Treatment of prostatitis in men: a description of the disease, symptoms, diagnosis and main drugs and therapy

Inflammation of the prostate gland is the most common disease in urological practice.

According to various sources, up to 20% of men suffer from it, and according to domestic experts, complaints about the symptoms of this pathology are presented by every second man who consulted to the doctor.

Treatment of prostatitis requires an integrated approach and serious diagnosis, since not always pronounced pain in the perineal region and other specific manifestations indicate the presence of inflammation prostate.

Conversely, the disease can be asymptomatic for a long time and can be detected during a routine examination. From a medical point of view, prostatitis is an inflammation of the glandular and connective tissues of the prostate gland, proceeding acutely or with constant relapses and arising under the influence of bacterial flora or exposure to non-infectious factors etiology.

The main reasons for the development of the disease are:

• pathogenic microorganisms, most often these are intracellular chlamydia, ureaplasma, mycoplasma, as well as enterococci, Escherichia coli, Klebsiella, Proteus, Pseudomonas aeruginosa, staphylococci, streptococci;
• sedentary and sedentary lifestyle;
• obesity;
• urinary tract infections;
• congestion in the pelvic area;
• smoking;
• excessive alcohol consumption;
• an excess of spicy, fatty and cholesterol-rich food, especially in combination with a violation of the drinking regime;
• diarrhea and constipation;
• transferred sexually transmitted diseases, including herpes infection;
• immunodeficiency states;
• hormonal disorders;
• hypothermia, especially in combination with a weakening of the body's defenses;
• disorders of the processes of urination;
• artificial prolongation of sexual intercourse, delayed ejaculation.

Today, there are several classification systems for prostatitis, which fully reflect the characteristics of the course of the disease, etiology and other clinical aspects of the disease. Basically, doctors use the principles of division proposed by specialists from the American National Institutes of Health.

In accordance with their recommendations, prostatitis treatment is prescribed based on the following forms:

• Acute prostatitis of an infectious nature. In turn, it is subdivided into catarrhal, proceeding with the defeat of individual excretory ducts of the prostate gland, sometimes it is complicated by calculous course with the formation of calculi. The follicular form affects the lobes of the prostate, and the parenchymal type is accompanied by inflammation of the entire organ as a whole, including both lobes and the surrounding connective tissue. The listed types of acute prostatitis do not proceed in isolation, they can rather be considered stages of this form of pathology.
• Chronic bacterial prostatitis. As a rule, it develops against the background of improper treatment of an acute form or with impaired immunity.
• Chronic non-bacterial prostatitis. It can occur in the form of an inflammatory and non-inflammatory form, the latter type is also called chronic pelvic pain syndrome. The etiological factors of this disease are not reliably known, its development is associated with a combination of several provoking reasons: lifestyle, nutrition, lack of physical activity. This form of pathology is the most common, in addition, the treatment of this type of prostatitis requires special attention.
• Asymptomatic inflammatory prostatitis. It proceeds without any clinical manifestations, it is diagnosed only by laboratory means.

The symptomatology of the disease is varied and primarily depends on the form of inflammation. Acute prostatitis begins with an increased urge to empty the bladder. Painful urination, especially at the end. Urine is secreted in small portions, the man is constantly haunted by the feeling of not completely emptying his bladder. If the inflammatory process affects the urinary tract, hematuria often occurs.

The clinical manifestations of acute prostatitis can be roughly divided into three groups. These are, the most common, pain, disorders of the functioning of the urinary system and intoxication. At the initial, catarrhal stage of acute prostatitis, pain is localized in the perineal region, symptoms of urinary disorders are present. A distinctive feature of this stage of the disease is normal laboratory parameters of blood and urine.

At the follicular stage, pain syndrome is also pronounced (discomfort increases with pressure on the prostate in the area scrotum or with digital examination of the prostate gland), urination is difficult due to an increase in size prostate. The man also complains about the symptoms of intoxication.

The temperature rises, accompanied by chills and sweating. In clinical analysis, the appearance of pus, leukocytes and bacteria in the urine is noted. Diffuse (parenchymal) prostatitis is very difficult, affecting all tissues of the prostate gland, and sometimes extends to certain areas of the urinary system (to the neck of the bladder and urethra). The pain is very pronounced, radiates to the head of the penis, testicles, pelvic region, lower back.

Urinary symptoms are on the rise. Sometimes, as a result of mechanical compression of the urethra by the swollen prostate gland, acute urinary retention occurs. Due to damage to the tissues of the prostate in the anus, pain during bowel movements and painful spasms with the urge to empty the bowel are disturbing. The temperature rises to high numbers, which is accompanied by chills, deterioration of health.

Chronic prostatitis sometimes occurs as a consequence of an acute form or develops independently. The man complains of pulling pains in the perineum and in the lower abdomen.

They are aggravated by urination and bowel movements. The fact is that there are no endings of nerve receptors in the tissues of the prostate gland, so pain impulses arise due to the involvement of surrounding cells in the inflammatory process.

A distinctive symptom of chronic prostatitis is mucous discharge from the urethra when emptying the bladder or intestines. The temperature periodically rises to subfebrile numbers. The exacerbation of this form of the disease is accompanied by an increase in the severity of the clinical manifestations of pathology. The prolonged course of chronic prostatitis leads to problems in sex due to impaired erectile function. A nocturnal erection appears, but the sensations during orgasm lose their brightness, ejaculation can be accompanied by severe pain, which often causes psychological impotence.

The combination of all the symptoms leads to sleep disturbance, sexual intercourse. This becomes the cause of irritability, nervousness and other psycho-emotional disorders. Therefore, the treatment of prostatitis must necessarily include small doses of sedative drugs.

Methods for diagnosing the disease and the basic principles of therapy

Diagnosis and establishment of the form of prostatitis is carried out in accordance with the protocols approved by the associations of urologists in our country and abroad.

According to the recommendations of specialists, the examination of the patient includes the following stages:

• questioning the patient, during which the doctor specifies the intensity of the pain syndrome, the severity of dysuria, features of sexual life, the presence of concomitant diseases and other aspects that affect treatment prostatitis;
• standard clinical laboratory analysis of urine and bacterial culture for flora and its sensitivity to antibacterial drugs;
• examination for sexually transmitted infections, which necessarily includes the determination of mycoplasma, ureaplasma, chlamydia and other bacteria that cause prostatitis;
• measuring the rate of urination (urofluometry);
• 4-glass urine sample, is a specific method for diagnosing inflammation of the prostate gland, in a few days before it, the patient is prescribed a course of antibiotics that cannot penetrate the tissues prostate. This is necessary to rule out urinary tract infections. The sample itself is carried out in this way: collect the first portion of urine (20-30 ml) in one glass, collect 10-15 ml of the average portion of urine in the next flask, then do prostate massage and take for analysis its discharge, collect the last portion of urine in the remaining flask;
• bacteriological examination of the secretion of the prostate, urine collected after massage of the prostate gland, sperm.

If the results 4-glass samples were inoculated with pathogenic microorganisms (their concentration in the secret of the prostate should be 10-15 times higher than in the first portion of urine), they are considered the causative agents of the disease, and treatment of prostatitis is carried out accordingly antibiotics.

Ultrasound examination is optional, it is very important and allows you to learn the following:

• differentiate prostatitis from prostate adenoma;
• identify possible foci of connective tissue formation;
• recognize malignant changes in prostate cells in time;
• to establish the localization of the blocked ducts, which is the cause of severe pain syndrome;
• identify circulatory disorders in the pelvic organs.

Conservative treatment of prostatitis is carried out in a complex manner. Almost all patients are prescribed a course of antibiotic therapy. The method of application (in the form of tablets or injections), the dosage and duration of treatment are determined by the doctor. To eliminate acute inflammation and pain, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are indicated. They irritate the mucous membrane of the digestive tract, so they are prescribed in the form of rectal suppositories.

With spasm of smooth muscles of the bladder neck and urethra, the use of drugs from the group of α-adrenergic receptor blockers and antispasmodics is justified.

Also shown are immunostimulating drugs, a complex of vitamins, sedatives. According to clinical studies, the treatment of chronic prostatitis, which proceeds with mild symptomatology, lends itself well to herbal medicine, in addition, the doctor can advise effective dietary supplements (Dietary supplement).

If the drug treatment of inflammation of the prostate gland is not effective enough, or does not work at all, surgery is indicated. A combination of drugs and physiotherapy methods works well. An integral part of the fight against prostatitis is transrectal massage of the prostate gland, warming up.

Recently, such methods of treatment as acupuncture, which affect the main reflex points, and hirudotherapy (using leeches), have been popular. Modern devices will help to quickly eliminate the main clinical manifestations of the inflammatory process, allowing for the treatment of prostatitis with a laser, ultrasound methods, magnetic wave therapy.

In the period of remission, resort treatment is advised in a specialized sanatorium. To increase the effectiveness of therapy, it is necessary to follow an appropriate diet with restriction of alcohol, spicy, spicy foods.

To prevent the development of exacerbations in chronic prostatitis and to prevent the occurrence of inflammatory changes, doctors recommend special gymnastics. Her main complex includes squats, leg raises and other exercises. The treatment of prostatitis with the help of alternative methods deserves special attention.

At home, you can prepare decoctions and infusions of medicinal herbs that have analgesic and anti-inflammatory activity. The statements of Dr. I.P. Neumyvakin.

He believes that all diseases, including inflammation of the prostate gland, arise from a disturbance in the body's acid-base balance. In his opinion, such disorders can be corrected with hydrogen peroxide and soda, their alternation in accordance with the scheme proposed by the professor - an alternative treatment for prostatitis. And although official medicine does not recognize such techniques, many patients consider them effective.

Treatment of prostatitis in men: medications, the use of hormones and antibiotics, immunocorrection, phyto- and physiotherapy

Antibacterial agents are the main drugs for the treatment of the inflammatory process of the prostate gland. In accordance with the recommendations of European urologists, the duration of their use is from 4 to 6 weeks, and American and Canadian specialists insist on the duration of treatment in 8-12 weeks. However, the final regimen of admission is determined by the doctor based on the severity of the course of the disease and the effectiveness of therapy.

When treatment of prostatitis in men is carried out, antibiotic drugs are prescribed in the following groups:

• Fluoroquinolones. They are drugs of the first stage due to their broad spectrum of action on the main causative agents of acute and chronic bacterial inflammation of the tissues of the prostate gland. Their positive properties include high bioavailability, rapid distribution directly in the lesion focus.
• Tetracyclines. Medicines of this class are highly active against chlamydia and mycoplasma, but do not have the desired effect when infected with E. coli and Pseudomonas aeruginosa.
• Macrolides. Despite the fact that these medicines penetrate well into the tissues of the prostate gland, there is currently a lack of clinical data on their effectiveness. In addition, they are not sufficiently active against gram-negative pathogenic flora.
• Sulfonamides. Some drugs of this class have not only bacteriostatic properties, but also have antifungal effects.

Hormonal treatment of prostatitis in men is practically not prescribed with testosterone-based drugs. The fact is that this pathology often develops at a relatively young age, so testosterone-based drugs can significantly affect the functioning of the gonads. However, in the inflamed tissues of the gland, processes occur that lead to the accumulation of the active form of testosterone (dihydrotestosterone), which contributes to the deterioration of the course of prostatitis. To eliminate such changes, drugs from the group of type II 5-α-reductase inhibitors are prescribed.

In the remission phase, the treatment of prostatitis in men is used with medications on a natural plant basis. Doctors prescribe dietary supplements and medicines that contain components that have anti-inflammatory, analgesic, antispasmodic, disinfectant and antimicrobial effects.

If conservative treatment of prostatitis in men and medications do not work, therapy is accompanied by massage of the prostate gland. Despite the fact that a lot of unsubstantiated rumors are associated with this procedure, which is why many men are simply ashamed of it, there is nothing to replace such manipulation with.

Correctly performed massage works as follows:

• blood flow in the tissues of the prostate is activated;
• improves the delivery of active components of drugs to the cells of the prostate gland;
• together with the secret, toxic products of the inflammatory reaction are excreted;
• improved drainage of the prostate ducts;
• the severity of symptoms of inflammation decreases;
• spermatogenesis is normalized;
• puffiness is eliminated, normal urination is restored.

At first glance, this procedure is quite simple, but it is not recommended to do it on your own, since for to obtain an optimal result, you need to select the correct pressure, intensity and frequency of sessions massage. Currently, there are prostate massagers on the market. However, their use should also be agreed with the urologist.

In chronic prostatitis, consultation with an immunologist is required. Many experts associate the recurrent course of the disease with disorders in the functioning of the immune system.

If, after carrying out the appropriate tests, deviations from the norm were detected, certain medications with immunomodulatory properties are prescribed.

According to doctors, Galavit is very effective, which is available in the form of sublingual tablets, injection solution and suppositories.

The exact dosage of the drug and the treatment regimen is determined by the doctor based on the data of the clinical blood test. Sometimes, in parallel with Galavit, intramuscular injections of Immunomax are prescribed. Physiotherapy treatment of prostatitis is carried out either in combination with medication, or in separate courses in the remission phase of the disease.

The following procedures have a good result:

• galvanization, which stimulates blood flow and metabolic processes in the tissues of the prostate using low-intensity current discharges;
• electrophoresis, prescribed in combination with external anti-inflammatory drugs, this procedure improves their penetration into the prostate gland;
• electrostimulation, according to the principle of action, this method of physiotherapy is similar to galvanization, it is carried out percutaneous, transrectal and transurethral, ​​however, the most popular is transcutaneous electrical stimulation, during which electrodes are applied to the area perineum;
• microwave therapy, also designed to stimulate the work of prostate cells, this method of treating prostatitis is called microwave therapy;
• ultrasound, carried out using high frequency vibrations;
• general or sedentary medicinal baths with decoctions of medicinal herbs;
• enemas;
• mud applications on the skin of the perineum.

But despite a wide selection of medication, physiotherapy and folk methods, treatment prostatitis in men (medications and other procedures) in most cases bring only temporary relief. Many doctors agree that inflammation of the prostate gland requires constant monitoring and regular use of appropriate medications and the implementation of certain prescribed by a doctor procedures.

Drugs for the treatment of prostatitis: a review of the most popular and effective drugs used to treat inflammation

The first-line drugs used to eliminate the inflammatory process in the prostate are antibiotics. As a rule, antibacterial drugs are prescribed only after the result of bacterial culture of prostate secretions for pathogenic flora and antibiotic sensitivity.

This is due to the fact that in a chronic infectious process, bacteria quickly develop resistance to the action of antimicrobial medications, and drugs prescribed without appropriate tests for the treatment of prostatitis may not only be ineffective, but also dangerous.

According to the medical literature, in the overwhelming majority of cases, one of the following antibiotics is prescribed:

• Levofloxacin (Tavanik, Remedia, Levolet). This drug is from the group of fluoroquinolones, prescribed at 250-500 mg per day in one or two doses. Usually the drug is well tolerated, but sometimes damage to the tendons and connective tissue is possible, so it caution is prescribed for men whose lifestyle or work activity is associated with intense physical loads.
• Ofloxacin (Tarivid, Zanocin). Another antibiotic belonging to the class of fluoroquinolones. The doctor sets the regimen individually. The daily amount of the drug is usually from 200 to 800 mg in two doses at intervals of 12 hours. In addition to the negative effect on tendons characteristic of all fluoroquinolones, Ofloxacin can cause photodermatosis and adverse reactions from the central nervous system (insomnia, dizziness, depression).
• Doxycycline (Unidox). This is a drug of the tetracyclines group, used when fluoroquinolones are ineffective. The dosage is 100-200 mg per day. They take the medicine for a long time, up to 2-3 weeks.
• Josamycin (Wilprafen). An antibiotic of the macrolide class, it has a wide spectrum of effectiveness. Take 0.5-1 g twice a day. The duration of treatment is determined by the doctor.
• Azithromycin (Azitral, Zetamax, Sumamed). In terms of the spectrum of effectiveness, it is similar to josamycin. Applied with intolerance to the latter. The dosage is 0.25-1 g once a day.
• Trimethoprim (Bactrim, Biseptol, Co-Trimoxazole). Strictly speaking, this drug is not an antibiotic, but it has an antimicrobial effect and belongs to the group of sulfonamides. Drink 40-60 mg once a day.
• Nitroxoline (5-NOC). Additionally, it has an antifungal effect. It also belongs to the group of sulfonamides, and it is prescribed more often than Trimethoprim and its analogues under other trade names. Prescribed 200 mg 3-4 times a day for a long time.

Although the list of broad-spectrum antibiotics is not limited to this list, in the overwhelming majority of cases, these drugs are used. They are distinguished from others by their ability to quickly accumulate in the tissues of the prostate gland.

In parallel with antibacterial agents, medications from the group of α-blockers are prescribed. The principle of their action is based on the effect on the receptors located in the smooth muscle tissues of the bladder neck. As a result, the outflow of urine is facilitated, the risk of urinary tract infections is reduced, and the processes of urination are normalized. Assign:

• Tamsulosin (Giperprost, Omnik, Fokusin) Give 400 mg once a day. Unlike other drugs from the group of α-blockers, this agent has practically no effect on blood pressure.
• Alfuzosin (Alfuprost, Dalfaz). Prescribe 3.5 mg three times a day (patients under 65 years old - 2.5 mg). Side effects with the use of this medication are extremely rare.

"Pure" pain relievers for the treatment of prostatitis are usually not prescribed.

Doctors give preference to modern non-steroidal anti-inflammatory drugs (NSAIDs), which, in addition to analgesic action eliminates the main symptoms of inflammation: swelling, increased permeability capillaries.

It is recommended to take Nimesulide (Nise, Nimesil) 100-200 mg twice a day and Meloxicam (Amelotex, Movalis) 7.5-15 mg once a day. These drugs belong to selective inhibitors of the main mediator of inflammation, cyclooxygenase of the second type (COX 2), therefore, undesirable reactions during their use are extremely rare. If blockers of α-adrenergic receptors are not effective enough, the use of muscle relaxants is indicated.

As a result of relaxation of smooth muscle tissues, the ducts of the urethra and prostate expand, and urination processes are facilitated. It is recommended to take No-Shpu 1-2 tablets up to 3 times a day and Baclofen 1 capsule three times a day. A special place in the therapy of inflammation of the prostate gland is occupied by drugs for the treatment of prostatitis, which accelerate the blood and lymph flow in the tissues of the organ.

Usually, medications based on animal products containing bovine prostate extract are prescribed. In addition, these medicines have anti-inflammatory activity and improve the functioning of the smooth muscle tissues of the bladder and urethra.

Suitable for long-term use:

• Vitaprost, give one tablet twice a day, the duration of admission is at least 10-14 days;
• Prostatilen is also produced in the form of rectal suppositories, the use of which improves the delivery of the active substance to the cells of the prostate gland;
• Samprost, produced in the form of a lyophilisate for the preparation of a solution for injection, is prescribed during an exacerbation of chronic prostatitis and for the prevention of postoperative complications. One intramuscular injection is given once a day for 10-15 days;
• Uroprost is the Russian analogue of Prostatilen. Applied in the same way: one suppository 1-2 times a day.

Plant-based medicines can replace drugs for the treatment of prostatitis containing animal products, these are:

• Prostagut Forte (Germany), contains nettle roots and creeping seborrhea fruits. Assign one capsule twice a day for a month.
• Prostanorm (Russia), contains the herb St. John's wort and Canadian goldenrod, licorice rhizomes and Echinacea purpurea. Assign orally 1-2 capsules three times a day or 40 drops of the extract diluted in 50 ml of water, three times a day. The course of treatment is up to 2 months.
• Cernilton (Russia), a homeopathic remedy that is used for the treatment of acute (4 tablets three times a day) and chronic (1 tablet 3 times a day) prostatitis. The duration of treatment is usually 12 weeks, but at the discretion of the doctor it can be extended up to six months.

Almost every man suffering from a disorder of the prostate gland is faced with erectile dysfunction. Therefore, drugs for the treatment of prostatitis and to increase potency are not an obligatory part of therapy, but desirable for most patients. It is usually advised to drink medicines based on sildenafil (Viagra, Maxigra, Tornetis), tadalafil (Cialis, Tedallis), vardenafil (Levitra).

To normalize the functioning of the prostate gland, multivitamin preparations are needed for treatment prostatitis, which necessarily contain tocopherol acetate, retinol, ascorbic acid, pyridoxine, calciferol.

How to treat prostatitis: exercise, folk remedies, prevention measures

Naturally, with acute symptoms of inflammation of the prostate gland, excessive physical activity is contraindicated. However, after the signs of intoxication and pain subside, the scheme for treating prostatitis can be supplemented with special gymnastics.

The minimum complex consists of the following movements:

• Kegel exercise, which consists in the rapid contraction and relaxation of the muscles of the perineum, their advantage is the ability to perform anywhere: at home, in the office and even in a traffic jam or at a public transport stop, they begin gymnastics with 10 contractions three times a day, gradually increasing the number of repetitions up to 50 times at a time an approach;
• "Scissors", they are performed lying on your back or rising on your elbows, while your legs should be kept as low as possible to the floor, and spread as wide as possible to the sides, 5 repetitions, 2 sets;
• lifting the legs from a supine position, if possible, they should be bent at the knees, pulled to the chest and raised the pelvis, do two sets of 5 repetitions;
• "Birch", this exercise, familiar from physical education lessons, must be performed 5 times, only two approaches, physically untrained men need to be careful and stop gymnastics if pain occurs in lumbar region;
• raising the pelvis from a supine position with the simultaneous dilution of the knees to the sides, 3 sets of 5-8 repetitions;
• lifting the legs from a prone position, limbs must be held for a few seconds at the highest point, 2-3 sets of 5 repetitions.

The number of repetitions of movements in one approach should be gradually increased, adding 2-3 every week. It is possible to decide how to treat prostatitis with the help of traditional medicine methods.

Doctors advise using the following recipes:

• Grind the peel of a ripe horse chestnut, take 25 g of powder, pour a glass of alcohol and take 25-30 drops three times a day.
• Take 30 g of fresh pear flowers, pour a liter of hot water and leave for 10 minutes. The broth is good for acute prostatitis. They drink 5 glasses a day.
• To prevent the development of an exacerbation and increase an erection, it is recommended to chew one Kalanchoe leaf a day.
• Take juniper berries, starting with one per day and gradually bring their number to 15, and then subtract one at a time.

Despite the fact that inflammation of the prostate gland is the most common disease, you can avoid the problem of how to treat prostatitis by following simple preventive measures.

First of all, regular training is needed. An active lifestyle will improve blood flow to the prostate tissue, prevent congestion and keep weight under control. You should also avoid hypothermia, promiscuous sex with women, but at the same time, sexual life should be regular.