Treatment of prostatitis is a time-consuming process that requires a comprehensive examination of the patient. For the correct management of a patient suffering from prostatitis, it is necessary to make an accurate diagnosis based on examination, test results and instrumental research methods.
It is important for the doctor to distinguish between acute and chronic inflammation of the gland, bacterial and aseptic process. Carrying out this differentiation allows you to determine the tactics of treatment.
During acute inflammation, there is a risk of complications, the treatment focuses on patient detoxification, antibacterial and anti-inflammatory therapy.
Antibacterial therapy against chronic inflammation in the gland is used, but it causes a positive effect in only 1-2 patients out of 10, since chronic prostatitis does not always have only a bacterial etiology.
Thus, an extremely important aspect of the treatment of chronic prostatitis is the complex effect of all known pathogenetic mechanisms of the disease.
Physiotherapy and diet therapy are added to 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, stress and normalize his psycho-emotional state.
Treatment of acute bacterial prostatitis
mode and diet
- bed rest.
- Sexual rest during treatment.
- Avoiding stressful effects of environmental factors (hypothermia, overheating, excessive insolation).
- diet.
Antibacterial drugs
The appointment of antibiotic therapy is mandatory for acute bacterial prostatitis (ABP) and is recommended for chronic inflammation of 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, it is possible to combine one of the listed antibiotics with drugs of 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, it is recommended to perform a bacterial culture of the urine to determine the flora and sensitivity to antibacterial drugs.
As a rule, when diagnosing ABP and severe intoxication, when infusion therapy is necessary, 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 larger than 1 cm in diameter is an absolute indication for surgery.
Transrectal or perineal access is used to drain a pancreatic abscess under transrectal ultrasound (TRUS) guidance.
There is evidence of the effectiveness of therapy with an abscess diameter of less than 1 cm.
With timely drainage of the pancreatic abscess, it can open spontaneously, the purulent content breaking through the fatty tissue surrounding the rectum, with the development of paraproctitis. During paraproctitis, open drainage of pararectal tissue is necessary.
About 1 in 10 patients with ABP develop acute urinary retention. It usually requires a suprapubic cystostomy (insertion of a urinary catheter can be painful and increase the risk of CD).
Most often, trocar cystostomy is performed under local anesthesia and under ultrasound control. Before the operation, the tube insertion site is punctured with a local anesthetic solution.
A small skin incision is made with a scalpel. Under ultrasound guidance, a trocar is inserted into the bladder cavity, through which a urinary catheter is passed into the bladder.
Management of chronic bacterial prostatitis
Chronic bacterial prostatitis (hereafter CKD) is treated with lifestyle changes and medication. It is of great importance:
- Avoiding environmental stressors.
- Maintaining physical activity.
- diet.
- Regular sexual activity without exacerbation.
- Use of barrier contraception.
medical treatment
Fluoroquinolones are more commonly used to treat chronic bacterial prostatitis (CKD).
Drugs of this group are preferred due to good pharmacokinetic characteristics, antibacterial activity against gram-negative flora, including P. aeruginosa.
Empiric antibiotic therapy for CKD is not recommended..
The duration of therapy is selected based on the specific clinical situation, the patient's condition and the presence of symptoms of intoxication.
The duration of antibiotic therapy in CKD is 4-6 weeks after diagnosis. The oral route of administration of high doses of drugs is preferred. 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)
Therapy of the bacterial form of inflammation of the pancreas can be carried out on an outpatient basis.
The patient is advised to:
- Leading an active lifestyle.
- Regular sexual life (at least 3 r / week).
- Barrier contraception.
- diet.
- Exclusion of alcohol.
Despite the absence of a bacterial component, it is possible to prescribe a two-week course of NCPPS therapy.
With the positive dynamics of the disease, with the 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.
- Nonsteroidal anti-inflammatory drugs.
- Muscle relaxants.
- 5α reductase inhibitors. At the moment, there is no evidence on the effectiveness of α1-blockers, muscle relaxants, 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, it is possible to massage the pancreas 3 times a week during the entire period of therapy.
- The effectiveness is not proven, but FTL is used: electrical stimulation, thermal, magnetic, vibration, laser, ultrasound therapy.
A cure in NCPPS, improving patients' quality of life is doubtful and unlikely due to the low efficacy 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, therapy is not necessary. .
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, insolation), which suppresses the activity of the body's immune system.
- Use of barrier contraception methods.
- diet.
Drug therapy includes the appointment of antibiotics with subsequent monitoring of effectiveness, in particular, fluoroquinolones, tetracyclines or sulfonamides for 30-40 days with PSA level control.
The criterion for the effectiveness of therapy is a decrease in the PSA level after 3 months of antibiotic therapy.
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 for the treatment of prostatitis is the higher bioavailability compared to oral forms of drugs and the creation of a higher concentration of the drug in the small pelvic vessels around the pancreas.
As a rule, rectal suppositories complement the prostatitis treatment regimens presented above, that is, they belong to supportive therapy.
| group of drugs | clinical effect |
|---|---|
| Suppositories based on nonsteroidal anti-inflammatory drugs | They reduce the synthesis of anti-inflammatory factors, stop pain and 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, improve microcirculation in the pancreas. Primary use in proctology. |
| Herbal suppositories | Local anti-inflammatory, analgesic and antiseptic action. |
| Suppositories based on polypeptides of animal origin | Organotropic action |
Diet and rational nutrition
Adherence to the diet is the main point in the treatment of chronic prostatitis. Certain types of products, the body's allergic reaction to them, can cause the development of inflammation of the pancreas, the development of symptoms of prostatitis.
Diet modification can lead to significant improvement in quality of life by reducing disease symptoms.
The most common foods that aggravate prostatitis symptoms are:
- Spicy food, spices.
- Hot pepper.
- Alcoholic drinks.
- Sour food, marinades.
- wheat.
- Წebovana.
- caffeine.
Bowel function and the pancreas are interrelated: with the development of problems related to the intestines, symptoms of inflammation of the prostate may develop, and vice versa.
An important aspect of preventing the development of prostatitis, in the prevention of the recurrence of inflammation in the stroma of the gland during the chronic course of the disease, is the administration of probiotics.
Probiotics are preparations containing bacteria that live in a healthy gut. The main effect of probiotics is to suppress the pathological microflora, replace it, synthesize certain vitamins, help digestion and, as a result, maintain the human immune system.
Most often, people consume 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 bacteria are killed in the stomach by the action of hydrochloric acid, and only a small part of them reaches the intestine).
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 of the pancreas can cause a lack of zinc in the body, eating pollutants.
Food allergies also contribute to the development of prostatitis.
Many men report an improvement in their condition, a reduction in disease symptoms when switching to a diet that eliminates wheat and gluten.
Gluten, a protein found in wheat, can cause chronic inflammation in the small intestine and cause malabsorption. A number of pathologies, including prostatitis, are the result of intestinal dysfunction.
In general, it is important to adopt 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 (acidic fruits should be avoided because they can aggravate the symptoms of prostatitis).
- vegetable protein.
- Foods containing zinc, zinc supplements.
- Omega-3 fatty acids (olive, olive and linseed oils, fish oil, sea fish contain a large amount of unsaturated and polyunsaturated fatty acids).
- Food rich in fiber (oatmeal, pearl barley).
Switching to a Mediterranean diet can significantly reduce the symptoms of pancreatic inflammation. 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.
You should refrain from drinking soda, coffee and tea. A patient with prostatitis should limit the intake of alcohol or stop drinking it altogether.
We are changing the way of life
- Limiting environmental stressors that can weaken the patient's immune system.
- Normalization of psycho-emotional state. This leads to an improvement in symptoms due to an increase in the pain threshold, an improvement in the functioning of the immune system and less fixation of the patient on his illness.
- Physical activity. Regular exercise without excessive exercise leads to a reduction in the symptoms of chronic prostatitis. An important aspect is the rejection of sports that are accompanied by pressure on the perineum (horse riding, cycling).
- Avoid sitting for long periods of time. Pressure on the perineal area causes stagnation of blood in the pelvis and secretion of the pancreas, which leads to exacerbation of the disease.
- Limitation of thermal procedures (bath, sauna) during disease exacerbation. During remission of prostatitis, it is possible to visit baths, saunas in short courses for 3-5 minutes. The possibility of going to the 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 after a steam room / get wet with cold water.
- Warm sitz baths lead to relief of symptoms of prostatitis. Taking regular warm baths, immersing the whole body in warm water, has a greater effect than baths where only the perineum and buttocks are exposed to warm water. In the bath, there is a greater relaxation of the muscles of the pelvic floor, a decrease in the pathological impulses of nerve fibers and, therefore, pain.
- regular sexual activity. Regular ejaculation promotes pancreatic secretion. Prolonged absence of sexual activity, ejaculation leads to stagnation of secretions in the ducts of the pancreas and increases the risk of its infection, development of inflammation in the pancreatic stroma.
- Use of barrier contraception methods for casual intercourse, the slightest suspicion of STIs in the patient and his sexual partner.
- A common concern of patients with prostatitis is the ability to maintain sexual activity. A patient with chronic prostatitis is not prohibited from sexual intercourse. Sexual rest is recommended during acute inflammation of the pancreas.
Success in the treatment of prostatitis does not belong only to the attending physician, but is the result of the joint work of the doctor and the patient.
If the patient follows all the doctor's recommendations and prescriptions, reduces the risk factors of disease relapse, and regularly undergoes examinations, then he contributes 50% to the success of the disease cure.