What you need to know about prostatitis

School of Pharmacologist: what you need to know about prostatitisR.I.Yagudina, L.K.Ovchinnikova, Federal State University "NCESMP" of Roszdravnadzor, I.M.Sechenov MMA

Russian Pharmacies Magazine No. 10-2007

Prostatitis is an inflammation of the prostate gland (prostate). It is the most common urological disease in men under 50 years of age and the third most common urological diagnosis in men over 50 years of age (after benign hyperplasia – BPH and prostate cancer), accounting for 8% of outpatient visits to the doctor. The incidence of prostatitis increases with age and reaches 30-73%.

It is believed that 30% of men suffer from prostatitis after 30 years, 40% after 40 years, 50% after 50 years, etc. The effect of the disease on the quality of life is comparable to myocardial infarction, angina pectoris, Crohn's disease, which also causes significant psychological and social problems in men of working age suffering from this pathology. According to various reviews, the prevalence of prostatitis in the population is estimated at 5-35%.

The young and middle age of patients, a decrease in some of them not only copulatory, but also reproductive function, persistent course, despite treatment, as well as frequent relapses give reason to regard this disease not only as a medical, but also a social problem.

ClassificationThe most common and generally accepted worldwide is the classification of prostatitis, developed under the auspices of the US Institute of Health.

According to it , there are 4 categories of the disease:

• Category I – acute prostatitis;
• category II – bacterial prostatitis;
• category III – abacterial prostatitis (chronic pelvic pain syndrome):
  • subcategory III A – chronic pelvic pain syndrome,
  • subcategory III B – chronic non-inflammatory pelvic pain syndrome;
• category IV – asymptomatic prostatitis.

According to the course of the disease, acute and chronic prostatitis are distinguished. Acute prostatitis differs from chronic by a more vivid symptom complex and forces the patient to seek help from a doctor. Chronic bacterial prostatitis occurs in 5-10% of cases of the disease, and 90-95% accounts for chronic abacterial prostatitis (chronic pelvic pain syndrome).

PathogenesisThe occurrence and development of prostatitis is largely due to the peculiarities of the anatomical structure of the prostate gland and its blood supply.

The prostate is a part of the male reproductive system that produces a specific secret that nourishes and protects spermatozoa. When the smooth muscle fibers of the prostate capsule and seminal vesicles contract, seminal fluid is released into the urethra – ejaculation (ejaculation).

The main function of the prostate is secretory. The secret produced by it consists of a liquid and dense fraction and includes proteins, carbohydrates, electrolytes, fats and hormones. The gland not only transports sperm, but also dilutes sperm, ensuring the mobility and viability of germ cells. The prostate is an important organ involved in the regulation of testosterone production, and also ensures the normal functioning of the erection mechanism.

The prostate is located under the bladder and covers the upper part of the urethra, so when its size increases, various urination disorders develop. Its anatomical structure differs from the structure of all other human glands. The prostate consists of several parts, one of which contains glandular tissue. The latter includes many small glands, each of which has its own excretory duct. Merging together, they form larger ducts. Both in small and large ducts there are extensions – sinuses, in which the secret of the prostate gland accumulates – prostatic juice. This juice is an excellent nutrient medium for the development of bacteria, and the lining of the sinuses of the cell is a favorable substrate for the life of intracellular agents of sexual infections (chlamydia, mycoplasma, ureaplasma, viruses). The prostate gland does not have its own main blood vessels and is supplied with small vessels from various sources. Therefore, the blood flow rate in the prostate is initially low, which predisposes to the formation of stagnant phenomena and the development of infectious processes. These circumstances largely determine the complexity of the structural changes of the prostate gland and the variety of clinical forms of prostatitis.

As a rule, the disease begins with the ingestion of a pathogenic microorganism into the gland. The infection can enter the prostate gland from the bladder, urethra, rectum, through the blood and lymphatic vessels of the pelvis. Note that by itself, infection in the prostate does not cause all manifestations of the disease. Moreover, we can even say that for the prostate, a different infection is a common phenomenon, which most often proceeds completely unnoticed. For the development of prostatitis with all its unpleasant clinic, in addition to etiological prerequisites, provoking factors are also needed. These include:

• general hypothermia of the body;
• problems with stool (the disease may not be caused by episodic constipation or diarrhea, but by regular defecation disorders);
• sitting work (risk groups include drivers, computer operators and all those who sit during the working day without being able to get up and exercise);
• prolonged sexual abstinence or excessive sexual activity;
• sedentary lifestyle;
• chronic inflammatory diseases of the body (for example, chronic bronchitis) and chronic foci of infection (for example, tonsillitis, untreated carious teeth);
• transferred venereal and urological diseases (gonorrhea, urethritis);
• any other conditions that contribute to the suppression of immunity (for example, overtraining in athletes, regular lack of sleep, overwork, inadequate and irregular nutrition, chronic stress, etc.).

All these factors either facilitate the penetration of microbes into the prostate, or lead to a deterioration of the blood supply to the pelvic organs, stagnant processes, which contributes to the reproduction of microorganisms and the development of the inflammatory process.

Clinical manifestations of prostatitisProstatitis can develop suddenly as an acute inflammatory disease with all the relevant symptoms.

In general, the clinical picture of this pathology looks like this:

• sharp start;
• signs of intoxication – high temperature (up to 38-39 °C) against the background of poor general health;
• prostatic triad:
  • severe pain in the perineum, groin area, over the pubis, in the anus, pain during defecation,
  • frequent painful urination,
  • sexual disorders.

In chronic prostatitis, the clinical picture is more often erased. Symptoms may be absent altogether. The body temperature occasionally rises to 37 ° C, pain or discomfort in the perineum are periodically noted, discomfort during urination and defecation, during which minor discharge from the urethra may be observed - one of the most characteristic symptoms of chronic prostatitis. Very often, problems with potency and sexual intercourse are attributed to general fatigue, psychological stress at work, lack of rest, and a person simply does not understand that he is sick. The manifestations of this form of pathology are diverse. For each patient, it can proceed in its own way. The main symptoms of chronic prostatitis are:

• prostatic triad:
  • pain in the genital area and pelvis, discomfort and pain above the pubis, in the perineum, in the rectum with irradiation to the testicles, penis, inguinal areas and inner thighs, pain during or after ejaculation,
  • increased frequency and painfulness of urination, weakening of the urine stream, feeling of incomplete emptying of the bladder,
  • decreased libido, erectile dysfunction of varying severity, accelerated ejaculation or prolongation of sexual intercourse, decreased brightness of orgasm;
• discharge from the urethra, prostatorrhea;
• concomitant psychological disorders.

Prostatitis often develops as a complication of a chronic sexually transmitted infection – chlamydia, trichomoniasis, ureaplasmosis, etc. At the same time, only very minor changes may occur during the course of the disease: discomfort during urination becomes slightly stronger, it is joined by mild pain in the perineum, discharge from the urethra during defecation. Changes in the already not too bright clinical picture of the disease can be so insignificant that patients do not pay attention to them at all.

During the chronic course of the disease, patients have problems with erection. This is due to the involvement in the inflammatory process of the nerves responsible for erectile function, which pass through the prostate. Chronic prostatitis has a very negative effect on the general well-being of a man, making him extremely irritable, grouchy, dissatisfied and concerned only with his own well-being. This often manifests itself so noticeably that, according to doctors, for the successful treatment of prostatitis, you need to be not only a good urologist, but also a psychologist.

Chronic prostatitis is characterized by a wave-like course, when periods of exacerbation alternate with remissions of different duration, during which the disease does not make itself felt in any way. As a result, many men prefer not to see a doctor. If the process spreads through the urinary system, it can lead to the development of cystitis and pyelonephritis. But more frequent complications of prostatitis are vesiculitis (inflammation of the seminal vesicles) and epididymoorchitis (inflammation of the testicles and their appendages). Ultimately, this can lead to a decrease in sexual desire, erectile dysfunction, premature ejaculation, impaired orgasm, infertility, the treatment of which will be extremely difficult and long, if at all possible.

Asymptomatic prostatitis is understood as the absence of any typical symptoms and complaints in general, with the exception of an increased number of leukocytes originating from the prostate. About a quarter of patients with chronic prostatitis may not make any complaints at all, and prostatitis is detected in them accidentally during a urological examination. Prostate cancer is often hidden under his mask.

Diagnosis and therapyDiagnosis of prostatitis – acute and chronic – is carried out after consultation with a urologist and identification of the clinical picture.

The doctor conducts a finger rectal examination of the prostate gland and an analysis of prostate secretions. The final diagnosis of prostatitis is confirmed by laboratory tests with the detection of sexually transmitted infections by conditionally pathogenic flora: bacterioscopic, bacteriological studies.

Along with drug regimens for the treatment of prostatitis, non-drug methods of its therapeutic correction are also used. First of all, this is physiotherapy, which includes special exercises and relaxation techniques that can alleviate the condition of some men, probably due to the calming of "irritated" muscles. Common techniques include:

• physical exercises. Stretching and relaxation of the pelvic muscles is sometimes used in conjunction with heat in order to make the muscles more mobile, which can reduce the severity of symptoms;
• biofeedback. This technique teaches you to control your body's reactions (including muscle relaxation). During biofeedback sessions, electrodes from the patient's body are attached to a monitor that shows heart rate, blood pressure, and the severity of muscle tension. The patient observes changes in indicators and learns to control himself independently;
• sedentary baths. Warm baths can relieve pain and promote relaxation of abdominal muscles;
• prostate massage. Some doctors believe that prostate massage helps to reduce obstruction and unlocks thin passages narrowed due to inflammation. This procedure is used now for some reason much less often than before;
• quantum therapy using the device "Rikta" can be prescribed from the first day of going to the doctor. Usually, after 2-3 of her sessions, the pain in the perineum disappears, urination normalizes, sleep and general condition improve. After 6-8 sessions, the soreness and swelling of the prostate decreases, its secret is normalized.

As you know, it is better to prevent any disease than to treat it. To prevent prostatitis, it is important to organize your life so that there are as few risk factors for the development of this disease as possible. For the prevention of prostatitis, sports, walking, proper sleep and wakefulness, full and sufficient nutrition are necessary. It is also advisable to take a number of biologically active additives. It is necessary to lead a regular sex life without excessive changes in one direction or another, avoid hypothermia, use laxatives with frequent constipation.

When detecting sexually transmitted diseases, it is necessary to consult a venereologist, you should not resort to self-medication. With frequent changes of sexual partners, regular examinations are necessary due to the possibility of infection with sexual infections.

Prostatitis is often manifested by poor, poorly expressed symptoms. If from time to time there are minor pains in the perineum, unpleasant sensations during urination or defecation, minor discharge from the urethra, you should definitely consult a urologist.

Portal "Eternal youth" www.vechnayamolodost.ru16.07.2008