A survey of residents of various countries showed that 2-10% of adult men experience symptoms that suggest problems with the prostate during their lifetime.
Any urinary disorder is a wake-up call, and self-medication in this case should be ruled out. However, the problems are not always associated with prostatitis.
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Our articles are written with love for evidence-based medicine. We refer to reputable sources and go for comments from reputable doctors. But remember: the responsibility for your health lies with you and your doctor. We do not write prescriptions, we make recommendations. It is up to you to rely on 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 sperm from the testicles.
The key task of the prostateconsists 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, that is, ejaculation.
Next to the prostate are seminal vesicles connected to the vas deferens, through which sperm leaves 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 mechanism of erection.
But upset urination, discomfort from incomplete emptying of the bladder, pain or discomfort associated with inflammation, lead to the fact that a person begins to feel nervous and shy. Because of this, psychological problems arise - as a rule, they are the ones that negatively affect the erection.
What is prostatitis
Prostatitis is an inflammation of the prostate gland that is 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 gland 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, Digestive and Kidney Diseases, or NIDDK.
To simplify a little, the classification divides prostatitis into bacterial and abacterial, that is, not associated with bacteria. This approach helps doctors make a critical decision - whether to prescribe antibiotics and additional drugs. Giving antibiotics to all patients with suspected prostatitis is wrong because 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 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 in well-being. The temperature rises to 38-39 ° C, with some people feeling weak, severe pain or burning in the perineum, scrotum or anus, in the lower abdomen, and sometimes in the 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 symptoms last for at least three months.
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, pain in the lower abdomen is more aching than sharp, but it is difficult to start urinating and empty the bladder completely. Moreover, unpleasant symptoms may temporarily disappear and, after a while, appear again.
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 had surgery or a prostate biopsy.
Chronic abacterial prostatitis associated with inflammation.The symptoms of inflammatory nonbacterial prostatitis are very similar to acute and chronic bacterial prostatitis. At the same time, there are no pathogenic bacteria in the semen, prostate skeleton and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate gland.
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 the semen, prostate skeleton and urine - this indicates that the prostate gland is not inflamed.
In the case of non-bacterial forms of prostatitis, it is far from always possible to figure out what 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 any discomfort. Most often, 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 40 years, the prostate begins to increase in size - this is called prostate adenoma, or benign prostatic hyperplasia. An overgrown prostate constricts the urethra, and because of this, problems with urination can begin: too frequent urge to use the toilet or urine leakage. When faced with symptoms of an 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 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 inconvenience, so if you have problems with urination, it is 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 the 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 conduct a massive microscopic examination of the prostate gland, we will find certain signs of its inflammation in all men without exception after 40 years. But it 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 nonbacterial prostatitis are very similar. Without consulting a urologist and special tests, it is impossible to distinguish one form of prostatitis from another and receive quality treatment. You can get an appointment with a urologist for free under the compulsory medical insurance policy 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 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 at the appointment, it makes sense to print the questionnaire and fill it out in advance.
Conduct a physical examination.The doctor will examine the patient, paying particular attention to the groin area. If there are swollen, painful lymph nodes in the groin, this increases the likelihood that the body is actually inflammatory. Typically, the exam includes a digital rectal exam - this 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 most likely inflamed.
Is it possible to do without a digital rectal examination
Digital rectal exam 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 gland through the rectum is done to obtain material for laboratory analysis - the secret of the prostate gland. If the secret cannot be obtained, the doctor can replace the analysis of the secretion of the prostate gland with either the analysis of the first portion of urine, or a two- and three-glass urine sample. These studies allow you to approximately 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 whether prostatitis is part of infections of the male genital glands and gives information about the quality of the ejaculate. In addition, the counting of leukocytes in the ejaculate makes it possible to differentiate between the inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If the patient is concerned about an upcoming digital examination or prostate massage, I would advise you to discuss this with your doctor. Perhaps the analysis of the secretion of the prostate, to obtain which just requires her massage, can be replaced by a urine or semen analysis.
Order blood tests, urine and prostate secretions.The diagnostic standard includes a microscopic examination of the secretion of the prostate gland, a general blood test, a general analysis of urine with microscopy of sediment, as well as a microbiological examination of urine and secretions of the prostate gland.
During microbiological studies, the patient's biological material is placed on a nutrient medium and it is looked at what bacteria will grow on it - this allows you to clarify the diagnosis. You can take tests in a private clinic for money or free of charge under the compulsory medical insurance.
Other tests and examinations - such as total prostate-specific antigen (PSA) concentration in the blood and 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, 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 provoked by bacteria, the doctor will select antibiotics. And if bacteria have nothing to do with it, medications will be required to help cope with the unpleasant symptoms of the disease.
Acute bacterial prostatitisbegin to treat without waiting for the 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 prescribed antibacterial drugs that penetrate well into the tissues of the prostate gland and act on the most "popular" causative agents of prostatitis and urinary infections.
Those people who feel more or less normal and are treated at home usually receive antibiotics in pills. And patients with a high fever who are treated in a hospital are more likely to be prescribed antibiotics by injection. With this treatment, in most patients with acute prostatitis, fever and pain are relieved by the second or sixth day after starting the medication.
When the patient's temperature returns to normal, and the signs of inflammation disappear, the doctor can transfer the patient from injections to pills. The total duration of antibiotic treatment 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 it could help release excess secretions 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 useless, but can also worsen the course of the disease, because as a result of massage, bacteria can get into neighboring, uninfected tissues.
Chronic bacterial prostatitisare also treated with antibiotics that target gram-negative bacteria. For treatment, fluoroquinolones are usually used - these antibiotics are considered fairly safe. But if the doctor suspects that other microorganisms have caused the prostatitis, he can prescribe additional antibacterial drugs without waiting for the test results.
With chronic prostatitis, antibiotics need to be taken longer than with acute. In accordance with the recommendations of urologists, they are prescribed in a course of 4-6 weeks.
Chronic abacterial prostatitisis not associated with bacteria, so patients with this disease are prescribed antibiotics only if, in addition to prostatitis, they have a urinary tract infection.
Since it is not clear what exactly causes abacterial prostatitis, treatment is mainly aimed at relieving pain when urinating. To do this, doctors prescribe alpha-1-blockers, medications that help relax the muscles in the prostate that are compressing the urethra. If pain persists, your doctor may prescribe non-steroidal 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 the 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 of the effectiveness of psychological assistance 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 planned and took too little time - usually less than 12 weeks. So it’s impossible to say whether all this helps or not.
How to avoid prostatitis: prevention
The main reason for discomfort in the prostate gland is a sedentary lifestyle and lack of regular sex life. Doctors believe that the highest chances of avoiding prostatitis are in men who:
- Have safe sex regularly.
- They regularly engage in moderate exercise.
- Avoid hypothermia.
- Having reached the age of 40, they undergo urological examination every year.
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 are followed in the diagnosis and treatment of prostatitis. It only depends on the doctor - and it doesn't matter where exactly he works.
Unfortunately, doctors in private clinics do not always adhere to the standards of medical care. This can lead to overdiagnosis and unnecessary treatment, so that the patient runs the risk of overpaying. In a state medical organization, the likelihood of adherence to all standards of diagnosis and treatment is higher. But patients need to take into account that a complete examination will take more time, sometimes much more than during an examination in a private clinic.
Remember
- Problems with the urinary tract in men are common, but not always the case in prostatitis. To understand what exactly is happening 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 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, this is bad. Before taking them, it makes sense to consult with 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 protected sex, a healthy lifestyle, and after 40 years - a regular urological examination by a doctor.