A survey conducted among residents of different countries showed that 2-10% of adult men experience symptoms of prostate problems during their lifetime.
Any urinary disorder is an alarm bell, and in this case self-medication should be excluded.However, problems are not always specifically related to prostatitis.
Go to the doctor
Our articles are written with a passion for evidence-based medicine.We cite reputable sources and seek comments from reputable physicians.But remember: you and your doctor are responsible for your health.We do not prescribe recipes, but give recommendations.Whether you rely on our point of view or not is up to you.
How does the prostate work?
The prostate, or prostate gland, is a walnut-shaped organ located just below the bladder.Between the halves of the "nut" passes the urethra, a tube through which urine leaves the bladder and sperm leaves the testicles.
The main function of the prostateit consists of the production of a secretion that is part of the seminal fluid.Thanks to this secretion, the spermatozoa are able to move.The second task of the prostate is to contract, ensuring ejaculation, i.e. ejaculation.
Next to the prostate are the seminal vesicles, which are connected to the vas deferens, through which the sperm leaves the genitals.The seminal vesicles produce the liquid part of the sperm and store the secretions of the prostate.
The secretion of the prostate is a mixture of citric acid and enzymes.This fluid liquefies the sperm, which enters the urethra from the vas deferens of the testicles.
Prostate problems do not always lead to erectile problems
In the vast majority of cases, sexual dysfunction is not associated with prostate problems because there is no physical connection between the prostate and the erection mechanism.
However, urinary incontinence, discomfort due to incomplete emptying of the bladder, pain or discomfort associated with inflammation lead to a person becoming nervous and embarrassed.Because of this, psychological problems arise - they usually have a negative effect on erection.
What is prostatitis?
Prostatitis is inflammation of the prostate associated with pathogenic microbes 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 urination problems, 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 recommended by the American National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Simplifying a bit, the classification divides prostatitis into bacterial and abacterial, that is, it is not associated with bacteria.This approach helps doctors make the important decision of whether to prescribe antibiotics and other drugs.It is wrong to give antibiotics for all suspected cases of prostatitis, because non-microbial forms of prostatitis are more common than bacterial ones.Taking unnecessary antibiotics is bad for your health.
The NIDDK classification identifies five forms of prostatitis.
Acute bacterial prostatitis.A disease most often caused by typical pathogens of urinary tract infections, such as E. coli, Klebsiella and Enterobacter.
Usually, the disease begins unexpectedly and is accompanied by a general deterioration of health.The temperature rises to 38-39 °C, some people feel weakness, severe pain or burning sensation in the perineum, scrotum or anus, lower abdomen and sometimes in the muscles.Some people experience pain during ejaculation.Sometimes bacterial prostatitis causes frequent, difficult and painful urination.
Chronic bacterial prostatitis.This disease can also be caused by microbes characteristic 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 symptoms of acute prostatitis, but may not be as severe or less severe.There is usually no fever or weakness, the lower abdominal pain is more aching than sharp, but it is difficult to initiate urination and empty the bladder completely.In addition, unpleasant symptoms may disappear temporarily and reappear after a while.
Any man can get acute and chronic bacterial prostatitis.But those at greatest risk are those who have a higher risk of exposure to pathogens: those who have sex, especially anal sex, without condoms, patients with urinary tract infections, and those who have recently had surgery or a prostate biopsy.
Chronic abacterial prostatitis associated with inflammation.The symptoms of inflammatory non-bacterial prostatitis are very similar to acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in the sperm, prostate gland and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate.
Chronic abacterial prostatitis or chronic pelvic pain syndrome without inflammation.The symptoms are similar to both acute and chronic bacterial prostatitis.At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in the semen, prostate gland and urine - this indicates that the prostate gland is not inflamed.
In the case of non-bacterial forms of prostatitis, it is not always possible to guess 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 discomfort.Most often, inflammation is discovered incidentally when the patient is examined for other problems, such as infertility.
How does prostatitis differ from prostate adenoma?
In about 8% of men after the age of 40, the size of the prostate begins to increase - this is called prostatic adenoma or benign prostatic hyperplasia.An enlarged prostate compresses the urethra and this can cause urination problems: too frequent urge to go to the toilet or leakage of urine.Faced with the symptoms of an adenoma, some patients may assume that they have prostatitis.
Although some of the symptoms of prostatic hyperplasia do resemble prostatitis, they are not the same.Prostatitis is inflammation of the prostate gland.An adenoma is an age-related uncontrolled proliferation of prostate cells that does not involve inflammation.
An adenoma can cause serious discomfort, so if you have problems urinating, it is important to see a urologist as soon as possible.However, adenoma is still not as dangerous as prostatitis because it does not increase the risk of developing cancer.
How often is chronic bacterial prostatitis diagnosed?
According to general literature data, worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis in 6-10% of cases.In addition, both types of chronic abacterial prostatitis account for 80-90% of all cases of the disease.
If we perform a massive microscopic examination of the prostate gland, we find certain inflammatory symptoms in all men over 40 without exception.But this has nothing to do with the diagnosis of "chronic bacterial prostatitis".
Many urological diseases can hide behind the mask of chronic prostatitis, and some of them are quite serious and require immediate treatment.Therefore, I recommend that all patients with symptoms reminiscent of prostatitis undergo a more detailed examination that will clarify the diagnosis.
How is prostatitis diagnosed?
From the patient's perspective, the symptoms of bacterial and non-bacterial prostatitis are very similar.Without a consultation with a urologist and special tests, it is impossible to distinguish one form of prostatitis from another and to receive quality treatment.As part of the compulsory health insurance, you can request an appointment with a urologist free of charge or request an appointment with a doctor at a private clinic.
The main task of a urologist who treats a patient with suspected prostatitis is to rule out other prostate diseases, such as cancer, and to determine the form of the disease.It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis, which has a proven or suspected pathogen.Here's what a doctor needs to do to figure it out.
Ask the patient about their symptoms and health.To gather more information, your doctor may recommend that you answer questions on a questionnaire called the Chronic Prostatitis Symptom Index.In some cases, in order not to waste time on the meeting, it is worth printing out the questionnaire and filling it out in advance.
Do a physical exam.The doctor examines the patient, paying particular attention to the groin area.If there are swollen, painful lymph nodes in the groin, this increases the likelihood that there is indeed an inflammatory process in the body.The test typically includes a digital rectal exam, which allows the doctor to assess the size, shape, and condition of the prostate.The study helps to understand whether the prostate is enlarged.If the gland is painful to the touch, it is probably inflamed.
Is it possible without a digital rectal examination?
Digital rectal examination and prostate massage are not the most pleasant procedures.In case of acute inflammation, this can cause pain.Some patients are so keen to avoid these procedures that they refuse to make an appointment with a urologist at all.
Digital rectal examination is a diagnostic method, but the prostate gland is massaged through the rectum to obtain material for laboratory analysis - prostate secretion.If secretions cannot be obtained, the doctor can replace the analysis of the prostate secretion with the analysis of the first dose of urine, or with a two- and three-glass urinalysis.These tests can roughly determine where the problem area is in the urinary tract.
Sometimes instead of this test, a spermogram analysis is prescribed for the same purpose.It helps to understand if the prostatitis is part of the infection of the male gonads and provides information about the quality of the ejaculate.In addition, counting leukocytes in the ejaculate makes it possible to distinguish between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.
If a patient is concerned about an upcoming digital exam or prostate massage, I recommend discussing this with their healthcare provider.Perhaps the analysis of prostate secretions, which requires massage, can be replaced by urine or sperm analysis.
He prescribes blood, urine and prostate secretion tests.The diagnostic standard includes a microscopic examination of prostate secretion, a general blood test, a general urine test with a sediment microscope, and a microbiological examination of urine and prostate secretion.
During the microbiological tests, the patient's biological material is placed on a culture medium, and the bacteria that grow on it are observed - this makes it possible to clarify the diagnosis.You can also be examined at a private clinic for money or free of charge as part of the mandatory health insurance.
Other tests and examinations, such as total prostate-specific antigen (PSA) blood tests and transrectal ultrasound (TRUS) of the prostate, are not usually performed when prostatitis is suspected.In some cases, TRUS of the prostate gland can reveal fibrosis, that is, a scar or a focus similar to a malignant tumor, but such tests are not recommended 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 prescribe antibiotics.And if bacteria have nothing to do with it, then you will need drugs that will help you cope with the unpleasant symptoms of the disease.
Acute bacterial prostatitisthey start treatment without waiting for test results - this is called empiric antibacterial therapy.In this approach, antibiotics are prescribed based on knowledge of which microbes most commonly cause prostate infections.
Usually, patients are prescribed antibacterial drugs that penetrate the prostate tissue well and act on the "more popular" pathogens of prostatitis and urinary tract infections.
Those who feel more or less normal and are treated at home are usually given antibiotic tablets.Antibiotic injections are more often prescribed for patients with high fever who are treated in hospital.With this treatment, in most patients with acute prostatitis, the fever and pain subside within the second to sixth day after starting the medication.
When the patient's temperature normalizes and signs of inflammation disappear, the doctor can switch the patient from injections to tablets.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 this could help release excess secretions built up in the gland and thus reduce swelling.Nowadays, however, most experts have reached a consensus that prostate massage should be avoided in case of bacterial prostatitis.This is not only painful and useless, but it can also worsen the course of the disease, because the massage can cause bacteria to enter the adjacent, non-infected tissues.
Chronic bacterial prostatitisHe was also treated with antibiotics for Gram-negative bacteria.Fluoroquinolones are usually used for treatment;these antibiotics are quite safe.But if the doctor suspects that prostatitis is caused by other microorganisms, he can prescribe additional antibacterial drugs without waiting for the test results.
In the case of chronic prostatitis, antibiotics must be taken for a longer period of time than in the case of acute prostatitis.According to the recommendations of urologists, they are prescribed in a course lasting 4-6 weeks.
Chronic abacterial prostatitisit is not related to bacteria, so patients with the disease are only prescribed antibiotics if they also have a urinary tract infection in addition to prostatitis.
Since it is not clear exactly what causes abacterial prostatitis, treatment is mainly aimed at relieving pain during urination.To achieve this, doctors prescribe alpha-1 blockers - drugs that help relax the muscles of the prostate that compress the urethra.If the pain persists, the doctor may prescribe non-steroidal anti-inflammatory drugs.The dose is selected individually for each patient.
Some patients with abacterial prostatitis benefit from cognitive behavioral therapy, which is the name given to sessions with a psychologist in which a person learns to manage pain without medication.However, there is no scientific evidence for the effectiveness of psychological support for abacterial prostatitis.
Studies in which researchers have tried to prove the effectiveness of other interventions such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal thermotherapy have been poorly designed and too short in duration—usually less than 12 weeks.So it's impossible to say whether all this helps or not.
How to avoid prostatitis: prevention
The main cause of prostate discomfort is a sedentary lifestyle and lack of regular sex life.Doctors believe that men who:
- Practice safe sex regularly.
- Do regular moderate exercise.
- Avoid hypothermia.
- After the age of 40, they undergo an annual urological examination.
Where is it better to treat prostatitis - at a public or private clinic?
The most important thing is to follow the principles of evidence-based medicine when diagnosing and treating prostatitis.It all depends on the doctor - and it doesn't matter exactly where 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, putting the patient at risk of overpayment.In a public healthcare organization, they are more likely to meet all diagnostic and treatment standards.However, patients should take into account that the full examination takes longer - sometimes significantly longer than in a private clinic.
Remember
- Urinary tract problems are common in men, but prostatitis is not always the cause.In order to understand what exactly happens to a person, it is necessary to undergo a thorough examination.
- Prostate problems rarely lead to erectile difficulties.In the case of prostatitis, it usually weakens due to the psychological problems behind the unpleasant symptoms.
- Not all forms of prostatitis are caused by bacteria: in 80-90% they have nothing to do with it.If a prostatitis is suspected, antibiotics are prescribed without further tests, this is bad.Before taking them, you should consult another doctor.
- A person with acute or chronic prostatitis may be prescribed a prostate massage to collect glandular secretions for analysis.
- The best way to prevent prostatitis is protected sex, a healthy lifestyle, and a regular medical urological examination after the age of 40.