Treatment of prostatitis is a laborious process that requires a comprehensive examination of the patient. For the correct treatment of a patient with prostatitis, it is necessary to make an accurate diagnosis based on an examination, test results and instrumental research methods.
It is important for the doctor to distinguish between acute and chronic inflammation in the gland, bacterial and aseptic process. Carrying out this differentiation allows you to determine the tactics of treatment.
With acute inflammation, the risk of complications, the focus of treatment is on the patient's detoxification, antibacterial and anti-inflammatory therapy.
Antibacterial therapy for chronic inflammation of the gland is used, but leads to a positive effect only in 1-2 patients out of 10, since chronic prostatitis does not always have only a bacterial etiology.
Therefore, an extremely important aspect in the treatment of chronic prostatitis is the complex effect on all known pathogenetic mechanisms of the disease.
Physiotherapy and diet therapy are added to antibacterial and anti-inflammatory treatment. For a patient with chronic prostatitis, it is extremely important to adjust his lifestyle, get rid of bad habits, stressful influences and normalize his psycho-emotional state.
Treatment of acute bacterial prostatitis
Mode and diet
- Bed rest.
- Sexual rest during the course of treatment.
- Avoiding stressful effects of environmental factors (hypothermia, overheating, excessive insolation).
- Diets.
Antibacterial drugs
The appointment of antibiotic therapy is mandatory for acute bacterial prostatitis (ABP) and is recommended for chronic inflammation in the gland.
OBP is a serious infectious and inflammatory process, accompanied by severe pain, fever and increased fatigue of the patient.
When ABP is diagnosed, the patient is given parenteral antibiotic therapy. Initially, broad-spectrum antibiotics are prescribed - penicillins, 3rd generation cephalosporins, fluoroquinolones.
At the beginning of therapy, a combination of one of the listed antibiotics with drugs from the group of aminoglycosides is possible. After stopping the acute process and normalizing the patient's condition, they are transferred to oral antibiotics and continue the therapy for 2-4 weeks.
If possible, before the appointment of empiric antibiotic therapy, it is recommended to do a bacterial culture of the urine to determine the flora and sensitivity to antibacterial drugs.
As a rule, when diagnosing ABP and severe intoxication, the need for infusion therapy, with complications of the disease (pancreatic abscess formation, acute urinary retention), the patient is hospitalized.
In the absence of complications, fever can be treated on an outpatient basis with oral medications.
Operative interventions
Surgical treatment is indicated for complications of OBP. An abscess with a diameter of more than 1 cm is an absolute indication for surgery.
Transrectal or perineal access is used to drain the pancreatic abscess under the guidance of transrectal ultrasound (TRUS).
There is evidence of the effectiveness of therapy with an abscess diameter of less than 1 cm.
In the case of untimely drainage of a pancreatic abscess, it can spontaneously open, a breakthrough of purulent contents in the fatty tissue around the rectum, with the development of paraproctitis. Paraproctitis requires open drainage of the pararectal tissue.
Approximately 1 in 10 patients with ABP develop acute urinary retention. As a rule, a suprapubic cystostomy is needed to remove it (insertion of a urinary catheter can be painful and increase the risk of developing CKD).
Most often, trocar cystostomy is performed under local anesthesia and under ultrasound control. Before the operation, the site of insertion of the tube is punctuated with a local anesthetic solution.
A small skin incision is made with a scalpel. Under ultrasound control, a trocar is inserted into the bladder cavity, through which a urinary catheter is introduced into the bladder.
Treatment of chronic bacterial prostatitis
Chronic bacterial prostatitis (hereafter referred to as CKD) is treated with lifestyle changes and medication. Of great importance are:
- Avoiding environmental stressors.
- Maintaining physical activity.
- Diets.
- Regular sexual activity without exacerbation.
- Use of barrier contraception.
Medical treatment
Fluoroquinolones are more commonly used in the treatment of chronic bacterial prostatitis (CKD).
This group of drugs is preferred due to good pharmacokinetic characteristics, antibacterial activity against gram-negative flora, including P. aeruginosa.
Empiric antibiotic therapy is not recommended in CKD..
The duration of therapy is selected based on the specific clinical situation, the patient's condition and the presence of symptoms of intoxication.
In CKD, the duration of antibiotic therapy is 4-6 weeks after diagnosis. The oral route of administration of drugs in high doses is preferred. If CKD is caused by intracellular bacteria, drugs from the tetracycline group are prescribed.
Antibacterial therapy for an established pathogen includes the appointment of the following drugs.
Chronic Pelvic Pain Syndrome (CPPS)
Therapy of the abacterial form of inflammation of the pancreas can be carried out on an outpatient basis.
The patient is advised:
- Leading an active lifestyle.
- Regular sex life (at least 3 r / week).
- barrier contraception.
- Diets.
- Cut out alcohol.
Despite the lack of a bacterial component, it is possible to prescribe a two-week course of treatment for NCPPS.
With positive dynamics of the disease, reduction of symptoms, the prescribed therapy lasts up to 30-40 days. In addition to antibiotics, the following are used to treat NCPPS:
- α1 - blockers.
- NSAIDs.
- Muscle relaxants.
- 5α reductase inhibitors. Currently, there is no evidence of the effectiveness of α1-blockers, muscle relaxants, 5α reductase inhibitors.
- With long-term treatment of NCPPS, it is possible to prescribe herbal preparations: extract of Serenoa repens, Pygeum africanum, Phleum pretense, Zea mays.
- Prostate massage. With NCPPS, it is possible to massage the pancreas up to 3 times a week during the entire period of therapy.
- Effectiveness is not proven, but FTL is used: electrostimulation, thermal, magnetic, vibration, laser, ultrasound therapy.
In NCPPS cure, improvement of patients' quality of life is doubtful and unlikely due to the low effectiveness of most of the listed therapies.
Asymptomatic inflammation
The main goal of treatment of type IV prostatitis is to normalize the level of prostate-specific antigen (PSA) with its increase. A normal PSA level does not require therapy..
Treatment of this type of prostatitis does not require hospitalization and is carried out on an outpatient basis.
Non-drug therapy includes:
- Active lifestyle.
- Elimination of stressful effects on the body (hypothermia, sunlight), which suppress the activity of the body's immune system.
- Use of barrier contraception methods.
- Diets.
Drug therapy includes the appointment of antibiotics with subsequent monitoring of effectiveness, namely fluoroquinolones, tetracyclines or sulfonamides for a period of 30-40 days with PSA level control.
The criterion for the effectiveness of the therapy is a decrease in the PSA level 3 months after the antibiotic therapy.
Long-term elevated PSA levels in type IV prostatitis require repeat prostate biopsies to rule out prostate cancer.
Rectal suppositories
The main advantage of using rectal suppositories in the treatment of prostatitis is the higher bioavailability compared to oral forms of drugs and the creation of the highest concentration of the drug in the vessels of the small pelvis, around the pancreas.
As a rule, rectal suppositories complement the prostatitis treatment schemes presented above, that is, they belong to adjuvant therapy.
| A group of drugs | Clinical effect |
|---|---|
| Suppositories based on NSAIDs | They reduce the synthesis of pro-inflammatory factors, reduce pain and stop fever. |
| Suppositories with antibacterial drugs | It is rarely used in the treatment of prostatitis. More often, doctors resort to intramuscular or intravenous antibiotics to treat bacterial prostatitis. |
| Suppositories with local anesthetics | In addition to the local anesthetic effect, they have an anti-inflammatory effect, improve microcirculation in the pancreas. Main application in proctology. |
| Plant-based suppositories | Local anti-inflammatory, analgesic and antiseptic action. |
| Suppositories based on polypeptides of animal origin | Organotropic action |
Diet and rational nutrition
Compliance with the diet is a key point in the treatment of chronic prostatitis. Some types of products, an allergic reaction of the body to them, can lead to the development of inflammation of the pancreas, development of symptoms of prostatitis.
A change in diet can lead to a significant improvement in the quality of life while reducing the symptoms of the disease.
The most common foods that aggravate prostatitis symptoms are:
- Spicy food, spices.
- Hot pepper.
- Alcoholic beverages.
- Pickled foods, pickles.
- wheat.
- Gluten.
- Caffeine.
The function of the intestine and pancreas are interconnected: as problems with the intestine develop, symptoms of inflammation of the prostate can develop, and vice versa.
An important aspect to prevent the development of prostatitis, to prevent the recurrence of inflammation in the stroma of the gland during the chronic course of the disease, is the intake of probiotics.
Probiotics are preparations containing bacteria that live in healthy intestines. The main effects of probiotics are the suppression of the pathological microflora, its replacement, the synthesis of certain vitamins, support of digestion and, as a result, maintenance of the human immune system.
Most often, a person consumes probiotics in the form of fermented milk products - kefir, yogurt, sour cream, fermented baked milk. The main disadvantage of these forms is the vulnerability of bacteria to the action of the acidic environment of the stomach (most of the bacteria die in the stomach under the action of hydrochloric acid and only a small number of them reach the intestines).
For best effect and more complete delivery, capsules with bacteria are suggested. The capsule passes through the aggressive environment of the stomach and dissolves in the intestines, keeping the bacteria intact.
The development of inflammation in the pancreas can lead to a lack of zinc in the body, eating pollutants.
Food allergies can also contribute to the development of prostatitis.
Many men note an improvement in their condition, a reduction in the symptoms of the disease when switching to a diet that refuses to eat wheat and gluten.
Gluten, a protein found in wheat, can cause chronic inflammation in the small intestine and lead to malabsorption. The result of impaired bowel function is a number of pathologies, including prostatitis.
In general, it is important to switch to a healthy diet and avoid foods that can cause inflammation of the pancreas. It is necessary to increase the consumption of products from the list below:
- Vegetables.
- Fruits (sour fruits should be avoided as they can worsen prostatitis symptoms).
- Plant protein.
- Foods high in zinc, zinc supplements.
- Omega-3 fatty acids (olives, olive oil and linseed oil, fish oil, marine fish contain unsaturated and polyunsaturated fatty acids in large quantities).
- Foods with a high fiber content (oats, pearl barley).
Switching to a Mediterranean diet can lead to a significant reduction in the symptoms of pancreatic inflammation. Reduced consumption of red meat, consumption of fish, beans, lentils, nuts, which are poor in saturated fat and cholesterol.
It is important to maintain adequate hydration of the body. A person should drink about 1. 5-2 liters of clean drinking water per day.
You should refrain from drinking soda, coffee and tea. A patient with prostatitis should limit alcohol intake or stop it altogether.
We change the way of life
- Limiting the stressful influences of the environment, which can lead to a weakening of the patient's immune system.
- Normalization of the psycho-emotional state. This leads to an improvement in symptoms due to an increase in the pain threshold, improvements in the functioning of the immune system and less fixation of the patient on his illness.
- Physical activity. Regular exercise without excessive exertion leads to a reduction in the symptoms of chronic prostatitis. An important aspect is the refusal of sports accompanied by pressure on the perineum (riding, cycling).
- Avoiding prolonged sitting. Pressure on the perineal area leads to stagnation of blood in the small pelvis and secretion of the pancreas, which leads to an exacerbation of the disease.
- Limitation of thermal procedures (bath, sauna) during exacerbation of the disease. It is possible to visit baths, saunas in short courses of 3-5 minutes per entry during remission of prostatitis. The possibility of visiting a bath, sauna must be agreed with the attending physician, each case is individual and requires a special approach to treatment. Under no circumstances should you jump into a pool of cold water/douse yourself with cold water after the steam room.
- Warm sitz baths lead to relief of prostatitis symptoms. Regularly taking warm baths with immersion of the whole body in warm water has a greater effect than baths in which only the perineum and buttocks fall into warm water. In the bath there is a greater relaxation of the muscles of the pelvic floor, a reduction of pathological impulses from the nerve fibers and therefore a reduction of pain.
- Regular sexual activity. Regular ejaculation contributes to pancreatic secretion. Prolonged lack of sexual activity, ejaculation leads to stagnation of secretion in the ducts of the pancreas and increases the risk of infection, development of inflammation in the stroma of the pancreas.
- The use of barrier contraceptive methods for casual sexual contact, the slightest suspicion of an STI in a patient and his sexual partner.
- A common problem in patients with prostatitis is the ability to maintain sexual activity. A patient with chronic prostatitis is not forbidden to have sex. In case of acute inflammation of the pancreas, sexual rest is recommended.
Success in the treatment of prostatitis does not belong only to the treating doctor, but is the result of the joint work of the doctor and the patient.
If the patient follows all the recommendations and prescriptions of the doctor, reduces the risk factors for recurrence of the disease, regularly undergoes examinations, then he contributes with his 50% to the success of the treatment of the disease.