Chronic prostatitis is an inflammatory disease characterized by prostate lesions and severe urodynamic disorders. One of the causes of chronic inflammation of the prostate is improper or untimely treatment in the acute phase, when desquamation and proliferation of the glandular epithelium is reversible and successfully corrected with drugs within 2-3 weeks.
Treatment of chronic prostatitis includes massive antibiotic therapy aimed at eradicating the infectious agent, a series of measures to increase the body's immune resistance, physiotherapeutic methods, heat therapy. Psychocorrection can also be included in the therapy regimen, because neurasthenic and neurosis-like conditions are often observed in men with long-term and recurrent prostatitis.
Why does inflammation become chronic?
Knowing the causes of chronic prostate inflammation is necessary to prevent worsening and improve the quality of life of patients. There are a number of factors that can affect the functional state of the glandular (glandular) tissue of the prostate and cause its inflammation based on desquamation and proliferation of epithelial cells.
The main cause of chronic prostatitis in men is a large contamination of the mucous membrane 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 causes of infection: enterobacteria (especially Escherichia coli), gonococci, staphylococci. Rarely, the infectious and inflammatory process takes place against the background of infection by viruses, fungi and protozoa, but such forms of prostatitis are quite successfully treated during the acute period and rarely give relapses, subject to proper and timely therapy.
It should also be borne in mind that one acute urinary tract infection is sufficient for the development of chronic aseptic prostatitis, so personal hygiene, condom use during intercourse and timely treatment of urinary tract disease are of great importance in preventing 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 remediation of chronic infection is an important stage in the complex treatment of long-term or long-term prostate inflammation.
Negative factors that can cause worsening of prostatitis (including non-infectious course) are:
- urinary tract injuries and operations on the organs of the genitourinary system;
- regular or severe hypothermia of the pelvic organs (bathing in open water in periods when the water is not warm enough or the weather is cold outside, working in refrigerators and freezers, etc. );
- hypodynamics caused by inactive work and insufficient physical activity of a man (sedentary lifestyle is one of the main factors in the development of chronic cognitive prostatitis);
- bad habits, in which the absorption of the most important macro- and microelements that determine the chemical composition and rheological properties of prostate secretions (zinc, chromium, selenium, manganese) is slowed down or disturbed;
- disorders in the intimate sphere (frequent masturbation, irregular sexual intercourse, long periods of abstinence, frequent arousal that does not end with intercourse);
- overweight;
- eating disorder (increased consumption of spicy, salty, smoked and fatty foods).
Pay attention! Urologists note that the leading pathogenetic factor in the development of chronic inflammation of the prostate gland is posterior urethritis. It has also been observed that inflammatory changes in the prostate in men appear in the first months after a gonorrhea infection.
Treatment of chronic prostatitis with drugs
Drug treatment of chronic prostatitis is aimed only at suppressing acute symptoms during exacerbation and destroying the infection, but drugs cannot be used as the only means (according to Dr. Pechersky, the effectiveness of such treatment will not exceed 36%).
The complete drug treatment regimen for prolonged or recurrent prostate inflammation used today as a standard in uncomplicated disease is presented in the table below.
Table. Preparations for the complex treatment of chronic prostatitis.
| Pharmacological Group | Purpose |
|---|---|
| Antibiotics from the group of macrolides, semisynthetic penicillins and third-generation cephalosporins with a broad spectrum of antibacterial activity. | Eradication (destruction) of pathogenic bacteria - the cause of infectious prostatitis, urethritis, cystitis and other urinary tract infections. |
| Antimicrobial and antiprotozoal agents. | Treatment of infections caused by pathogenic microbes and protozoa. |
| Nonsteroidal anti-inflammatory drugs (preferably in the form of rectal suppositories). | Reduction of inflammation in prostate tissues, relief of pain in the perineum, intergluteal space, sacrum and groin. |
| Antiseptics in the form of rectal suppositories. | Rehabilitation of the rectal mucosa and prevention of its infection with prolonged prostatitis. |
| Alpha blockers. | Normalization of urination, renewal of daily urine. |
| Microcirculation correctors. | Removal of congestion in the vessels of the small pelvis, restoration of normal blood and lymph flow. |
| Correctors of urodynamics (agents that affect metabolism in prostate tissues). | Improving metabolic and metabolic processes in prostate tissues and its nutrition. |
| Power regulators. | Complex treatment of erectile dysfunction, improvement of chemical composition, viscosity and fluidity of semen, increase in sperm activity (use of drugs of this group is indicated for patients whose prostatitis is complicated by autoimmune infertility) |
The duration of antibiotic treatment is at least 4-6 weeks. Under no circumstances should you take antibacterial drugs without a doctor's prescription, because the leading factor in choosing therapy is the results of microscopic examination of prostate secretions and fluid released spontaneously as a result of prostate massage. Some antibiotics, for example, penicillins (combination of amoxicillin with clavulanic acid) are reserve drugs, and their improper use can lead not only to the absence of clinically significant effect and 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. Antidepressants with selective inhibition of serotonin reuptake are used to suppress these symptoms.
Physiotherapy
Heat therapy is the main method of treating chronic prostatitis outside the period of exacerbation (after regression of acute symptoms). Heat therapy refers to physiotherapy methods and doses the effect of heat on the affected area. The benefits of thermal procedures are in the normalization of blood circulation, alleviation of inflammatory processes, reduction of chronic pelvic pain, which is one of the main clinical manifestations of chronic prostatitis, which reduces the quality of life of men. Heat also improves the penetration of medicinal substances into the prostate tissue, so in some cases physiotherapy is used to increase the effectiveness of drug therapy (for example, electrophoresis with antibiotics). For men at high risk of blood clots, heating is prescribed for prophylaxis because the heat has a moderate resorption effect.
There are a large number of methods of thermal action on the body, and the choice of a particular method of treatment should be carried out by a doctor, taking into account the clinical picture, form and stage of the disease, age of the man and his individual tolerance. The following methods of thermotherapy are most effective for prostatitis:
- thermal application with minerals (ozokerite, paraffin, bischofite), salt or sand;
- electric hotplates;
- deep heating of high strength tissues for direct effect on blood vessels and nerve endings (diathermy);
- exposure to high-frequency alternating magnetic fields to eliminate pain, alleviate inflammation and eliminate neurosis-like manifestations (inductothermy);
- ultrasound therapy (promotes resorption of abscesses and healing of formed scars);
- electrophoresis with introduction of electrodes into the rectum;
- exposure of prostate tissue to high-frequency pulse currents (darsonvalization).
In some physiotherapy rooms, chronic prostatitis is treated by applying hot mud ("mud pants"). Such procedures have a positive effect not only on blood and lymph circulation, but also on the production of prostate secretions, as well as on the nutrition of the tissues of the inflamed organ. In some cases, the mud is injected directly into the rectum in the form of a tampon, because with this method of application it is possible to quickly achieve a therapeutic effect and a positive response to therapy.
Other treatments
The scheme of complex treatment, in addition to drug and heat therapy, is supplemented by various procedures prescribed by the doctor, taking into account the specifics of the pathology in each case.
Prostate massage
This is one of the main methods of treatment of chronic inflammation of the prostate, which is desirable to use in almost 90% of cases (in the absence of contraindications). Massage is the effect of the finger on the prostate to stimulate the outflow of secretory fluid. The duration of the procedure is usually about 1-2 minutes. The criterion for sufficient effect is complete emptying of the prostate, which the patient perceives as relief (of which he should inform the doctor).
The benefits of massage are determined by the therapeutic effect that can be achieved after going through the course (8-12 procedures). With an uncomplicated course, these are:
- normalization of muscle tone;
- improving blood circulation in the vessels of the prostate (therefore, it accelerates the transport of medicinal substances into the tissues of the affected organ and increases the effectiveness of therapy);
- restoration of secretory patency;
- normalization of blood and lymph outflow from the prostate (especially significant in cognitive prostatitis).
The procedure is contraindicated in the acute period due to the high risk of spreading the infection to the surrounding tissues and organs (hematogenous infection), along with other infectious diseases of the genitourinary system, the presence of cysts or stones in the prostate. Prostate massage is not prescribed for patients diagnosed with tuberculous organ damage, adenoma, or other neoplastic diseases (including cancerous prostate lesions). In the presence of diseases of the rectum (hemorrhoids, anal fissure, proctitis, paraproctitis), massage can cause complications and cause relapse of the underlying disease.
Important! Studies show that almost 42% of men refuse prostate massage due to the increased psychological discomfort associated with the peculiarities of this procedure. Physicians ’work with such patients should include detailed information on the consequences of refusing treatment and possible complications, especially infertility and persistent sexual dysfunction. In some cases, it may be advisable to prescribe light sedatives a few days before starting treatment.
Hot enema
Hot enemas are home treatments for chronic prostatitis, but urologists recognize their effectiveness and recommend them for faster and more effective treatment of prostatitis. The water temperature for these enemas should be around 42 ° C. Before the procedure it is necessary to clean the intestines with regular enemas or laxatives. The amount of one enema is from 150 to 300 ml. It is recommended to empty the bowel 30-50 minutes after application of the solution.
Below are recipes for chronic prostatitis.
- Dissolve 10 drops of iodine and about 20 ml of chlorhexidine in 200 ml of water. Apply at bedtime for 15 days.
- A decoction of chamomile, St. John's wort or calendula should be introduced into the rectum (about 250 ml) and then kept for 1 hour. The procedure is repeated once a day for 2 weeks.
- Buckwheat oil (40-50 ml) is heated to 40 ° C and introduced into the rectum for 20-30 minutes. The course of treatment is 10-15 days. The procedure is best done before bedtime.
- In the case of severe pain syndrome, which significantly limits the patient's mobility and worsens the quality of life, microclysters with novocaine can be used. Dissolve 2 ampoules of 2% novocaine solution in 180 ml of steep chamomile decoction. Hold for at least 50 minutes. Repeat daily for 1 week.
Anti-inflammatory drugs, antiseptics, antibiotics can also be used for microclysters. The use of these drugs is allowed with the permission of a doctor strictly in the prescribed dose.
Treatment of chronic prostatitis: step by step instructions
The use of different treatment methods is not enough to completely get rid of chronic prostatitis. If a man does not follow the diet and does not change his lifestyle, exacerbations will occur regularly, which will lead to irreversible changes in the structure and functional activity of the prostate glands and permanent dysuric and sexual disorders. To increase the effectiveness of treatment and the duration of remission, you should follow the recommendations given in the instructions below for patients with chronic prostatitis.
- Step 1. If a man is diagnosed with chronic prostatitis, he should start correcting his diet. Foods high in fat, salt and spices should be excluded from the menu. Fats raise the level of cholesterol in the blood, and salt promotes fluid retention and edema in the prostate tissue. Spices (like various chemical additives) irritate the mucous membrane of the urinary system, causing worsening of existing symptoms.
- Step 2. It is also necessary to completely eliminate alcoholic beverages, because they slow down the absorption of nutrients, disrupt blood and lymph circulation and negatively affect the metabolism in the prostate. If a man suffers from tobacco addiction, measures should be taken to eliminate this habit (toxic substances in tobacco smoke violate the viscosity and fluidity of prostate secretions and change its chemical composition).
- Step 3. Overweight men should consult an endocrinologist and nutritionist for 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 phase in complex therapy is weight loss in patients with high BMI.
- Step 4. In order to eliminate congestion associated with hypodynamic disorder, it is necessary to ensure an appropriate level of physical activity appropriate to age and physical fitness. Swimming, physiotherapy exercises, stretching exercises, walking are useful for prostatitis.
- Step 5. For the normal functioning of the prostate it is necessary to monitor the quality of sexual life. It is advisable to have a steady sexual partner, avoid episodes of sexual arousal if there is no possibility of further intercourse, and check for genital infections regularly, which can also cause exacerbation of chronic prostatitis.
Men with recurrent prostatitis must monitor emotional stress, avoid stressful situations, as well as prolonged exposure to cold or drafts.
Chronic prostatitis is a disease that is difficult to treat, especially if the patient does not follow the prescriptions of a doctor who does not approach responsibly to issues of diet and regimen. Inflammation of the prostate is dangerous with serious complications, so you need to approach the problem holistically. Men with this diagnosis should understand that the pills alone are not enough to fully restore all prostate functions, so the basic therapy methods for chronic prostatitis suggested by a doctor should not be abandoned, even if they cause primary psychological or physical discomfort.