What is chronic prostatitis symptoms. The main approaches to the treatment of chronic prostatitis in men. Preventive methods of inflammation of the prostate

It is a serious problem even for modern urology, since many questions regarding this disease still remain unclear. There is an opinion that chronic prostatitis is a pathology that implies that a person has a whole range of health problems, including tissue damage, functional disorders of the work of not only the prostate gland and urinary tract, but also other systems of male organs.

Since there is no single characteristic of the concept of "chronic prostatitis", this negatively affects the diagnosis and treatment of the disease as a whole.

In order to make this diagnosis, a man must have pain in the perineum, in the pelvic area and in the organs of the genitourinary system for at least 3 months (USA, National Institutes of Health). Signs such as urination disorder and detection of bacteria in secret are not prerequisites for making a diagnosis.

In this case, the process of inflammation in the tissues of the prostate gland must be confirmed by the data of histological studies of prostate tissues, or by microbiological analysis of the secret. Ultrasound examination allows you to clarify the nature of changes in the organ.

Epidemiology of chronic prostatitis

Statistics indicate that the disease is extremely common and is in first place among all diseases of the male reproductive system of an inflammatory nature. In addition, this pathology holds a leading position among all diseases that affect young men in general. We are talking about the representatives of the stronger sex up to 50 years. Average age patients - 43 years, while 30% of men until they reach 80 years of age will definitely suffer this pathology.

Up to 35% of all visits to a urologist in the Russian Federation are due to chronic prostatitis. Often the disease occurs with complications - it can be vesiculitis, dysuria, erectile dysfunction, inability to conceive a child, epididymitis. These and other complications occur according to various data in 7-36% of cases.

Causes chronic prostatitis varied. The disease occurs under the influence of infectious agents, while patients have neurovegetative, hemodynamic, immunological, hormonal disorders. It affects the reflux of urine into the prostate lobes, biochemical factors (disturbance of metabolic processes, and in particular salt metabolism), as well as disturbances in the functioning of growth factors responsible for the proliferation of living cells.

Experts identify the following provocateur factors that influence the formation of the disease:

Infections of the genitourinary system (non-compliance with the rules of personal hygiene, lack of a permanent sexual partner, refusal to protect, the presence of an infection in a partner);

Surgical interventions on the prostate without prior preparation with antibacterial agents;

Dysrhythmia of sexual life;

Regular hypothermia;

catheterization Bladder on an ongoing basis;

Physical inactivity.

The role of immunological disorders in the development of the disease should not be rejected. If there is an imbalance of immunocompetent factors, namely cytokines, then this directly affects the work of immunity.

Intraprostatic reflux of urine contributes to the development of chronic non-bacterial prostatitis.

Chronic abacterial prostatitis is associated with neurogenic disorders of the pelvic floor muscles, as well as those elements that are responsible for the functioning of the bladder wall, prostate and urethra.

Pelvic pain syndrome may be due to the fact that a man forms myofascial trigger points, which are located next to the prostate gland and the organs of the genitourinary system. Points that are the result of injuries, surgical interventions and some diseases that can lead to pain in the perineum, pubis and nearby areas.

Symptoms of chronic prostatitis

The symptoms of chronic prostatitis are diverse, but the pain and discomfort that occurs in the pelvic area and lasts at least 3 months come to the fore.

In addition, men suffer from erectile dysfunction and urination disorders:

As for pain, they occur mainly in close proximity to the prostate gland, that is, in the perineum, but can radiate to the anus, to the inner surface of the thigh, scrotum, lower back, sacrum and inguinal zone. When pain occurs on one side and radiates to the testicle, most likely this is not a symptom of chronic prostatitis.

Libido suffers, erection does not occur at the moment when there are adequate conditions for this, but although certain sexual disorders are present, complete impotence is not observed.

Another symptom of chronic prostatitis is premature ejaculation. This is typical for initial stages the development of the disease. As the pathology progresses, ejaculation becomes, on the contrary, slow. Orgasm is often dim, devoid of richness and emotional color. The ejaculate loses its qualitative and quantitative characteristics.

The disease is characterized by irritative symptoms (increased urination at night, urgency, pain and burning sensation during bladder emptying, urinary incontinence). Ifravesical obstruction with bladder occlusion is less common.

The disease has an undulating course, the symptoms either weaken or become stronger, but they clearly indicate the presence of inflammation.

The following stages of development of chronic prostatitis can be distinguished:

exudative stage. A man experiences pain in the scrotum, in the groin, in the pubis. Urination becomes more frequent, there may be a feeling of discomfort at the end of intercourse. Erections can hurt.

Alternative stage. The pains intensify, are localized mainly in the pubic region, in the groin and are given to the sacrum. Emptying the bladder most often goes without any difficulty, although it may occur more often than usual. Erection does not suffer.

proliferative stage. The stream of urine loses its strength, during an exacerbation of the disease, urination becomes more frequent. The erection is intense, but some slowing down of the reaction is possible.

Scar stage. Prostate tissue sclerosis occurs. In the pubic area, in the sacrum there is a feeling of heaviness. Urination becomes more frequent, the urge disturbs the man not only during the day, but also at night. Ejaculation may be completely absent, erection becomes weak.

One should not expect that the symptoms characteristic of a particular stage will be present in a strictly defined order and will occur in in full. They may vary depending on the characteristics of the individual course of the disease. But pain, increased urination and functional erectile dysfunction will gradually increase.

At the same time, many men underestimate the severity of the disease until they encounter it. Meanwhile, studies show that the quality of life of people with this problem suffers no less than if they had suffered, Crohn's disease, or.

The classification of prostatitis was proposed in 1995 in the United States, developed by scientists from the National Institutes of Health:

Acute bacterial prostatitis - type 1 (5% of all diagnosed inflammation of the prostate gland).

Chronic bacterial prostatitis - type 2.

Abacterial prostatitis of chronic course - type 3. This prostatitis is also called chronic pelvic pain syndrome.

Inflammatory form (with a leukocyte jump in the discharge from the prostate) of chronic prostatitis - type 3A. Diagnosed among the total mass of chronic prostatitis in 60% of cases.

Non-inflammatory form (without leukocyte surge) of chronic prostatitis - type 3B. Diagnosed among the total mass of chronic prostatitis in 30% of cases.

Asymptomatic prostatitis - type 4.

Diagnosis of chronic prostatitis

Diagnosis of chronic prostatitis is not particularly difficult when there is a complex of symptoms (pain, urination disorders, sexual disorders). However, it happens that the pathology is asymptomatic, which requires additional methods research, other than the standard survey and examination of the patient. These are physical, laboratory, and instrumental methods. Be sure to study the immunological status of the patient, a neurological examination.

In addition, questionnaires and questionnaires have been developed that allow you to clarify the subjective feelings of the patient, give more full information about the state of his health, about the strength of pain, about disorders of urination, erection, ejaculation, about the patient's psycho-emotional moods.

Often practicing urologists use the prostatitis symptom scale questionnaire developed by the American National Institutes of Health - this is the NIH-CPS questionnaire.

Laboratory diagnosis of chronic prostatitis

Laboratory diagnosis of chronic prostatitis allows you to distinguish between abacterial and bacterial forms of the disease, determine the type of pathogen and make the most accurate diagnosis. When the fourth urine sample, or prostate secretion, contains more than 10 leukocytes in the PZ, or bacterial associations, chronic inflammation of the prostate is confirmed in this case. If the number of leukocytes is increased, but the bacteria are not sown, the material should be examined for the detection of chlamydia and other STD pathogens in it.

Discharge from the urethra is sent to the laboratory to detect leukocytes, bacterial, fungal or viral flora, as well as mucus in it.

A scraping taken from the urethra is studied by PCR, which makes it possible to identify pathological sexually transmitted agents.

The secret of the prostate is sent for microscopic examination to count the number of leukocytes, macrophages, amyloid and Trousseau-Lallemand bodies. They also conduct its bacteriological study and immunological study, determine the level of nonspecific antibodies.

10 days after the digital rectal examination, blood is taken to determine the concentration of PSA in it. If the indicator exceeds 4.0 ng / ml, then the patient is recommended to undergo a prostate biopsy to exclude cancer.

Based on the results of the performed studies, a diagnosis is made.

Instrumental diagnosis of chronic prostatitis

transrectal ultrasound procedure gland makes it possible to clarify the form of the disease, its stage. With the help of ultrasound, it is possible to weed out other diagnoses, track the effectiveness of the therapy, visualize the size of the prostate, its echostructure (exclude the presence of cysts, stones, sclerotic changes, abscess), the density and uniformity of the seminal vesicles.

Urodynamic studies and myography of the pelvic floor muscles reveal neurogenic disorders and infravesical obstruction, which often accompanies chronic prostatitis.

Tomography, both computed and magnetic resonance, is used to make a differential diagnosis, in particular, with prostate cancer. In addition, these methods make it possible to identify existing disorders in the spinal column, in the pelvic organs.

Differential diagnosis of chronic prostatitis

Differential diagnosis of chronic prostatitis is of no small importance, since there is a risk that a man has a more serious disease.

So, the differential diagnosis is established with diseases such as:

Bladder dysfunction of neurogenic origin, complex regional pain syndrome, functional disorder of the detrusor-sphincter system, pseudodyssynergia;

Prostate adenoma, hypertrophic changes in the neck of the bladder, bladder stricture;

Chronic inflammation of the prostate gland occurs in men of any age. The catalyst in most cases is an infectious factor: trichomonas, staphylococci and gonococci. Bacteria that enter the body provoke inflammation of the urethral canal, the prostate gland itself.

Chronic prostatitis is often asymptomatic. The disease itself is determined only after the transition to an acute form. Late diagnosis is also explained by the fact that the first symptoms of chronic prostatitis in men are often ignored.

Statistics show a constant "rejuvenation" of the disease. More and more patients are turning to urologists at the age of 30 years.

Chronic prostatitis - what is it

The prostate gland is located under the bladder. The main functions are to protect vesica urinaria from ingestion, seminal fluid, as well as the production of prostate secretion, a necessary component of the male seed. Inflammation of the tissues of the gland, provoked by infection, congestion and other factors, gradually becomes permanent.

Chronic prostatitis leads to degenerative changes. The tissue structure is gradually deformed. Often, against the background of inflammation, stones appear in the ducts. Some types of prostatitis cause cancer.

Was developed international system classification, facilitating the differentiation between different diseases of the prostate gland.

Chronic prostatitis - causes

It is generally accepted that inflammation of the prostate gland is caused by two main factors: bacterial and abacterial.

The first is associated with the entry of pathogens and infections into the patient's body. Most often, sexually transmitted bacteria act as a catalyst.

The second cause of occurrence is not associated with an infectious agent. Inflammation can be catalyzed by:

• Hypothermia of the body.
• Hormonal disorders associated with aging, irregular sex life.
• Bad habits.
• Injury to the pelvic organs.
• Congestion caused by metabolic disorders and a sedentary lifestyle.

After diagnosing prostatitis, the root cause of chronic prostatitis is necessarily determined. The course of therapy is prescribed based on what exactly caused the inflammation. Bacterial and non-infectious prostatitis are treated differently.

Urologists name several additional factors that aggravate the situation and affect the severe course of the disease:

• Sexual abstinence.
• Inferior ejaculation (selection of interrupted sexual intercourse as a method of contraception).
• Stress.
• Bad habits - alcohol abuse and smoking.
• Not proper nutrition.
• Past inflammatory diseases. Often they act as the cause of chronic prostatitis.

Inflammation is accompanied by destructive changes in the prostate gland, which makes it possible to classify the disease into several categories.

Classification of chronic inflammation of the prostate

Varieties of prostatitis have received their ICD-10 code - N41. To clarify the diagnosis and differentiation of the catalyst infection, a separate classification B95-B97 is used. The symptom rating scale divides the disease into several groups and subgroups:

• I - acute inflammation, accompanied by a sharp rise in temperature, fever.
• II - chronic prostatitis, provoked by an infectious factor.
• III - the class includes a disease in which pelvic pain syndrome begins to manifest. It is customary to distinguish two subgroups:
  1. IIIA - there are signs of an inflammatory process. Subfebrile temperature is maintained.
  2. IIIB - no inflammation.
• IV - prostatitis in which there are no symptomatic manifestations. Deviations from the norm are detected exclusively by instrumental diagnostic methods.

According to the ICD code:

• N41.1 Diagnose chronic prostatitis.
• N41.8 Inflammatory diseases of the prostate.
• N41.9 Definitive diagnosis not made.

How chronic prostatitis manifests itself - its symptoms

The first signs of chronic prostatitis in men appear at an advanced stage of the disease. Often, early development has no clinical manifestations. Symptoms, even if present, are temporary, short-term and of little intensity.

According to clinical manifestations, there are three stages of development of prostatitis:

• Initial indirect signs of chronic prostatitis - as already noted, the onset of the disease is not expressed by clearly distinguishable symptoms. Signs are subtle or non-existent.
  Signs that you should pay attention to: burning sensation during ejaculation, decreased potency, painful urination.
• Secondary signs chronic inflammation prostate - at this stage, pathological changes occur in the structure of tissues, the appearance of scar formations, a decrease in urogenital function.
  The stage is characterized by a sharp deterioration in potency and urination, increased sweating, severe pain in the pelvic area, lumbar spine, and scrotum.
• Signs of advanced disease - the prostate ceases to function in a normal way. Healthy tissues begin to metamorphose. The gland increases in size. Interspersed with blood and pus appear in the urine, there is a constant feeling of incomplete emptying of the bladder, night trips to the toilet become more frequent. Erectile function is reduced so much that we can talk about complete impotence.

In addition to the symptoms characteristic of each stage of development, there are common signs that appear throughout the course of the disease.

Pain syndrome

Chronic prostatitis in the late stage of development has a pronounced symptomatology. Characteristic clinical manifestations are pains of strong intensity that do not go away on their own and require the use of analgesics and antispasmodics.

Pain syndrome accompanies the entire period of development of the disease. During the primary signs of prostatitis, discomfort and burning in the urethral canal are of little intensity, so they are often ignored. Pain is often falsely attributed to sciatica, fatigue. After pain relief or taking an antispasmodic such as No-Shpa, the symptom usually goes away.

Over time, the clinical picture becomes more and more saturated. The pain syndrome manifests itself more intensely, remains after taking analgesics. Unpleasant sensations accompany every act of urination, defecation and ejaculation.

Pain radiates from the spine to the scrotum, sometimes to the limbs, accompanied by convulsions, numbness. Skin rashes, itching and burning of tissues in the prostate and genital organs are a normal reaction of the body to internal inflammation.

Temperature increase

Chronic inflammation of the prostate gland in an acute form is accompanied by fever and fever. There is a sharp increase in temperature, reaching up to 39-40 °. Indicators are stable. Body temperature does not decrease even after taking antipyretics.

Sluggish prostatitis is characterized by subfebrile course. Constant indicators of chronic inflammation, in the range of 37-37.2°.

It is strictly forbidden to bring down the temperature and take medicines on your own to reduce external manifestations!

Dysuria

The first signs of chronic prostatitis are manifested in various urinary disorders. Over time, the symptoms become more saturated, which helps to determine the disease. Manifestations of dysuria:

• Frequent nighttime urge to go to the toilet.
• Sensation of incomplete emptying of the bladder.
• Hematuria (blood in urine), purulent discharge.
• Pain during urination.

Clinical signs and the intensity of their manifestation directly affect the diagnosis, and require a mandatory additional study. Symptoms may indicate other inflammatory diseases of the genitourinary system, and.

Violations of the functions of the genital organs

Chronic prostatitis leads to the appearance of scar formations that impair blood supply. Nutritional deficiencies lead to:

• Decreased potency - with chronic prostatitis, sexual disorders are observed. One of the characteristic symptoms is a normal erection, which decreases sharply during intercourse. In the advanced stage, a steady potency sets in.
• Infertility - after the appearance of scars in the seminal ducts, the viability of spermatozoa decreases. Inflammation changes the structure and composition of the ejaculate. In the advanced stage, the sperm thickens, lumps appear.
• Pain during intercourse - discharge from the urethral canal is observed. During sexual intercourse, discomfort and painful manifestations are felt, especially during ejaculation. Often, psychosomatic causes lead to the patient's stable impotence.

The main symptoms of chronic prostatitis: pain, fever, dysuria, dysfunction of the genital organs. When making a diagnosis, the intensity and duration of the period from the onset of the onset of clinical signs, as well as related symptoms, are taken into account.

How can chronic inflammation of the prostate be diagnosed?

Prostatitis has no symptoms to accurately differentiate the disease. Some disorders of the genitourinary system have similar symptoms. An accurate diagnosis can only be made after a complete examination of the patient, including laboratory tests and methods of instrumental detection of the disease.

Suspecting the presence of violations in the work of the pelvic organs, the urologist will prescribe a mandatory rectal examination. If tissue changes are detected during palpation, several laboratory tests are prescribed.

Laboratory research methods

Clinical blood and urine tests differentiate the presence of an inflammatory process and can often explain the catalyst for the development of the disease. When making a diagnosis, additional information will be required from the results of the following laboratory tests:

• Cytological and bacteriological analysis of urine. The PSA level is set. Protein levels rise sharply with inflammation of the gland tissues.
• Taking a swab from the urethra.
• Microscopy of the secretion of the prostate - according to the results, failures in the work of the prostate gland are determined. Differentiate cancer from chronic tissue inflammation.
  Sowing the secret of the prostate is prohibited during the acute period of the disease, accompanied by high body temperature, exacerbation of hemorrhoids, cracks in the anus.
• Tests for STIs (sexually transmitted infections) - one of the common catalysts for prostate inflammation - pathogens.
  Trichomonas, staphylococci, and gonococci can all cause disease. Prostatitis develops during the active phase of bacterial reproduction, and after the infection has already been cured.

Laboratory research is an obligatory component of the diagnosis of prostatitis and the subsequent choice of treatment method.

Instrumental detection of the disease

There are three main research methods for prostatitis. Each method of instrumental diagnostics provides information about changes in the structure of gland tissues, has its own indications and contraindications:

• Tomography - MRI is often prescribed to diagnose chronic prostatitis. The study allows you to get a layered picture of the prostate. MRI signs accurately indicate chronic inflammation, and also show the beginning of tissue degeneration into a malignant formation.
  The magnetic resonance technique is absolutely harmless, but has contraindications associated with the impossibility of examining patients with pacemakers, metal staples and shunts (left during surgical operations).
• Transrectal TRUS are informative methods that indicate the presence of inflammation with great certainty. Echographic signs of structural changes in the prostate by the type of chronic prostatitis include: deviations from the norm in volume and size, structure, the presence of pathological formations.
  Ultrasound technique is not prescribed for acute inflammation of the rectum, the presence of cracks in the anus, hemorrhoids.
• Ultrasound - transabdominal technique has no contraindications. The method is less informative compared to TRUS and MRI. Sonographic features make it difficult to determine the space of the abdominal cavity. Diagnostic results are often controversial and require clarification. The advantage of ultrasound is the simplicity and speed of the study.

The accuracy of the echographic picture largely depends on the experience of the doctor conducting the study.

Differential search for disease

After receiving the results of clinical and biochemical studies, an assessment of the symptoms of chronic inflammation of the prostate gland is carried out. Common standards for diagnosis have been developed and are valid throughout the world.

To facilitate the task of the urologist, the NIH-CPSI symptom index was invented, made in the form of a questionnaire or questionnaire. The doctor fills in the columns of the document, after which he makes a diagnosis.

There are computer programs based on the NIH-CPSI index. The doctor is required to fill out a questionnaire, and the system will independently conduct a total assessment of symptoms in chronic prostatitis. The effectiveness of the technique has been proven worldwide.

After calculating the results of the questionnaire, when making a diagnosis, the assessment of instrumental and clinical studies is additionally taken into account: the presence of echo signs of chronic prostatitis, an increased PSA level, and the detection of an infectious marker during secretion microscopy. The more data the urologist has, the more accurate the result will be.

What is dangerous chronic prostatitis - its consequences

The consequences of chronic prostatitis in men are disorders in the work of the genitourinary system. These include:

• Impotence.
• Acute urinary retention.
• Infertility.

Fibrotic changes that accompany a neglected disease become the cause of the development of oncology. Normal tissues are transformed into malignant ones. Therefore, the prevention of functional changes in the prostate gland in order to prevent the development of cancer is an extremely important task facing the urologist.

When making a diagnosis, the presence of prostatic intraepithelial neoplasia, a precursor of oncology and fibrotic changes, is taken into account. A neglected disease often leads to the need for a surgical operation: prostatectomy.

Diagnosis of prostatitis and differentiation of the disease from related disorders of the pelvic organs is an important task for doctors and patients. The detection of the first symptoms depends entirely on the man himself. If any discomfort occurs during urination, decreased erection, constant subfebrile temperature - reasons to immediately seek professional medical help. Delay is dangerous!

is an inflammatory disease characterized by damage to the prostate gland and severe urodynamic disorders. One of the causes of chronic inflammation of the prostate is incorrect or untimely treatment at the acute stage, when the desquamation and proliferation of the glandular epithelium is reversible and successfully corrected by medication within 2-3 weeks. Treatment of the chronic form of prostatitis includes massive antibacterial therapy aimed at eradicating the infectious agent, a set of measures to increase the body's immune resistance, physiotherapeutic methods, and thermotherapy. Psychocorrection can also be included in the therapy regimen, since men with long-term and recurrent prostatitis often have neurasthenic and neurosis-like conditions.

Knowing the causes of chronic inflammation of the prostate is necessary to prevent exacerbations and improve the quality of life of patients. Exist a large number of factors that can affect the functional state of the glandular (glandular) tissue of the prostate gland and cause inflammation, which is based on desquamation and proliferation of epithelial cells.

The main cause of chronic prostatitis in men is extensive contamination of the mucous membranes of the organs of the genitourinary system with pathogenic microorganisms. In the vast majority of cases (more than 80%) of infectious prostatitis, gram-negative and gram-positive bacteria become the causative agent of infection: enterobacteria (in particular, Escherichia coli), gonococci, staphylococci. Less commonly, an infectious-inflammatory process occurs against the background of infection with viruses, fungi and protozoa, but such forms of prostatitis are quite successfully treated during the acute period and rarely give relapses, provided that the therapy is correct and timely.

It is also necessary to take into account that for the development of chronic aseptic prostatitis, a single acute infection of the urinary tract is sufficient, therefore, personal hygiene, the use of condoms during sexual intercourse and timely treatment of diseases of the urinary tract are of great importance in the prevention of this disease in men. Medicine knows cases of hematogenous (through the systemic circulation) infection of the prostate in chronic sinusitis, tonsillitis and other diseases that contribute to the active growth of pathogenic flora, so the sanitation of foci of chronic infection is an important step in complex treatment for prolonged or protracted inflammation of the prostate.

Negative factors that can cause exacerbation of prostatitis (including non-infectious course) are:

Note! Urologists note that the leading pathogenetic factor in the development of chronic inflammation of the prostate gland is posterior urethritis. It was also noted that inflammatory changes in the prostate in men appear during the first months after a gonorrhea infection.

Treatment of chronic prostatitis with drugs

Treatment of the chronic form of prostatitis with medical methods is aimed only at suppressing acute symptoms during the period of exacerbation and destruction of the infection, but cannot be used as the only remedy (the effectiveness of such treatment will not exceed 36%, according to Dr. Pechersky).

The full scheme of drug treatment of protracted or recurrent inflammation of the prostate, which is used today as a standard for uncomplicated course, is presented in the table below.

Table. Preparations for the complex treatment of chronic prostatitis.

Pharmacological group	Purpose of application	Preparations
Antibiotics from the group of macrolides, semi-synthetic penicillins and third-generation cephalosporins with a wide range antibacterial activity.	Eradication (destruction) of pathogenic bacteria - the causative agents of infectious prostatitis, urethritis, cystitis and other genitourinary infections.	Ceftriaxone, Cefixime, Cefotaxime, Amoxicillin, Flemoxin, Azithromycin, Clarithromycin.
Antimicrobial and antiprotozoal agents.	Treatment of infections caused by pathogenic microbes and protozoa.	"Trichopol", "Metronidazole".
Non-steroidal anti-inflammatory drugs (preferably in the form of rectal suppositories).	Reduction of the inflammatory process in the tissues of the prostate, relief of pain in the perineum, intergluteal space, sacrum and groin.	"Indomethacin", "Ibuprofen".
Antiseptics in the form of rectal suppositories.	Sanitation of the mucous membranes of the rectum and prevention of its infection with long-term prostatitis.	"Chlorhexidine" (candles).
Alpha blockers.	Normalization of urination, restoration of daily diuresis.	"Tamsulosin", "Alfuzosin".
Microcirculation correctors.	Elimination of congestion in the vessels of the small pelvis, restoration of normal blood and lymph flow.	"Trental", "Actovegin".
Correctors of urodynamics (means that affect the metabolism in the tissues of the prostate).	Improvement of metabolic and metabolic processes in the tissues of the prostate gland and its nutrition.	Animal preparations based on bovine prostate extract (Permixon, Prostagut, Prostamol Uno) and herbal remedies with a pronounced anti-inflammatory effect (based on creeping palm extract).
potency regulators.	Comprehensive treatment of erectile dysfunction, improvement chemical composition, viscosity and fluidity of seminal fluid, increased activity of spermatozoa (the use of drugs in this group is indicated for patients whose prostatitis is complicated by autoimmune infertility).	Speman, Impaza, Silden, Primaksetin.

"Prostamol Uno"

The duration of antibiotic treatment is at least 4-6 weeks. In no case should you take antibacterial drugs without a doctor's prescription, since the leading factor in the selection of therapy is the results of a microscopic examination of prostate secretion and fluids spontaneously secreted as a result of prostate massage. Some antibiotics, for example, penicillins (a combination of amoxicillin with clavulanic acid) are reserve drugs, and their improper use can lead not only to the absence of a clinically significant effect and the progression of 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. To suppress these symptoms, antidepressants with selective serotonin reuptake inhibition are used: Fluoxetine, Flunisan, Profluzak.

Physiotherapy treatment

- the main method of treating chronic prostatitis outside periods of exacerbation (after regression of acute symptoms). Heat therapy refers to the methods of physiotherapy and is a dosed effect of heat on the affected area. The benefits of thermal procedures are the normalization of blood circulation, the relief of inflammatory processes, the reduction of chronic pelvic pain, which is one of the main clinical manifestations of chronic prostatitis, which reduces the quality of life of a man. Heat also improves the penetration of medicinal substances into the tissues of the prostate, therefore, in some cases, physiotherapy is used to increase the effectiveness of drug therapy (for example, electrophoresis with antibiotics). For men with a high risk of thrombosis, heating is prescribed for prevention, since heat has a moderate absorbable effect.

There are a large number of methods of thermal effects on the body, and the choice of a specific treatment method should be carried out by a doctor, taking into account the clinical picture, the form and stage of the disease, the age of the man and his individual tolerance. The most effective for prostatitis are the following methods of heat treatment:

The modern multifunctional complex of electro-magnetic laser therapy KAP-ELM-01 "Andro-Gin" provides a combined effect of a laser, a magnetic field, electric currents, light waves and is used for treatment inflammatory diseases urinary tract in men and women

In some physiotherapy rooms, chronic inflammation of the prostate is treated with hot mud applications (“mud panties”). Such procedures have a positive effect not only on blood and lymph circulation, but also on the production of prostate secretion, as well as tissue nutrition of the inflamed organ. In some cases, 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 the therapy.

Other treatments

The complex treatment scheme, in addition to drug and heat therapy, is supplemented by various procedures that the doctor prescribes, taking into account the characteristics of the course of the pathology in each case.

This is one of the main methods of treating chronic inflammation of the prostate gland, which is advisable to use in almost 90% of cases (in the absence of contraindications). Massage is a finger impact on the prostate in order to stimulate the outflow of secretory fluid. The duration of the procedure is usually about 1-2 minutes. The criterion for sufficient exposure is the complete emptying of the prostatic glands, which the patient feels as relief (which he must report to the doctor).

The benefits of massage are determined by the therapeutic effect that can be achieved after undergoing a course of treatment (8-12 procedures). In an uncomplicated course, this is:

• 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 therapy increases);
• restoration of secretory patency;
• normalization of the outflow of blood and lymph from the prostate gland (especially significant in cognitive prostatitis).

The procedure is contraindicated during the acute period due to the high risk of infection spreading to surrounding tissues and organs (hematogenous infection), other infectious diseases of the genitourinary system, the presence of cysts or stones in the prostate. Prostate massage is not prescribed for patients who have been diagnosed with tuberculous organ damage, adenoma or other tumor diseases (including cancerous lesions of the prostate gland). In the presence of diseases of the rectum (hemorrhoids, anal fissure, proctitis, paraproctitis), massage can cause complications and provoke a relapse of the underlying disease.

Hemorrhoids - one of the contraindications

Important! Studies show that almost 42% of men refuse prostate massage due to increased psychological discomfort associated with the peculiarities of this procedure. The doctor's work with such patients should include detailed information about the consequences of refusing treatment and possible complications, in particular, infertility and persistent disorder of sexual function. In some cases, it may be appropriate to prescribe light sedatives a few days before the start of treatment (Persen, Afobazol, Tenoten).

hot enemas

Hot enemas are among the home treatments for chronic prostatitis, but urologists recognize their effectiveness and recommend them for faster and effective treatment 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 one enema is from 150 to 300 ml. It is recommended to empty the intestines one hour 30-50 minutes after the administration of the solution.

Recipes used for chronic inflammation of the prostate are given below.

From medicines for microclysters, anti-inflammatory drugs, antiseptics, antibiotics can also be used. The use of these drugs is permissible with the permission of a doctor strictly in the indicated dosage.

Treatment of chronic prostatitis: step by step instructions

The use of various methods of treatment 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 prostatic glands and persistent dysuric and sexual disorders. In order for the effectiveness of treatment and the duration of remission to be higher, one should adhere to the recommendations outlined in the instructions below for patients with chronic prostatitis.

Step 1. If a man is diagnosed with "chronic prostatitis", you should start with the correction of the diet. From the menu it is necessary to exclude products with a large amount of fat, salt and spices. Fats increase the level of cholesterol in the blood, and salt contributes to fluid retention and the formation of edema in the tissues of the prostate. Spices (as well as various chemical additives) irritate the mucous membranes of the urinary tract, provoking an exacerbation of existing symptoms.

Step 2 It is also necessary to completely exclude alcoholic beverages, as they slow down absorption. useful substances, violate the circulation of blood and lymph, negatively affect the metabolism in the prostate. If a man suffers from tobacco dependence, measures should be taken to get rid of this habit (toxic substances in tobacco smoke violate the viscosity and fluidity of prostate secretion and change its chemical composition).

Step 3 Overweight men need to contact an endocrinologist and a nutritionist to undergo a comprehensive diagnosis and correction of body weight, taking into account the identified deviations. Obesity is the most important factor in the development of chronic prostatitis, and an important step in complex therapy is weight loss in patients with high BMI.

Step 4 To eliminate congestion associated with hypodynamic disorder, it is necessary to provide an adequate level of physical activity, corresponding to age and physical fitness. Useful for prostatitis swimming, exercise therapy, stretching exercises, hiking.

Step 5 For normal functioning prostate need to monitor the quality of sexual life. It is desirable to have a permanent sexual partner, to avoid episodes of sexual arousal if there is no possibility of further sexual intercourse, and to be regularly checked for sexual infections, which can also provoke 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.

Video - How is prostatitis treated?

Chronic prostatitis is a disease that is difficult to treat, especially if the patient does not comply with the prescription of the attending physician and does not take a responsible approach to the organization of nutrition and regimen. Inflammation of the prostate is dangerous with serious complications, so you need to approach the problem comprehensively. Men with this diagnosis should understand that pills alone are not enough to fully restore all the functions of the prostate gland, so you should not refuse the methods of basic therapy for chronic prostatitis proposed by the doctor, even if they cause primary psychological or physical discomfort.

Chronic prostatitis called inflammation of the prostate gland, which men of all ages face. In most cases, chronic prostatitis is the result of exposure to Trichomonas and other sexually transmitted infections. In itself, inflammation of the gland is not terrible, but in the absence of effective treatment, it can lead to male infertility, impotence.

Chronic prostatitis occupies one of the leading places among the genital pathology of men of reproductive age. And, unfortunately, prostatitis is getting younger and younger. Currently, patients of urologists and andrologists are increasingly becoming men younger than 30 years of age.

What role does the prostate gland play in the body?

The prostate, shaped like a chestnut, is located under the bladder. It prevents seminal fluid from entering it, and also produces prostate secretion, an important component of sperm.

Most common cause chronic inflammation of the prostate are infections and sexually transmitted pathogens (for example, Trichomonas). Also, the development of chronic prostatitis is greatly facilitated by a sedentary lifestyle. But prostatitis itself is not so terrible as the fact that this disease is a trigger for the occurrence of more severe diseases - male infertility, prostate adenoma.

The reasons for its appearance of the disease also include:

• frequent hypothermia;
• low immunity;
• hormonal disorders;
• the presence of a person's bad habits;
• injuries of the pelvic organs;
• sedentary lifestyle.

The causes of chronic prostatitis in men can be divided into two types:

1. Infections. They enter the body in various ways - through the urethra, with the flow of blood or lymph from foci of infection or inflamed organs in their own body.
2. Violation of blood circulation in the prostate gland or stagnation of its secretion that occur in the following cases:

• sexual abstinence for a long time;
• often interrupted sexual intercourse or unrealized excitement;
• defective ejaculation.

Stress, a sedentary lifestyle, and alcoholism can also contribute to chronic prostatitis. Exacerbation of chronic prostatitis is often observed after hypothermia, various infectious diseases, errors in the diet (too spicy food, alcohol).

The most common symptoms of chronic prostatitis are:

1. feeling of discomfort or pain in the inguinal and suprapubic areas, perineum, scrotum, rectum, in the lumbosacral region;
2. frequent and painful urge to urinate;
3. pain in the lower abdomen (constant or at the time of urination);
4. intermittent or sluggish urine stream;
5. reduction in the duration of sexual intercourse, worsening of erection, decreased libido, premature ejaculation;
6. periodic / permanent absence of morning erection (spontaneous);
7. pain of a pulling nature in the head of the penis after ejaculation, which disappears on its own within half an hour.

Many men do not pay attention to the signs of chronic prostatitis, believing that the disease will pass by itself. However, it progresses, causing various complications: pyelonephritis, cystitis, vesiculitis. Over time, against the background of inflammation of the prostate, infertility and impotence develop.

Diagnosis of the disease

To identify the disease of chronic prostatitis in men, laboratory tests are needed. In most cases, this is an analysis of urine, ejaculate and prostate secretion. Also, to detect the disease, an ultrasound of the pelvic organs and the prostate gland is performed, and a digital rectal examination of the prostate will be performed.

Before starting treatment, a bacteriological culture of the prostate secretion will be carried out in the laboratory to determine the sensitivity of your microflora to various antibacterial drugs. Without this, treatment will be ineffective, and may lead to a complication of the disease.

Complications that can be caused by chronic prostatitis.

Running or untreated chronic prostatitis causes a lot of concomitant diseases that seriously complicate the life of a man:

• Vesiculitis - inflammation of the seminal vesicles, often accompanies prolonged abstinence and requires inpatient treatment.
• Abscess of the gland is a severe pathology requiring hospitalization.
• Sclerosis of the prostate - develops with a long course of prostatitis, and requires surgical treatment.
• Cysts and, as a consequence, prostate stones.

Treatment of chronic prostatitis

Treatment of chronic prostatitis should be carried out under the strict supervision of a physician. The best cure for chronic prostatitis is Prostatilen suppositories, as well as numerous antibacterial drugs, alpha-blockers and non-steroidal anti-inflammatory drugs.

Answering the question of how to treat chronic prostatitis, experts talk about antibacterial agents - cephalosporins, protected penicillins, fluoroquinolones. All of them eliminate the cause of the disease - a bacterial infection.

Alpha-blockers are drugs for chronic prostatitis, designed to relax the muscles of the urethra, facilitating the outflow of urine. In fact, they do not have a therapeutic effect, but only eliminate the unpleasant symptoms of inflammation.

Talking about how to cure chronic prostatitis, urologists do not forget to mention anti-inflammatory drugs that reduce the inflammatory process in the tissues of the prostate and reduce pain. The most common NSAIDs are Nimesulide, Meloxicam and Diclofenac.

If anti-inflammatory drugs do not cope with the task, hormonal drugs are connected to them - Prednisolone, Dexamethasone.

Table: Antibacterial drugs used in the treatment of chronic prostatitis

A drug	Advantages	disadvantages	Recommendations for use
Fluoroquinols	Excellent penetration into prostate tissue. Good bioavailability. Equivalence of oral and parenteral pharmacokinetics. Good activity against typical and atypical pathogens.	Cross allergy. Phototoxicity. Influence on the central nervous system.	Recommended for use.
Trimethoprim	Good penetration into prostate tissue. Does not require dosage selection. Good antimicrobial activity.	Negative against Pseudomonas aeruginosa and enterobacteria.	Second line drug.
macrolides	Moderate activity against Gram-positive bacteria. Activity against atypical pathogens. Good penetration into prostate tissue. Low toxicity.	Insufficient activity against gram-negative bacteria.
Tetracyclines	Good activity against atypical pathogens.	Inactive against Pseudomonas aeruginosa. Insufficient activity against staphylococci, Escherichia coli.	Used for specific pathogens.

An effective cure for chronic prostatitis

The most effective medicine for chronic prostatitis, this drug is in separate demand among potential clients - this is Prostatilen. This drug is available in the form of suppositories (rectal suppositories) and ampoules (injections), the action of the drug is aimed at strengthening the walls of blood vessels and improving blood circulation at the micro level.

The effect of the use of the drug Prostatilen in chronic prostatitis:

• Improving the functionality of the prostate.
• Reduction of congestion, reduction of edema internal organ men.
• Reduction of severe symptoms of chronic prostatitis.
• Normalization of full blood circulation in the pelvic area, reducing the likelihood of blood clots in the blood vessels.
• Decrease in the concentration of leukocytes that infiltrate prostate tissue.

Methods of treatment of chronic prostatitis

In most cases chronic illness prostatitis is successfully treated with conservative methods. But it should be remembered that therapy will bring a quick positive result with an integrated approach. In addition, it is strongly recommended to reconsider the lifestyle - alcohol abuse, unbalanced diet, sedentary lifestyle and promiscuity, etc.

• prostate massage carried out manually through the anus. It is worth noting that the procedure is not very pleasant, but the effectiveness is very high.
• Physiotherapy procedures. Treatment of chronic prostatitis with thermal physiotherapy gives good results by improving microcirculation and absorption of drugs into tissues. Physiotherapeutic procedures include ultrasonic heating and irrigation with an antibacterial solution using enemas.
• Balneotherapy. In many sanatoriums, chronic prostatitis is successfully treated with balneotherapy methods, that is, with the help of mineral waters. For the treatment of patients with prostatitis, low-mineralized water is usually prescribed both inside and in the form of baths. The most famous balneological resorts where prostatitis is treated are Evpatoria, Saki, Truskavets, Morshyn, Zheleznovodsk.
• Diet therapy. You should start adhering to a special diet already at the first signs of prostatitis. First of all, you should refuse alcoholic beverages, since ethyl alcohol irritates the prostate ducts, increasing pain and inflammation. It is also necessary to limit the intake of fatty meat in order to exclude the formation of cholesterol plaques and further deterioration of blood circulation. Legumes, mushrooms, offal, salty and spicy foods, tea and coffee, carbonated drinks, and pastries are prohibited.
  The diet for chronic prostatitis should include foods rich in zinc (it is found in seafood and pumpkin seeds). It is recommended to eat as many vegetables as possible (except for those that contribute to gas formation - for example, cauliflower), dairy products, cereals and dried fruits.

Preventive measures

Chronic prostatitis in men usually does not develop if they are often outdoors, play sports. In addition, the prevention of chronic prostatitis is the rejection of bad habits and casual sex.

There are primary, aimed at preventing the occurrence of the disease, prevention and secondary, the task of which is to prevent the recurrence (exacerbation) of existing chronic prostatitis.

Primary prevention comes down to regular sexual intercourse, a balanced diet, adherence to a physical activity regimen, timely and complete treatment of any infectious (purulent) diseases of the body and timely sanitation of the oral cavity.

Secondary prevention provides for regular examination by a urologist and preventive treatment - multivitamins, restorative drugs, sports.

As a drug for the prevention of prostate diseases, in particular chronic prostatitis, you can use Prostatilen suppositories.