main treatment, because if the factors that predispose to the development of prostatitis persist, the disease will sooner or later make itself felt again.Taking this into account, you must make certain changes in your life, this applies to playing sports, normalizing your waking/sleeping schedule, a nutritious and balanced diet, walking, eliminating bad habits.

If symptoms indicating prostatitis appear, it is advisable to consult a urologist.