A study among residents of different countries showed that 2-10% of older men experience symptoms that suggest prostate problems throughout their lives.
Any violation of urination is a signal to wake up and self-medication in this case should be excluded. However, the problems are not always related to prostatitis.
Go to the doctor
Our articles are written with a passion for evidence-based medicine. We refer to reputable sources and seek comments from respected doctors. But remember: you and your doctor are responsible for your health. We do not write recipes, 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 separated from the bladder, and sperm from the testicles.
The key task of the prostateconsists in creating a secret that is part of the sperm. Thanks to this secret, sperm can 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 leave the genitals. The seminal vesicles produce the liquid part of the sperm and store the prostate 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 do not always lead to erection problems
In most cases, sexual dysfunction is not associated with prostate problems, as 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. Therefore, 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 the 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 urinating, 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 Diabetes, Digestive and Kidney Diseases or NIDDK.
To simplify a bit, the classification divides prostatitis into bacterial and abacterial, ie not associated with bacteria. This approach helps doctors make an important decision - whether to prescribe antibiotics and additional medications. Giving antibiotics to all patients with suspected prostatitis is wrong, as 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 commonly 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, and some people feel 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. Bacterial prostatitis sometimes has 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.
The symptoms of chronic bacterial prostatitis are similar to the acute ones, but can be less severe or less severe. Fever and weakness are usually absent, the pain in the lower abdomen is more painful than acute, but it is difficult to start urinating and completely empty the bladder. In addition, the unpleasant symptoms may temporarily disappear and reappear after a while.
Every man can get acute and chronic bacterial prostatitis. But those 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 recentlyunderwent surgery or 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 in the semen, prostate skeleton and urine there are no pathogenic bacteria, but the concentration of leukocytes will be high - this indicates inflammation of the prostate gland.
Chronic abacterial prostatitis or chronic pelvic pain syndrome that is not associated with inflammation.The symptoms also mimic acute and chronic bacterial prostatitis. At the same time there are no pathogenic bacteria and a high concentration of leukocytes in 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 not always possible to understand what causes the development of the disease. Risk groups are also difficult to identify.
Asymptomatic inflammatory prostatitis.This form of the disease does not cause discomfort. Inflammation is most often discovered by accident when a patient is examined for other problems, such as infertility.
How prostatitis differs from prostate adenoma
In about 8% of men after the age of 40, the prostate begins to enlarge - this is called prostate adenoma or benign prostatic hyperplasia. The overgrown prostate constricts the urethra and therefore problems with urination can begin: too often a desire to use the toilet or urine leakage. Faced with symptoms of adenoma, some patients may suspect that they have developed prostatitis.
Although 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 adenoma is an age-related uncontrolled proliferation of prostate cells that is not associated with inflammation.
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 cancer.
How often is chronic bacterial prostatitis diagnosed?
According to the aggregated literature data worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis - in 6-10% of cases. In addition, both variants of chronic abacterial prostatitis account for 80-90% of all cases.
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 this 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 that 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 consultation with a urologist and special tests it is impossible to distinguish one form of prostatitis from another and get quality treatment. You can make an appointment with a urologist free of charge under the compulsory health insurance policy or make an appointment with a doctor at a private clinic.
The main task of the urologist to whom a patient with suspected prostatitis has come is to rule out other prostate diseases, such as cancer, and to determine what form of the disease the man has. It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen. Here's what the doctor needs to do to understand.
Ask the patient about symptoms and well-being.To gather more information, your doctor may ask you to answer questions from a questionnaire called the Chronic Prostatitis Index. In some cases, in order not to waste time on the appointment, it makes sense to print the questionnaire and fill it out in advance.
Perform a physical examination.The doctor will examine the patient, paying special attention to the groin area. If there are swollen, painful lymph nodes in the groin, this increases the likelihood that the body is inflammatory. The examination usually includes a digital rectal examination, 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 most likely inflamed.
Is it possible to do without a digital rectal examination
Digital rectal examination 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 they generally refuse to make an appointment with a urologist.
Digital rectal examination is a diagnostic method, but the prostate gland is massaged through the rectum to obtain material for laboratory analysis - the secret of the prostate gland. If the secretion cannot be obtained, the doctor may replace the analysis of prostate secretion either with an analysis of the first portion of urine, or with a sample of two and three cups of urine. These tests allow you to roughly determine where the problem area is in the urinary tract.
Sometimes a semen test for the same purpose is prescribed instead. Helps to understand whether prostatitis is part of infections of the male genital glands and provides information about the quality of ejaculate. In addition, the count of leukocytes in the ejaculate makes it possible to distinguish between 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 prostate secretion to obtain, which simply requires its massage, can be replaced by analysis of urine or semen.
Order blood tests, urine and prostate secretions.The diagnostic standard includes microscopic examination of prostate secretion, general blood test, general urine analysis with microscopy of sediment, as well as microbiological examination of urine and prostate secretions.
During microbiological tests, the patient's biological material is placed on a nutrient medium and they see what bacteria are growing on it - this allows you to clarify the diagnosis. You can take tests at a private clinic for money or free of charge under compulsory health insurance.
Other tests and examinations - such as total concentrations of prostate-specific antigen (PSA) in the blood and transrectal prostate ultrasound (TRUS) - are not usually performed when prostatitis is suspected. In some cases, prostate TRUS may 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 caused by bacteria, the doctor will choose antibiotics. And if the bacteria have nothing to do with it, drugs will be needed to help deal with the unpleasant symptoms of the disease.
Acute bacterial prostatitisstart treatment without waiting for the test results - this is called empirical antibiotic therapy. In this approach, antibiotics are prescribed based on the knowledge of which microbes most often 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 causes of prostatitis and urinary tract infections.
People who feel more or less normal and are treated at home usually receive antibiotic pills. And patients with a high fever who are treated in a hospital are more likely to be prescribed injections of antibiotics. With this treatment, in most patients with acute prostatitis, the fever and pain are relieved on the second to sixth day after starting treatment.
When the patient's temperature normalizes 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 to release excess secretions accumulated in the gland and thus reduce its swelling. Today, however, most experts have reached a consensus that prostate massage should be avoided in bacterial prostatitis. This is not only painful and useless, but can also worsen the course of the disease, as as a result of massage the bacteria can get into neighboring, uninfected tissues.
Chronic bacterial prostatitisare also treated with antibiotics targeting gram-negative bacteria. Fluoroquinolones are commonly used for treatment - these antibiotics are considered quite safe. But if the doctor suspects that other microorganisms have caused prostatitis, he may prescribe additional antibacterial drugs without waiting for the test results.
In chronic prostatitis, antibiotics should be taken longer than in acute. According to the recommendations of urologists, they are prescribed within 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.
As it is not clear what exactly causes abacterial prostatitis, treatment is mainly aimed at relieving the pain of urination. To do this, doctors prescribe alpha-1-blockers, drugs that help relax the prostate muscles that compress the urethra. If the pain persists, your doctor may prescribe non-steroidal anti-inflammatory drugs. The dosage for each patient is chosen individually.
Some patients with abacterial prostatitis are helped by cognitive behavioral therapy - so-called sessions with a psychologist, during which a person learns to deal with pain without medication. At the same time, there is still no scientific evidence for the effectiveness of psychological care for abacterial prostatitis.
Studies in which researchers are trying to prove the effectiveness of other interventions, such as acupuncture, chair electromagnetic therapy, prostate massage or transrectal thermotherapy, have been poorly planned and have taken too little time - usually less than 12 weeks. So it is impossible to say whether all this helps or not.
How to avoid prostatitis: prevention
The main cause of 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 regular safe sex.
- They regularly engage in moderate exercise.
- Avoid hypothermia.
- After the age of 40, they undergo a urological examination every year.
Where it is better to treat prostatitis - in a public or private clinic
Most importantly, the principles of evidence-based medicine are followed in the diagnosis and treatment of prostatitis. It just depends on the doctor - and it doesn't matter 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, so that the patient risks overpaying. In the state medical organization the probability of compliance with all standards for diagnosis and treatment is higher. But patients should keep in mind that a full examination will take longer, sometimes much longer, than during a private clinic examination.
I remember
- Urinary tract problems in men are common, but not always in prostatitis. To find out exactly what is happening to a person, you need to undergo a thorough examination.
- Prostate problems rarely lead to erection difficulties. Usually in prostatitis it weakens due to psychological problems that occur 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 further testing, this is bad. Before taking them, it makes sense to consult another doctor.
- A man with acute or chronic prostatitis may be prescribed a prostate massage to collect glandular secretions for analysis.
- The best way to prevent prostatitis is safe sex, a healthy lifestyle and after 40 years - a regular urological examination by a doctor.