Treatment of prostatitis is a time-consuming process that requires a comprehensive examination of the patient. In order to correctly treat a patient suffering from prostatitis, an accurate diagnosis must be established based on the examination, test results and instrumental research methods.
It is important for the doctor to distinguish between acute and chronic gland inflammation, bacterial and aseptic processes. Making this distinction allows you to determine the tactics of treatment.
In acute inflammation, there is a risk of complications, the emphasis during the treatment is on detoxification of the patient, antibacterial and anti-inflammatory therapy.
Antibacterial therapy for chronic inflammation of the gland is used, but it leads to a positive effect in only 1-2 patients out of 10, since chronic prostatitis does not always have only a bacterial etiology.
Therefore, a complex effect on all known pathogenetic mechanisms of the disease is an extremely important aspect in the treatment of chronic prostatitis.
Physiotherapy and diet therapy are given for antibacterial and anti-inflammatory treatment. It is extremely important for a patient suffering from chronic prostatitis to correct his lifestyle, get rid of bad habits, stressful effects, and normalize his psycho-emotional state.
Treatment of acute bacterial prostatitis
Fashion and diet
- Bed rest.
- Sexual rest during treatment.
- Avoiding the stressful effects of environmental factors (hypothermia, overheating, excessive radiation).
- Weight loss.
Antibacterial drugs
Antibiotic therapy is mandatory for acute bacterial prostatitis (ABP) and recommended for chronic glandular inflammation.
OBP is a serious infectious and inflammatory process accompanied by severe pain, fever and increased patient fatigue.
When ABP is diagnosed, the patient receives parenteral antibiotic therapy. Initially, broad-spectrum antibiotics are prescribed - penicillins, 3rd generation cephalosporins, fluoroquinolones.
At the beginning of therapy, it is possible to combine one of the listed antibiotics with drugs from the aminoglycoside group. 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 empiric antibiotic therapy is prescribed, bacterial culture of the urine is recommended to determine the flora and sensitivity to antibacterial drugs.
As a general rule, in the case of diagnosis of ABP and severe poisoning, the need for infusion therapy with complications of the disease (formation of pancreatic abscess, acute urinary retention) is hospitalized.
In the absence of complications, fever can be treated on an outpatient basis with oral medication.
Operative interventions
In case of complications of OBP, surgical treatment is recommended. An abscess larger than 1 cm in diameter is an absolute indication for surgery.
Transrectal or perineal access is used to drain the pancreatic abscess under transrectal ultrasound (TRUS) guidance.
There is evidence for the effectiveness of therapy for abscesses less than 1 cm in diameter.
If the pancreatic abscess is drained prematurely, it can open spontaneously, the purulent content breaking through into the fatty tissue surrounding the rectum, with the development of paraproctitis. In case of paraproctitis, open drainage of the pararectal tissue is required.
About 1 in 10 patients with ABP develop acute urinary retention. This usually requires a suprapubic cystostomy (insertion of a urinary catheter can be painful and may increase the risk of developing CKD).
Most often, trocar cystostomy is performed under local anesthesia and under ultrasound control. Before the operation, the insertion site of the probe is pierced with a local anesthetic solution.
A small skin incision is made with a scalpel. Under ultrasound guidance, a trocar is introduced into the bladder cavity, through which the urinary catheter is guided into the bladder.
Treatment of chronic bacterial prostatitis
Chronic bacterial prostatitis (CKD) is treated with lifestyle changes and medication. The following are of great importance:
- Avoiding environmental stressors.
- Maintaining physical activity.
- Weight loss.
- Regular sexual activity without aggravation.
- Use of contraception.
Medical treatment
Fluoroquinolones are more commonly used to treat chronic bacterial prostatitis (CKD).
This group of drugs is advantageous 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 the therapy is selected based on the specific clinical situation, the patient's condition and the presence of poisoning symptoms.
In CKD, the duration of antibiotic therapy is 4-6 weeks after diagnosis. Oral administration of high-dose medications is beneficial. If CKD is caused by intracellular bacteria, drugs from the tetracycline group are prescribed.
Antibacterial therapy of the established pathogen includes the appointment of the following drugs.
Chronic Pelvic Pain Syndrome (CPPS)
The therapy of the abacterial form of pancreatitis can also be performed on an outpatient basis.
The patient is advised to:
- Leading an active lifestyle.
- Regular sex life (at least 3 r / week).
- barrier-free contraception.
- Weight loss.
- Exclusion of alcohol.
Despite the absence of a bacterial component, it is possible to prescribe a two-week therapy for NCPPS.
With the positive dynamics of the disease and the reduction of symptoms, the prescribed therapy is continued for 30-40 days. In addition to antibiotics to treat NCPPS, the following are used:
- α1 - blockers.
- NSAIDs.
- Muscle relaxants.
- 5α-reductase inhibitors. Currently, there is no evidence for the effectiveness of α1-blockers, muscle relaxants, and 5α-reductase inhibitors.
- With long-term treatment of NCPPS, it is possible to prescribe herbal preparations: Serenoa repens extract, Pygeum africanum, Phleum pretense, Zea mays.
- Prostate massage. With NCPPS, the pancreas can be massaged up to 3 times a week during the entire duration of the therapy.
- The effectiveness is not proven, but FTL is used: electrical stimulation, thermal, magnetic, vibration, laser, ultrasound therapy.
In NCPPS, recovery and improvement of patients' quality of life are doubtful and unlikely due to the low efficiency of most of the listed therapies.
Asymptomatic inflammation
The main goal of therapy for type IV prostatitis is to normalize the level of prostate-specific antigen (PSA) as it increases. With a normal PSA level, no therapy is needed..
Treatment of this type of prostatitis does not require hospitalization and is done on an outpatient basis.
Non-drug therapy includes:
- Active lifestyle.
- Elimination of the effects of stress on the body (hypothermia, irradiation), which suppress the activity of the body's immune system.
- Use of contraceptive methods.
- Weight loss.
Drug therapy includes the appointment of antibiotics with subsequent control of effectiveness, namely fluoroquinolones, tetracyclines or sulfonamides for a period of 30-40 days with control of the PSA level.
The criterion for the effectiveness of the therapy is a decrease in the PSA level 3 months after the antibiotic treatment.
Long-term elevated PSA levels in type IV prostatitis require repeat prostate biopsy to rule out prostate cancer.
Rectal suppositories
The main advantage of using rectal suppositories in the treatment of prostatitis is greater bioavailability compared to oral drug forms, as well as creating the highest concentration of the drug in the vessels of the small pelvis, around the pancreas.
Rectal suppositories usually supplement the prostatitis treatment regimen presented above, that is, they belong to adjuvant therapy.
| Drug group | Clinical effect |
|---|---|
| Suppositories based on NSAIDs | They lead to a decrease in the synthesis of pro-inflammatory factors, reduce pain and stop fever. |
| Suppositories with antibacterial drugs | It is rarely used to treat prostatitis. More often, doctors use 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 and improve microcirculation in the pancreas. Primary use in proctology. |
| Herbal suppositories | Local anti-inflammatory, analgesic and antiseptic effect. |
| Suppositories based on polypeptides of animal origin | Organotropic effect |
Diet and rational nutrition
Adherence to the diet is a key point in the treatment of chronic prostatitis. Certain types of products, the body's allergic reaction to them, can lead to the development of inflammation of the pancreas and symptoms of prostatitis.
Dietary modification can significantly improve quality of life while reducing disease symptoms.
The most common foods that aggravate prostatitis symptoms are:
- Spicy foods, spices.
- Spicy paprika.
- Alcoholic drinks.
- Sour foods, marinades.
- Wheat.
- Gluten.
- Caffeine.
Intestinal function and the pancreas are related: with the development of intestinal problems, symptoms of prostatitis may develop, and vice versa.
The intake of probiotics is an important aspect in preventing the development of prostatitis and the recurrence of inflammation in the stroma of the gland in the chronic course of the disease.
Probiotics are preparations that contain healthy intestinal bacteria. The main effects of probiotics are the suppression and replacement of pathological microflora, the synthesis of certain vitamins, the promotion of digestion and, as a result, the 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 the bacteria to the acidic environment of the stomach (most of the bacteria die in the stomach under the influence of hydrochloric acid, and only a small part of them reaches the intestine).
Capsules containing bacteria were recommended for best effect and more complete delivery. The capsule passes through the aggressive environment of the stomach and dissolves in the intestines, thus keeping the bacteria intact.
The development of inflammation in the pancreas can lead to zinc deficiency in the body, eating pollutants.
Food allergies can also contribute to the development of prostatitis.
Many men notice an improvement in their condition and a reduction in the symptoms of the disease when they switch 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 intestinal 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 in the pancreas. The consumption of products from the following list should be increased:
- Vegetables.
- Fruits (Acid fruits should be avoided because they can aggravate the symptoms of prostatitis).
- vegetable protein.
- Foods with a high zinc content, zinc supplements.
- Omega-3 fatty acids (olives, olive and linseed oil, fish oil, marine fish contain large amounts of unsaturated and polyunsaturated fatty acids).
- Foods rich in fiber (oatmeal, pearl barley).
Switching to a Mediterranean diet can lead to a significant reduction in the symptoms of pancreatitis. Reduced consumption of red meat, fish, beans, lentils, nuts, which are low in saturated fat and cholesterol.
It is important to maintain adequate hydration of the body. A man should drink about 1. 5-2 liters of clean drinking water per day.
Drinking soda, coffee and tea should be avoided. A patient with prostatitis should limit or stop drinking alcohol altogether.
We change the way of life
- Limitation of stressful environmental effects, which can lead to a weakening of the patient's immune system.
- Normalization of the psycho-emotional state. Due to the increase in the pain threshold, symptoms improve, the functioning of the immune system improves, and the patient is less attached to his illness.
- Physical activity. Regular exercise without excessive training leads to a reduction in the symptoms of chronic prostatitis. An important aspect is the rejection of sports, together with pressure on the perineum (horse riding, cycling).
- Avoiding prolonged sitting. Pressure on the perineal region leads to stagnation of blood in the pelvis and secretion of the pancreas, which leads to aggravation of the disease.
- Restriction of thermal procedures (bath, sauna) during the exacerbation of the disease. It is possible to visit the baths and saunas in short courses of 3-5 minutes per entry during the remission of prostatitis. The possibility of going to the bath or sauna must be discussed with the attending physician, each case requires a unique and special treatment approach. Do not under any circumstances jump into a pool of cold water after the steam bath / douse yourself with cold water.
- Warm sitz baths relieve the symptoms of prostatitis. Regularly taking warm baths, immersing the whole body in warm water, has a greater effect than baths where only the perineum and buttocks fall into warm water. In the bath, the muscles of the pelvic floor relax to a greater extent, pathological impulses from nerve fibers decrease, and as a result, pain also decreases.
- Regular sexual activity. Regular ejaculation contributes to the secretion of the pancreas. Prolonged lack of sexual activity and ejaculation leads to stagnation of secretion in the ducts of the pancreas and increases the risk of infection and the development of inflammation in the stroma of the pancreas.
- Use of contraceptive methods in case of casual sexual contact, in case of the slightest suspicion of STI in the patient and his sexual partner.
- A common problem for patients with prostatitis is the ability to maintain sexual activity. Patients with chronic prostatitis are not prohibited from having sex. Sexual rest is recommended in case of acute pancreatitis.
The success of the treatment of prostatitis is not solely the responsibility of the attending physician, but the result of the joint work of the physician and the patient.
If the patient complies with all medical recommendations and regulations, reduces the risk factors for the recurrence of the disease, and regularly participates in examinations, he contributes 50% to the success of the disease's cure.