Treatment of prostatitis is a time-consuming 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 examination, test results and instrumental research methods.
Important for the doctor is the distinction between acute and chronic gland inflammation, bacterial and aseptic process. This differentiation allows you to determine the treatment tactics.
With acute inflammation, the risk of complications, the main focus of treatment is detoxification of the patient, antibacterial and anti-inflammatory therapy.
Antibacterial therapy for chronic inflammation in the gland is used, but gives a positive effect only in 1-2 out of 10 patients, since chronic prostatitis does not always have only a bacterial etiology.
Therefore, an extremely important aspect in the treatment of chronic prostatitis is a complex effect on all known pathogenetic mechanisms of the disease.
The antibacterial and anti-inflammatory treatment is complemented by physiotherapy and diet therapy. It is extremely important for a patient with chronic prostatitis to correct his lifestyle, get rid of bad habits and stressful influences, and normalize his psycho-emotional state.
Treatment of acute bacterial prostatitis
mode and diet
- Bed rest.
- Sexual rest during treatment.
- Avoidance of adverse effects of environmental factors (hypocooling, overheating, excessive sun exposure).
The appointment of antibiotic therapy is mandatory in acute bacterial prostatitis (ABP), and is recommended in chronic inflammation in the gland.
OBP is a serious infectious and inflammatory process, which is accompanied by severe pain, fever and increased fatigue in the patient.
When ABP is diagnosed, the patient is given parenteral antibiotic therapy. First of all, 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 the termination of the acute process and the normalization of the patient's condition, they are switched to oral antibiotics and continue therapy for 2-4 weeks.
If possible, before the appointment of empiric antibiotic therapy, it is recommended to conduct a bacterial culture of urine to determine the flora and sensitivity to antibacterial drugs.
As a rule, the patient is hospitalized with the diagnosis of ABP and severe intoxication, the need for infusion therapy, with complications of the disease (formation of an abscess of the pancreas, acute urinary retention).
In the absence of complications, fever is possible outpatient treatment with oral drugs.
Surgical treatment is indicated for complications of OBP. An abscess with a diameter of more than 1 cm is an absolute indication for surgery.
The pancreatic abscess is drained under transrectal ultrasound guidance (TRUS) via a transrectal or perineal approach.
There is evidence of the effectiveness of therapy with an abscess diameter of less than 1 cm.
With untimely drainage of a pancreatic abscess, it can spontaneously open, a breakthrough of purulent contents into the fatty tissue surrounding the rectum with the development of paraproctitis. In paraproctitis, open drainage of the pararectal tissue is necessary.
About 1 in 10 people with ABP will develop acute urinary retention. A suprapubic cystostomy is usually required to remove it (insertion of a urinary catheter can be painful and increase the risk of CKD).
Most commonly, trocar cystostomy is performed under local anesthesia and under ultrasound guidance. Before the operation, the insertion point of the tube is punctured with a local anesthetic solution.
A small skin incision is made with a scalpel. A trocar is inserted into the bladder cavity under ultrasound guidance, through which a urinary catheter is inserted into the bladder.
Management of chronic bacterial prostatitis
Chronic bacterial prostatitis (hereinafter referred to as CKD) is treated with lifestyle changes and medication. Of great importance are:
- Avoidance of environmental stressors.
- maintaining physical activity.
- Regular sexual activity without exacerbation.
- Use of barrier contraception.
Fluoroquinolones are more commonly used in the treatment of chronic bacterial prostatitis (CKD).
This group of drugs is preferred due to good pharmacokinetic properties and antibacterial activity against gram-negative flora, including P. aeruginosa.
Empirical antibiotic therapy for CKD is not recommended..
The duration of therapy depends on the specific clinical situation, the condition of the patient 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. When 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 pancreatitis can be carried out on an outpatient basis.
The patient is recommended:
- Lead an active lifestyle.
- Regular sex life (at least 3 r / week).
- barrier contraception.
- exclusion of alcohol.
Despite the absence of a bacterial component, it is possible to prescribe a two-week course of therapy for NCPPS.
With positive disease dynamics, a decrease in symptoms, the prescribed therapy is continued for up to 30-40 days. In addition to antibiotics for the treatment of NCPPS are used:
- α1 - blockers.
- muscle relaxer.
- 5α-Reductase Inhibitors. Currently there is no evidence of the effectiveness of α1-blockers, muscle relaxants, 5α-reductase inhibitors.
- In long-term treatment of NCPPS, herbal supplements may be prescribed: Serenoa repens extract, Pygeum africanum, Phleum pretense, Zea mays.
- prostate massage. With NCPPS it is possible to massage the pancreas up to 3 times a week for the entire duration of therapy.
- Efficacy has not been proven, but FTL is used: electrical stimulation, thermal, magnetic, vibration, laser, ultrasound therapy.
In the case of NCPPS, a cure and improvement in the patient's quality of life is doubtful and improbable due to the low effectiveness of most of the therapies listed.
The main goal of therapy for type IV prostatitis is the normalization of the level of prostate specific antigen (PSA) with its increase. If the PSA value is normal, no therapy is required..
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 (hyperthermia, sun exposure) that suppress the activity of the body's immune system.
- Use of barrier contraception methods.
Drug therapy includes the appointment of antibiotics with subsequent monitoring of their effectiveness, namely fluoroquinolones, tetracyclines or sulfonamides for a period of 30-40 days with control of the level of PSA.
The criterion for the effectiveness of the therapy is a decrease in the PSA value 3 months after antibiotic therapy.
Long-term elevated PSA levels in type IV prostatitis require repeated prostate biopsies to rule out prostate cancer.
The main advantage of using rectal suppositories in the treatment of prostatitis is higher bioavailability compared to oral forms of drugs and the formation 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 regimens presented above, that is, they belong to adjuvant therapy.
|drug group||clinical effect|
|Suppositories based on NSAIDs||They lead to a reduction 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 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. Primary use in proctology.|
|Plant based 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 an important point in the treatment of chronic prostatitis. Certain types of products, an allergic reaction of the body to them, can lead to the development of inflammation in the pancreas and the development of symptoms of prostatitis.
A change in diet can lead to a significant improvement in quality of life and at the same time reduce the symptoms of the disease.
The most common foods that make symptoms of prostatitis worse are:
- Spicy food, spices.
- Hot pepper.
- Alcoholic drinks.
- Acid foods, marinades.
Intestinal function and pancreas are interconnected: with the development of intestinal problems, symptoms of inflammation of the prostate can develop and vice versa.
An important aspect in preventing the development of prostatitis, in preventing the recurrence of inflammation in the stroma of the gland in the chronic course of the disease, is taking probiotics.
Probiotics are supplements containing bacteria that live in a healthy gut. The main effects of probiotics are the suppression of pathological microflora, their replacement, the synthesis of certain vitamins, the support 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 susceptibility of bacteria to the action of the acidic environment of the stomach (most bacteria die in the stomach under the action of hydrochloric acid, and only a few of them get into the intestines).
Capsules containing bacteria have been suggested for the best effect and more complete delivery. The capsule passes through the aggressive environment of the stomach and dissolves in the intestine, leaving the bacteria intact.
The development of inflammation in the pancreas can lead to a lack of zinc in the body and eating pollutants.
Food allergies can also contribute to the development of prostatitis.
Many men notice an improvement in their condition, a decrease 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 following list:
- Fruits (Sour fruits should be avoided as they can worsen symptoms of prostatitis).
- vegetable protein.
- Foods high in zinc, zinc supplements.
- Omega-3 fatty acids (olives, olive and linseed oils, fish oil, sea fish contain large amounts of unsaturated and polyunsaturated fatty acids).
- High-fiber foods (oatmeal, pearl barley).
Switching to the Mediterranean diet can lead to a significant reduction in the symptoms of inflammation in the pancreas. Reduced consumption of red meat, consumption of fish, beans, lentils, nuts that are low in saturated fat and cholesterol.
It is important to keep the body properly hydrated. A man needs to drink about 1. 5-2 liters of clean drinking water per day.
You should avoid soda, coffee and tea. A patient with prostatitis needs to limit or stop drinking alcohol altogether.
We change the way of life
- Limitation of stressful environmental influences that can lead to a weakening of the patient's immune system.
- Normalization of the psycho-emotional state. It leads to an improvement in symptoms by raising the pain threshold, improved functioning of the immune system and reducing the patient's fixation on their 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, accompanied by pressure on the dam (horseback riding, cycling).
- Avoid prolonged sitting. Pressure on the perineal region leads to stagnation of blood in the pelvis and pancreatic secretion, which leads to an exacerbation of the disease.
- Restriction of thermal procedures (bath, sauna) during an exacerbation of the disease. It is possible to visit the baths, saunas in short courses of 3-5 minutes per entry during remission of prostatitis. The possibility of going to the bath or sauna should be agreed with the attending physician, each case is individual and requires a special approach to treatment. In no case should you jump into a pool with cold water / douse yourself with cold water after the steam bath.
- Warm sitz baths relieve the symptoms of prostatitis. Regular taking of warm baths with immersion of the whole body in warm water has a greater effect compared to baths in which only the perineum and buttocks are immersed in warm water. In the bath, there is a greater relaxation of the pelvic floor muscles, a decrease in the pathological impulses of the nerve fibers and, as a result, a decrease in pain.
- Regular sexual activity. Regular ejaculation contributes to the secretion of the pancreas. Prolonged lack of sexual activity, ejaculation leads to stagnation of the secret in the ducts of the pancreas and increases the risk of infection, the development of inflammation in the stroma of the pancreas.
- The use of barrier contraceptive methods with occasional sexual intercourse, the slightest suspicion of an STI in a 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 forbidden to have sex. Sexual rest is recommended for acute inflammation in the pancreas.
Success in the treatment of prostatitis does not lie solely with the treating doctor, but is the result of the joint work of doctor and patient.
If the patient follows all the doctor's recommendations and orders, reduces the risk factors for the recurrence of the disease, and undergoes regular examinations, then he contributes his 50% to the success of the cure.