A survey of residents of various countries showed that 2-10% of adult men experience symptoms suggesting prostate problems during their lifetime.
Any urinary disorder is a warning signal, and self-medication in this case should be excluded. However, the problems are not always associated with prostatitis.
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Our articles are written with a passion for evidence-based medicine. We use reliable sources and seek feedback from reputable doctors. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. It's up to you to trust our point of view or not.
How the prostate works
The prostate, or prostate gland, is a walnut-like organ located just below the bladder. Between the halves of the "nut" passes the urethra - a tube through which urine is excreted from the bladder and semen from the testes.
The key task of the prostateconsists of the production of a secret that is part of the semen. Thanks to this secret, the sperm can move. The second task of the prostate is to contract, allowing ejaculation, that is, ejaculation.
Next to the prostate are seminal vesicles connected to the vas deferens, through which sperm leave the genitals. Seminal vesicles produce the liquid part of semen and store 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 prostate problems, as there is no physical connection between the prostate and the erection mechanism.
But disturbed urination, discomfort due to incomplete emptying of the bladder, pain or discomfort associated with inflammation, lead to a person starting to feel nervous and shy. Due to this, psychological problems arise - as a rule, it is they who negatively affect the erection.
What is prostatitis
Prostatitis is an inflammation of the prostate associated with pathogens 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 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 it a bit, the classification divides prostatitis into bacterial and abacterial, that is, not associated with bacteria. This approach helps doctors make an important decision: to prescribe antibiotics and additional medications. Giving antibiotics to all patients with suspected prostatitis is a mistake, as non-microbial forms of prostatitis are more common than bacterial. 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 disease begins 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 muscles. Some people experience pain during ejaculation. Sometimes with bacterial prostatitis there is frequent, difficult and painful urination.
Chronic bacterial prostatitis.This disease can also be caused by microbes typical of acute prostatitis. The disease is considered chronic if the symptoms last for at least three months.
Symptoms of chronic bacterial prostatitis are similar to those of acute prostatitis, but may be less severe or less severe. Fever and weakness are usually absent, pain in the lower abdomen is more painful than sharp, but it is difficult to start urinating and completely empty the bladder. In addition, unpleasant symptoms may temporarily disappear, and after some time reappear.
Any man can get sick with acute and chronic bacterial prostatitis. But those who are 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 a urinary tract infection, and people who have recently hadprostate surgery or biopsy. .
Chronic abacterial prostatitis associated with inflammation.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, the prostate skeleton and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate.
Chronic abacterial 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 semen, the prostate skeleton and urine - this indicates that the prostate is not inflamed.
In the case of non-bacterial forms of prostatitis, it is far from always possible to determine what cause leads to the development of the disease. Groups at risk are also difficult to define.
Asymptomatic inflammatory prostatitis.This form of the disease does not cause any discomfort. Most often, the inflammation is discovered by chance when the patient is examined for other problems, such as infertility.
How prostatitis differs from prostate adenoma
In about 8% of men after 40 years of age, the prostate begins to enlarge - this is called prostate adenoma, or benign prostatic hyperplasia. An invaded prostate narrows the urethra, and as a result, urination problems may begin: too frequent urge to go to the bathroom or urine leakage. Faced with symptoms of adenoma, some patients may assume that they have developed prostatitis.
While some of the symptoms of prostatic hyperplasia may indeed resemble prostatitis, they are not the same. Prostatitis is inflammation of the prostate. And an adenoma is an uncontrolled overgrowth of prostate cells associated with age that is not associated with inflammation.
The adenoma can cause serious discomfort, 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 a 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 6-10% of cases. In addition, the two variants of chronic abacterial prostatitis account for 80-90% of all cases of the disease.
If we do a massive microscopic examination of the prostate, we will find some signs of its inflammation in all men without exception after 40 years. But that has nothing to do with the diagnosis of chronic bacterial prostatitis.
There are many urological diseases that can hide behind the mask of chronic prostatitis, some of them are quite serious and require immediate treatment. Therefore, I recommend that all patients with symptoms resembling 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 to receive quality treatment. You can get an appointment with a urologist free of charge under compulsory health insurance or make an appointment with a doctor in a private clinic.
The main task of a urologist, to whom a patient with suspected prostatitis came to see, is to exclude other diseases of the prostate, for example, cancer, and to determine what form of the disease a 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 should do to figure it out.
Ask the patient about symptoms and well-being.To collect more information, your doctor may suggest that you complete a questionnaire called the Chronic Prostatitis Symptom Index. In some cases, in order not to waste time at the appointment, it is a good idea to print the questionnaire and complete it in advance.
Do 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, it increases the likelihood that the body is actually inflammatory. 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 if the prostate is enlarged. If the gland is painful to the touch, it is probably inflamed.
Is it possible to do without a digital rectal exam
DRE and prostate massage are not the most pleasant procedures. With acute inflammation, it can be painful. Some patients are so eager to avoid these procedures that they normally refuse to make an appointment with a urologist.
Digital rectal examination is a diagnostic method, but massage of the prostate through the rectum is performed to obtain laboratory material for analysis - the secret of the prostate. If the secret cannot be obtained, the doctor may replace the analysis of the secretion of the prostate with either the analysis of the first portion of urine or a urine sample with two and three glasses. These studies allow you to roughly determine 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 if prostatitis is part of the infections of the male genital glands and gives information on the quality of the ejaculate. In addition, counting leukocytes in the ejaculate makes it possible to differentiate between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If the patient is concerned about an upcoming digital exam or prostate massage, I advise you to discuss this with your doctor. Perhaps the prostate secretion test, to be obtained which just requires a massage, can be replaced by a urine or semen test.
Order blood, urine and prostate tests.The diagnostic standard includes microscopic examination of prostate secretion, general blood test, general urine analysis with sediment microscopy, as well as microbiological examination of urine and secretions from the prostate.
During microbiological studies, the patient's biological material is placed on a nutrient medium and he sees which bacteria are growing there - this allows you to clarify the diagnosis. You can take tests in a private clinic for money or for free as part of compulsory medical insurance.
Other tests and exams - such as the concentration of total prostate specific antigen (PSA) in the blood and transrectal ultrasound of the prostate (TRUS) - are usually not done if prostatitis is suspected. In some cases, the TRUS of the prostate may reveal fibrosis, that is, a scar 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 choose antibiotics. And if the bacteria have nothing to do with it, medication will be needed to help cope with the unpleasant symptoms of the disease.
Acute bacterial prostatitisstart treatment without waiting for the test results - this is called empiric antibiotic therapy. With this approach, antibiotics are prescribed based on knowledge of the germs most likely to cause prostate infections.
Typically, patients are prescribed antibacterial drugs that penetrate well into prostate tissue and act on the most "popular" causative agents of prostatitis and urinary tract infections.
People who feel more or less normal and are treated at home are usually given antibiotics in pill form. And patients with high fever who are treated in hospital are more likely to be prescribed antibiotics by injection. With this treatment, in most patients with acute prostatitis, fever and pain are relieved from the second to sixth day after starting treatment.
When the patient's temperature returns to normal and the signs of inflammation go away, the doctor can transfer the patient from the injections to the pills. The total duration of antibiotic treatment is usually about 2 to 4 weeks.
Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique. It was once believed that it could help release excess secretions that have accumulated in the gland and thus reduce its swelling. However, today most experts have come to a consensus that prostate massage should be avoided for bacterial prostatitis. This is not only painful and unnecessary, but can also worsen the course of the disease, because as a result of massage bacteria can get into nearby uninfected tissues.
Chronic bacterial prostatitisare 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 caused the prostatitis, he may prescribe additional antibacterial drugs without waiting for the test results.
With chronic prostatitis, antibiotics need to be taken longer than with acute prostatitis. In accordance with the recommendations of urologists, they are prescribed in 4-6 weeks.
Chronic abacterial prostatitisis 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 known exactly what causes abacterial prostatitis, treatment is primarily aimed at relieving pain during urination. To do this, doctors prescribe alpha-1-blockers, drugs that help relax the muscles in the prostate that compress the urethra. If the pain persists, your doctor may prescribe nonsteroidal anti-inflammatory drugs. The dosage for each patient is selected individually.
Some patients with abacterial prostatitis are helped by cognitive behavioral therapy - this is the name of sessions with a psychologist, during which a person learns to cope with pain without medication. At the same time, there is still no scientific evidence for the effectiveness of psychological assistance for abacterial prostatitis.
Studies in which researchers attempted to prove the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage or transrectal heat therapy, were poorly planned and took too little time -generally less than 12 weeks. So it is impossible to say whether all of this helps or not.
How to avoid prostatitis: prevention
The main reason for prostate discomfort is a sedentary lifestyle and lack of regular sex life. Doctors believe the greatest chance of avoiding prostatitis is in men who:
- Have safe sex on a regular basis.
- They regularly practice moderate exercises.
- Avoid hypothermia.
- Having reached 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 that the principles of evidence-based medicine be 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 the standards of medical care. This can lead to overdiagnosis and unnecessary treatment, so the patient runs the risk of overpaying. In a state medical organization, the likelihood of adhering to all standards of diagnosis and treatment is higher. But patients should be aware that a full exam will take longer, sometimes much longer than a private clinic exam.
Remember
- Urinary tract problems in men are common, but not always the case in prostatitis. To understand what exactly happens to a person, you need to undergo a thorough examination.
- Prostate problems rarely lead to erection difficulties. Usually, with prostatitis, it weakens due to psychological problems that arise against the background of unpleasant symptoms.
- Not all forms of prostatitis are caused by bacteria: in 80-90% they have nothing to do with it. If a person with suspected prostatitis is prescribed antibiotics without further testing, that is bad. Before taking them, it makes sense to consult another doctor.
- A person with acute or chronic prostatitis may be prescribed a prostate massage to collect a glandular secretion for analysis.
- The best way to prevent prostatitis is safe sex, a healthy lifestyle and, after 40 years, a regular urological examination by a doctor.