Prostatitis for "dummies"

Just about prostatitisAlexey Yakovlev aka botalex

About 10% of men suffer from prostatitis. The disease, as a rule, does not pose a threat to life, often becomes the cause of serious psychological suffering, with consequences for the patient's self-esteem, family life and even for his social adaptation.

It happens that emotional experiences themselves fix the pain syndrome, which leads to the development of psychosomatic pelvic pain. Therefore, the modern medical classification of prostatitis introduces such a concept as "chronic pelvic pain syndrome" in order to emphasize that chronic non-bacterial prostatitis and pain in the prostate gland (prostatodynia) are not always caused by a pathological process in the prostate itself. Simply put, often the pain attributed to prostatitis is not associated with the prostate at all.

There are a lot of pseudo-medical speculations and struggle-intensive myths around prostatitis, which are primarily associated with misconceptions about the causes of this disease.

Prostatitis is classified as follows:

• Type I – acute bacterial prostatitis
• Type II – chronic bacterial prostatitis
• Type III – chronic non-bacterial prostatitis (chronic pelvic pain syndrome)
• Type IV – asymptomatic inflammatory prostatitis

Myth # 1 lies in the common misconception that most chronic prostatitis is directly caused by infection, and therefore, with any exacerbation, some urologists prescribe expensive tests to expose malicious bacteria, followed by the appointment of shock doses of antibacterial drugs.

In fact, bacteria are responsible in only 5-10% of cases. Whereas the lion's share of prostatitis (chronic pelvic pain syndrome) is caused by other causes: autoimmune, chemical irritation due to urine being thrown into the prostate, psychosomatic, etc., and in practice in most cases these causes cannot be identified in each individual case.

Myth # 2 says that bacterial prostatitis is caused by ureaplasmas, mycoplasmas, trichomonas, chlamydia – in general, a favorite set of sexually transmitted infections for urological examination.

In reality, these infections never cause bacterial prostatitis. Along with others, there are theories that these sexual infections can trigger inflammatory types of chronic pelvic pain, along with viruses, anaerobic bacteria, certain staphylococci, etc., however, studies have clearly shown that there is no direct role for them in maintaining the pathological process, and therefore it is not recommended to treat chronic pelvic pain with any antibiotics.

Despite this, many doctors, and not only Russian ones, continue to ignore evidence-based studies and prescribe antibacterial drugs to most of their patients with each exacerbation.

As for 5-10% of prostatitis, which are really caused by bacteria, almost all of them are caused by the introduction of intestinal microflora into the prostate gland. In most cases (80%), the culprit of bacterial prostatitis is E. coli.

This bacterium has evolved with us in such a way that it has learned to thrive not only in the normal intestinal flora, but also in the genitourinary tract, where some genetically susceptible individuals may behave in no way friendly, causing, in particular, bacterial prostatitis in men and cystitis in women. Since our immune system does not actively fight the "native" E. coli, the urogenital infections caused by it become chronic.

The other 20% of bacterial prostatitis is caused by Pseudomonas aeruginosa, Klebsiella, proteus, enterococci and other bacteria that are always present in the normal flora of our body. Only in such, by no means frequent, cases of acute and chronic bacterial prostatitis, antibacterial drugs should be prescribed.

Mycoplasmas with ureaplasmas are, as a rule, commensals, i.e. conditionally pathogenic bacteria, and therefore, if your doctor associates your prostatitis with them, and even unreasonably prescribes antibiotics against these infections with each exacerbation, contact another specialist for a second opinion.

And I tearfully beg you, fellow men: stop harassing your women who have been diagnosed with these same ureaplasmas! The detection of these bacteria does not indicate insidious infidelity! Many women got ureaplasma at birth, passing through the birth canal of the mother, and it may not be detected every time, although it may be present in the body for life.

Myth No. 3 is a favorite misconception in Russia that diseases such as prostatitis or cystitis are caused by hypothermia. Don't sit on the cold! – experts advise, – you will earn prostatitis!

As you already understand, the cause of prostatitis is not hypothermia. Although it should be noted that with a certain psychological attitude, cultivated in Russians since early childhood, even innocent drafts and a feeling of discomfort experienced in the cold cause the release of a large number of stress hormones that can "weaken" the immune system in a certain way, as a result of which the chronic bacterial process already existing in the patient may worsen.

In people with psychosomatic pelvic pain, such a myth by itself can trigger an exacerbation if the patient is convinced of the importance of the cold factor.

TreatmentAcute bacterial prostatitis is relatively easy to treat.

The main thing here is not to self–medicate! Not all antibacterial drugs penetrate the prostate; in addition, fecal bacteria can be resistant to many drugs, and therefore they need to be sown and tested for sensitivity to antibacterial agents. With the correct selection of the drug, acute prostatitis can be defeated, as a rule, in 4-6 weeks.

Chronic bacterial prostatitis is more difficult to treat, because with chronic inflammation, the environment inside the prostate gland becomes more alkaline, which further complicates the diffusion of antibiotics into the diseased organ. Thus, the list of available remedies narrows, whereas with their repeated use, the resistance of bacteria to them increases.

Non-bacterial prostatitis, which causes up to 95% of all prostatitis, is not easy to treat at all. Therefore, all treatment is aimed at relieving symptoms with the next exacerbation. At the same time, the patient should be aware that such a disease has a long-term chronic character, and there are no methods or means for its complete cure.

Without realizing this reality, patients are often disappointed in doctors, move from one specialist to another, experiencing all sorts of, as a rule, very expensive and, importantly, ineffective and even completely useless methods of treatment.

Since psychosomatic disorders occupy a large share in the structure of chronic pelvic pain syndrome, it is impossible not to take into account the placebo effect of many popular drugs and physiotherapy. As for the official medical opinion, there is no panacea here due, first of all, to the very heterogeneity of pelvic pain – different causes provide for different approaches to treatment.

With chronic prostatitis, doctors often prescribe:

Traditional methods:

• Medications from the alpha-blocker group, which, by relaxing certain muscle fibers, can relieve pain when urinating.
• Medications from the group of nonsteroidal anti-inflammatory drugs (ibuprofen, aspirin, etc.), which can also relieve pain.
• Prostate massage. It is very popular in Russia and really brings relief to some patients. However, its effectiveness is disputed by many experts.

• Physiotherapy (warming up) is a method based on thermal microwave exposure in the prostate area. It is also a very popular method of treatment. However, there is still not enough data to clearly prove that its effect significantly exceeds the placebo effect.
• Psychotherapy. It is effective for many patients, since mental suffering in chronic prostatitis may be more significant than physical. Unfortunately, this area of medicine is not developed in Russia, and therefore it is not easy to find a good psychotherapist for such cases.

Alternative medicine offers many of its own remedies, such as:

• Acupuncture. There are very few good studies on this method so far, and therefore it is too early to say that "needles" are really more effective than placebo.
• Dietary supplements and herbal medicine. Formulas of such preparations include extracts of various plants, minerals and vitamins (zinc, selenium, vitamins E and D are especially often used). Despite the fact that almost all patients with chronic prostatitis resort to such means, their effectiveness remains very doubtful. Some encouraging data have been accumulated on the bioflavonoid quercetin, which is found in green tea, onions and other plants, but the plants themselves do not contain enough of this substance for a clinical effect, and therefore quercetin is used as concentrated dietary supplements.

Independent measures:

• A warm bath. It gives a good reflex effect in many patients during the period of exacerbation of pelvic pain.
• Avoid alcohol, caffeinated drinks, spicy food.
• To avoid pressure on the prostate during prolonged sitting, use soft seats or put a flat pillow.
• During exacerbations, it is better to give up the bike. Outside of exacerbations, wear special cycling shorts with a soft lining sewn in and pick up a special saddle with a groove in the middle.

Portal "Eternal youth" http://vechnayamolodost.ru
11.11.2011