A survey of residents of several countries showed that 2 to 10% of adult men have symptoms that suggest prostate problems during their lifetime.
Any urinary disorder is a warning sign and, in this case, self-medication should be ruled out. However, the problems are not always associated with prostatitis.
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How the prostate works
The prostate, or prostate, is a walnut-like organ located just below the bladder. Between the halves of the "walnut" passes the urethra - a tube through which urine is excreted from the bladder and sperm from the testes.
The main task of the prostateit consists in the production of a secret that is part of the semen. Thanks to this secret, sperm are able to move. The second task of the prostate is to contract, allowing ejaculation, ie, ejaculation.
Next to the prostate are the seminal vesicles connected to the vas deferens, through which sperm leave the genitals. The seminal vesicles produce the liquid portion of the semen and store the prostatic secretion.
The secret of the prostate is a mixture of citric acid and enzymes. This fluid dilutes the semen, which flows into the urethra from the testicular vas deferens.
Prostate Problems Don't Always Lead to Erection Problems
In the vast majority of cases, sexual dysfunction is not associated with problems with the prostate because there is no physical connection between the prostate and the erection mechanism.
But pain when urinating, discomfort due to incomplete emptying of the bladder, pain or discomfort associated with inflammation, lead to the person starting to feel nervous and shy. That is why psychological problems arise - as a rule, they are the ones that negatively affect the erection.
what is prostatitis
Prostatitis is inflammation of the prostate 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 when urinating, 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 for the Study of Diabetes Mellitus, 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 an important decision - whether to prescribe antibiotics and additional medications. Giving antibiotics to all patients with suspected prostatitis is wrong because non-microbial forms of prostatitis are more common than bacterial ones. Taking unnecessary antibiotics is bad for your health.
The NIDDK classification identifies five forms of prostatitis.
Acute bacterial prostatitis.A disease that is most often caused by pathogens typical of urinary tract infections: for example, E. coli, Klebsiella, and Enterobacter.
As a rule, the illness starts unexpectedly and is accompanied by a general deterioration in well-being. The temperature rises to 38-39°C, with some people experiencing 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, urination is frequent, difficult, and painful.
Chronic bacterial prostatitis.This disease can also be caused by microbes typical of acute prostatitis. The disease is considered chronic if symptoms last for at least three months.
The symptoms of chronic bacterial prostatitis are similar to those of acute, but may be less severe or less severe. Fever and weakness are usually absent, lower abdominal pain is more painful than acute, but it is difficult to start urinating and completely emptying the bladder. Also, the unpleasant symptoms may temporarily disappear and, after a while, reappear.
Any man can get sick with acute and chronic bacterial prostatitis. But those most at risk are those most at 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 prostate surgery or biopsy.
Chronic bacterial prostatitis associated with inflammation.The symptoms of non-bacterial inflammatory prostatitis are very similar to those of acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria in the semen, prostate skeleton and urine, but the white blood cell concentration will be high - this indicates inflammation of the prostate.
Bacterial chronic prostatitis or chronic pelvic pain syndrome, not associated with inflammation.Symptoms also mimic acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in the semen, prostate skeleton 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 discover the cause that 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 of the time, inflammation is discovered by chance when the patient is being examined for other problems, such as infertility.
How Prostatitis Differs From Prostate Adenoma
In about 8% of men after the age of 40, the prostate starts to increase in size - this is called an adenoma of the prostate or benign prostatic hyperplasia. An overgrown prostate compresses the urethra and, as a result, problems with urination can begin: very frequent desire to use the toilet or leakage of urine. When faced with symptoms of adenoma, some patients may assume they have developed prostatitis.
While some of the symptoms of an enlarged prostate may actually resemble prostatitis, they are not the same thing. Prostatitis is an inflammation of the prostate. And an adenoma is an uncontrolled, age-related proliferation of prostate cells that is not associated with inflammation.
Adenoma can cause serious problems, so if you have trouble urinating, it's important to see a urologist as soon as possible. However, an adenoma is still not as dangerous as prostatitis because it does not increase the risk of cancer.
How often is chronic bacterial prostatitis diagnosed?
According to generalized data in the literature, worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis - in 6 to 10% of cases. Furthermore, both variants of chronic abacterial prostatitis account for 80-90% of all cases of the disease.
If we conduct a massive microscopic examination of the prostate, we will find certain signs of its inflammation in all men, without exception, after 40 years. But it has nothing to do with diagnosing chronic bacterial prostatitis.
There are many urological diseases 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 symptoms similar to those of prostatitis have 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 receive quality treatment. You can make an appointment with a urologist free of charge under the mandatory medical insurance policy or make an appointment with a doctor at a private clinic.
The main task of the urologist, whom a patient suspected of having prostatitis has come to see, is to rule out other diseases of the prostate, eg cancer, and to determine what 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 is what a doctor must do to find this out.
Ask the patient about symptoms and well-being.For more information, your doctor may suggest taking questions from a questionnaire called the Chronic Prostatitis Symptom Index. In some cases, in order not to waste time in the consultation, it makes sense to print the questionnaire and fill it out in advance.
Get a physical exam.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 the body is actually inflammatory. The exam usually includes a digital rectal exam, which allows the doctor to assess the size, shape and condition of the prostate. The study helps to understand if the prostate is enlarged. If the gland is painful to touch, it is more likely to be inflamed.
It is possible to do 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 are so eager to avoid these procedures that, in principle, they 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 to obtain material for laboratory analysis - the secret of the prostate. If the secret cannot be obtained, the doctor may substitute an analysis of the prostate secretion with an analysis of the first portion of the urine or a urine sample of two and three glasses. These studies allow you to determine approximately where the problem area is in the urinary tract.
Sometimes, instead of this examination, a semen analysis is prescribed for the same purpose. It helps to understand whether prostatitis is part of infections of the male genital glands and provides information on the quality of ejaculation. In addition, the leukocyte count in ejaculation allows us to differentiate between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If the patient is concerned about an upcoming digital scan or prostate massage, I encourage you to discuss this with your doctor. Perhaps the analysis of the secretion of the prostate, to obtain what only requires your massage, can be replaced by an analysis of urine or semen.
Order blood tests, urine and prostate secretions.The diagnostic pattern includes a microscopic examination of the prostate secretion, a general blood test, a general analysis of the urine with sediment microscopy, as well as a microbiological examination of the urine and secretions of the prostate.
During microbiological studies, the patient's biological material is placed in a nutrient medium and they see which bacteria grow in it - this allows you to clarify the diagnosis. You can get tested at a private clinic for money or free under mandatory medical insurance.
Other tests and tests - such as total prostatic specific antigen (PSA) blood concentration and transrectal prostate ultrasound (TRUS) - are generally not performed if prostatitis is suspected. In some cases, TRUS of the prostate may 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 select antibiotics. And if the bacteria have nothing to do with it, medications will be needed to help deal with the unpleasant symptoms of the disease.
Acute bacterial prostatitisstart treating without waiting for test results - this is called empirical antibiotic therapy. With this approach, antibiotics are prescribed based on knowledge of which germs are most likely to cause prostate infections.
As a rule, patients are given antibacterial drugs that penetrate well into prostate tissues and act on the more "popular" causative agents of prostatitis and urinary infections.
People who feel more or less normal and are treated at home are often given antibiotic pills. And patients with a high fever who are treated at the hospital are more likely to be prescribed injectable antibiotics. With this treatment, in most patients with acute prostatitis, fever and pain are relieved from the second to the sixth day after starting medication.
When the patient's temperature returns to normal and signs of inflammation disappear, the doctor can transfer the patient 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. In the past, it was thought that it could help to release excess secretions accumulated in the gland and thus reduce its swelling. However, most experts today have come to a consensus that prostate massage should be avoided for bacterial prostatitis. This is not only painful and useless, but it can also make the course of the illness worse because, as a result of the massage, bacteria can enter nearby uninfected tissues.
Chronic bacterial prostatitisthey are also treated with antibiotics that target gram-negative bacteria. For treatment, fluoroquinolones are usually used - these antibiotics are considered quite safe. But if the doctor suspects that other microorganisms have caused the prostatitis, he or she can prescribe additional antibacterial drugs without waiting for the test results.
In chronic prostatitis, antibiotics need to be taken longer than in acute prostatitis. As per the urologists' recommendations, they are prescribed in a 4 to 6 week course.
Chronic bacterial prostatitisit is not associated with bacteria, so patients with this disease are only prescribed antibiotics if, in addition to prostatitis, they have a urinary tract infection.
Since it is not clear what exactly causes bacterial prostatitis, treatment is primarily aimed at relieving pain when urinating. 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 nonsteroidal anti-inflammatory medications. The dosage for each patient is selected individually.
Some patients with bacterial prostatitis are helped by cognitive-behavioral therapy - this is the name of sessions with a psychologist, during which the person learns to deal with pain without medication. At the same time, there is still no scientific evidence of the effectiveness of psychological care for bacterial 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 took too little time - usually less than 12 weeks. So it's impossible to say whether all this helps or not.
How to prevent prostatitis: prevention
The main reason for prostate discomfort is sedentary lifestyle and lack of regular sex life. Doctors believe that the greatest chances of preventing prostatitis are in men who:
Where is it best to treat prostatitis - in a public or private clinic
Most importantly, the principles of evidence-based medicine are followed in the diagnosis and treatment of prostatitis. It just depends on the doctor - and it doesn't matter where exactly he works.
Unfortunately, doctors in private clinics do not always meet medical care standards. This can lead to overdiagnosis and unnecessary treatment, putting the patient at risk of overpaying. In a state medical organization, the likelihood of adherence to all standards of diagnosis and treatment is greater. But patients need to take into account that a full exam takes longer, sometimes much longer than during an exam in a private clinic.