Chronic prostatitis is an inflammatory disease characterized by lesions of the prostate and severe urodynamic disorders. One of the causes of chronic prostate inflammation is improper or inopportune treatment in the acute phase, when the desquamation and proliferation of the glandular epithelium is reversible and successfully corrected by medication in 2-3 weeks.
The treatment of chronic prostatitis includes massive antibiotic therapy with the aim of eradicating the infectious pathogen, a set of measures to increase the body's immunoresistance, physiotherapeutic methods, thermotherapy. Psychocorrection can also be included in the therapy regimen, as neurasthenic and neurosis-like conditions are often seen in men with recurrent and long-term prostatitis.
Why does inflammation become chronic?
Knowing the causes of chronic prostate inflammation is necessary to prevent exacerbations and improve patients' quality of life. There are a large number of factors that can affect the functional state of the glandular (glandular) tissue of the prostate and cause its inflammation, which is based on the desquamation and proliferation of epithelial cells.
The main cause of chronic prostatitis in men is the widespread contamination of the mucous membranes of the genitourinary system with pathogenic microorganisms. In the overwhelming majority of cases (over 80%) of infectious prostatitis, gram-negative and gram-positive bacteria become the causative agent of the infection: enterobacteria (in particular, Escherichia coli), gonococci, staphylococci. Less frequently, the infectious and inflammatory process continues in the context of infection by viruses, fungi and protozoa, but these forms of prostatitis are treated quite successfully during the acute period and rarely show recurrences, subject to correct and timely therapy.
It should also be borne in mind that for the development of chronic aseptic prostatitis, a single acute urinary tract infection is sufficient, therefore, personal hygiene, the use of condoms during sexual intercourse and timely treatmentUrinary tract diseases are of great importance in preventing this disease in men. Medicine knows cases of hematogenous infection (through systemic circulation) of the prostate in chronic sinusitis, tonsillitis and other diseases that contribute to the active growth of pathogenic flora, therefore, the rehabilitation of chronic infection foci is an important step in complex treatment forprolonged or prolonged inflammation of the prostate.
The negative factors that can cause exacerbation of prostatitis (including non-infectious course) are:
- Urinary tract injuries and surgery on the organs of the genitourinary system;
- regular or severe hypothermia of Organs pelvic organs (swimming in open tanks during periods when the water is not hot enough or the weather is cold outside, working in refrigerators and freezers, etc. );
- hypodynamics caused by sedentary work and insufficient physical activity in men (sedentary lifestyle is one of the main factors in the development of chronic cognitive prostatitis);
- bad habits, in which the absorption of the most important macro and microelements that determine the chemical composition and the rheological properties of prostate secretions (zinc, chromium, selenium, manganese) is delayed or impaired;
- disorders of the intimate sphere (frequent masturbation, irregular intercourse, long periods of abstinence, frequent arousal that does not end with intercourse);
- overweight;
- eating disorder (increased consumption of spicy, very salty, smoked and fatty foods).
Pay attention! Urologists note that the main pathogenic factor in the development of chronic prostate inflammation is posterior urethritis. It has also been observed that inflammatory changes in the prostate in men appear during the first months after a gonorrheic infection.
Treatment of chronic prostatitis with drugs
Treatment of chronic prostatitis with drugs is only intended to suppress acute symptoms during an exacerbation and destroy the infection, but the drugs cannot be used as the only means (the effectiveness of this treatment will not exceed 36%, according toDr. Pechersky).
A complete treatment regimen for prolonged or recurrent prostate inflammation, which is used today as a standard for uncomplicated disease, is shown in the table below.
Table. Preparations for the complex treatment of chronic prostatitis.
| Pharmacological group | Objective |
|---|---|
| Macrolides antibiotics, semi-synthetic penicillins and third generation cephalosporins with a broad spectrum of antibacterial activity. | Eradication (destruction) of pathogenic bacteria - agents that cause infectious prostatitis, urethritis, cystitis and other urinary infections. |
| Antimicrobial and antiprotozoal agents. | Treatment of infections caused by pathogens and protozoa. |
| Nonsteroidal anti-inflammatory drugs (preferably in the form of rectal suppositories). | Reduction of the inflammatory process in the prostate tissues, pain relief in the perineum, intergluteal space, sacrum and groin. |
| Antiseptics in the form of rectal suppositories. | Rehabilitation of rectal mucous membranes and prevention of their infection with prolonged prostatitis. |
| Alpha blockers. | Normalization of urination, restoration of daily urine production. |
| Microcirculation correctors. | Elimination of congestion in the small pelvis vessels, restoration of normal blood and lymph flow. |
| Urodynamic correctors (agents that affect metabolism in prostate tissues). | Improvement of metabolic and metabolic processes in prostate tissues and their nutrition. |
| Power regulators. | Complex treatment of erectile dysfunction, improving the chemical composition, viscosity and fluidity of the seminal fluid, increasing sperm activity (the use of drugs in this group is indicated for patients whose prostatitis is complicated by autoimmune infertility). |
The duration of antibiotic treatment is at least 4-6 weeks. In no case should medications with an antibacterial effect be taken without a prescription, since the main factor in choosing therapy is the results of a microscopic examination of prostate secretions and fluids released spontaneously as a result of prostate massage. Some antibiotics, for example, penicillins (a combination of amoxicillin and clavulanic acid) are reserve drugs, and their misuse can lead not only to the absence of a clinically significant effect and to the progression of the pathology, but also to the development of superinfection.
Important! In some cases, men with chronic prostatitis need psychocorrection, especially if the pain syndrome is combined with behavioral changes, increased anxiety, irritability and neurasthenia. Antidepressants with selective inhibition of serotonin reuptake are used to suppress these symptoms.
Physiotherapy
Heat therapy is the main method of treating chronic prostatitis outside periods of exacerbation (after regression of acute symptoms). Heat therapy refers to physical therapy methods and is a metered effect of heat on the affected area. The benefits of thermal procedures are in the normalization of blood circulation, relief of inflammatory processes, reduction of chronic pelvic pain, which is one of the main clinical manifestations of chronic prostatitis, which reduces man's quality of life. Heat also improves the penetration of medicinal substances into the prostate tissue, so in some cases, physiotherapy is used to increase the effectiveness of drug therapy (for example, electrophoresis with antibiotics). For men at high risk of thrombus formation, warm-up is prescribed for prophylaxis, as heat has a moderate reabsorption effect.
The methods of thermal effects on the body are numerous, and the choice of a specific treatment method must be made by the doctor, taking into account the clinical picture, the form and stage of the disease, the age of the man and hisindividual tolerance. The most effective methods of heat therapy for prostatitis are:
- thermal applications with minerals (ozocerite, paraffin, bischofite), salt or sand;
- electric heating pads;
- deep heating of highly resistant tissues for a direct effect on blood vessels and nerve endings (diathermy);
- exposure to alternating high frequency magnetic fields to eliminate pain, relieve inflammation and eliminate neurosis-like manifestations (inductothermia);
- ultrasound therapy (promotes the resorption of abscesses and the healing of formed scars); electrophoresis
- with introduction of electrodes in the rectum;
- exposure to prostate tissue by high-frequency impulse currents (darsonvalização).
In some physical therapy rooms, chronic inflammation of the prostate is treated with applications of hot mud ("mud pants"). These procedures have a positive effect not only on the circulation of blood and lymph, but also on the production of prostate secretion, as well as on the nutrition of the tissues of the inflamed organ. In some cases, the mud is injected directly into the rectum in the form of tampons, since with this method of administration it is possible to quickly achieve a therapeutic effect and a positive response to therapy.
Other treatments
The complex treatment scheme, in addition to drug and thermal therapy, is complemented by several procedures that the doctor prescribes, taking into account the peculiarities of the pathology in each case.
Prostate massage
This is one of the main methods of treating chronic inflammation of the prostate, the use of which is advisable in almost 90% of cases (in the absence of contraindications). Massage is a finger effect on the prostate to stimulate the secretory fluid to escape. The duration of the procedure is usually about 1-2 minutes. The criterion for a sufficient effect is the total emptying of the prostate glands, which the patient feels a relief from (which he must inform the doctor).
The benefits of massage are determined by the therapeutic effect that can be achieved after taking a course of treatment (8-12 procedures). With an uncomplicated course, they are:
- normalization of muscle tone;
- improvement of blood circulation in the vessels of the prostate (due to this, the transport of medicinal substances to the tissues of the affected organ is accelerated and the effectiveness of the therapy increased);
- restoration of secretory permeability;
- normalization of prostate blood and lymph flow (especially significant in cognitive prostatitis).
The procedure is contraindicated in the acute period due to the high risk of spreading the infection to the surrounding tissues and organs (hematogenous infection), with other infectious diseases of the genitourinary system, presence of cysts or stones in the prostate. Prostate massage is not prescribed for patients diagnosed with a tuberculous lesion, adenoma or other neoplastic diseases (including cancerous lesions of the prostate). In the presence of diseases of the rectum (hemorrhoids, anal fissure, proctitis, paraproctitis), massage can cause complications and cause recurrence of the underlying disease.
Important! Studies show that almost 42% of men refuse prostate massage due to the increase in psychological discomfort associated with the peculiarities of this procedure. The doctor's work with these patients should include detailed information about the consequences of refusing treatment and possible complications, in particular, infertility and persistent sexual dysfunction. In some cases, it may be advisable to prescribe mild sedatives a few days before starting treatment.
Hot enemas
Hot enemas are home treatments for chronic prostatitis, but urologists recognize their effectiveness and recommend them for faster and more effective treatment of prostatitis. The water temperature for these enemas should be around 42 ° C. Before the procedure, it is necessary to clean the intestines with a regular enema or laxatives. The volume of an enema is 150 to 300 ml. It is recommended to empty the intestine in one hour 30-50 minutes after administration of the solution.
The prescriptions for chronic prostate inflammation are listed below.
- Dissolve 10 drops of iodine and about 20 ml of chlorhexidine in 200 ml of water. Apply at bedtime for 15 days.
- A decoction of chamomile, St. John's wort or marigold should be introduced into the rectum (about 250 ml) and then kept for 1 hour. The procedure is repeated once a day for 2 weeks.
- Sea buckthorn oil (40-50 ml) is heated to 40 ° C and introduced into the rectum for 20-30 minutes. The course of treatment is 10-15 days. The procedure is best done before bed.
- In case of severe pain syndrome, which significantly limits the patient's mobility and worsens his quality of life, microclysters with novocaine may be used. Dissolve 2 ampoules of 2% novocaine solution in 180 ml of a deep chamomile decoction. Hold for at least 50 minutes. Repeat daily for 1 week.
Anti-inflammatories, antiseptics and antibiotics can also be used in medications for microclysters. The use of these drugs is permitted with the authorization of a doctor strictly in the indicated dosage.
Treatment of chronic prostatitis: step-by-step instructions
The use of various treatment methods is not enough to completely get rid of chronic prostatitis. If a man does not monitor his diet and does not change his lifestyle, exacerbations will occur regularly, leading to irreversible changes in the structure and functional activity of the prostate glands and persistent dysuric and sexual disorders. For the effectiveness of treatment and the duration of remission to be greater, you must follow the recommendations set out in the instructions below for patients with chronic prostatitis.
- Step 1. If a man is diagnosed with chronic prostatitis, he should start by correcting his diet. It is necessary to exclude from the menu foods with large amounts of fat, salt and spices. Fats increase blood cholesterol levels and salt promotes fluid retention and swelling in the prostate tissue. Spices (like various chemical additives) irritate the mucous membranes of the urinary tract, causing an exacerbation of existing symptoms.
- Step 2. It is also necessary to completely eliminate alcoholic beverages, as they delay the absorption of nutrients, disrupt the circulation of blood and lymph and negatively affect the prostate metabolism. If a man is addicted to tobacco, measures must be taken to get rid of this habit (the toxic substances in tobacco smoke violate the viscosity and fluidity of prostate secretion and alter its chemical composition).
- Step 3. Overweight men should consult an endocrinologist and nutritionist for a comprehensive diagnosis and correction of body weight, taking into account the deviations identified. Obesity is the most important factor in the development of chronic prostatitis, and an important stage in complex therapy is weight loss in patients with a high BMI.
- Step 4. To eliminate stagnation phenomena associated with hypodynamic disorder, it is necessary to provide an adequate level of physical activity, corresponding to age and physical fitness. Swimming, physiotherapy exercises, stretching exercises and walking are useful for prostatitis.
- Step 5. For normal prostate function, it is necessary to monitor the quality of sexual life. It is advisable to have a permanent sexual partner, to avoid episodes of sexual arousal if there is no possibility of other sexual relations, and to have regular exams for genital infections, which can also cause an exacerbation of chronic prostatitis.
Men with recurrent prostatitis need to monitor emotional stress, avoid stressful situations, as well as prolonged exposure to cold or drafts.
Chronic prostatitis is a disease that is difficult to treat, especially if the patient does not follow the prescription of the attending physician and does not take a responsible approach to issues of nutrition and regimen. Inflammation of the prostate is dangerous with serious complications, so you need to address the problem comprehensively. Men with this diagnosis should understand that pills alone are not enough to completely restore all prostate function, so you should not abandon the basic therapy methods for chronic prostatitis suggested by your doctor, even if they cause primary psychological or physical discomfort.