Treatment of prostatitis is a time-consuming process that requires a thorough examination of the patient. For the correct management of prostatitis patients, it is necessary to make an accurate diagnosis based on examination, test results and instrumental research methods.
It is important for doctors to make a distinction between acute and chronic inflammation in the gland, bacterial and aseptic processes. Carrying out this differentiation allows you to determine treatment tactics.
In acute inflammation, the risk of complications, the emphasis in treatment is on patient detoxification, antibacterial and anti-inflammatory therapy.
Antibacterial therapy for chronic inflammation in the gland is used, but leads to a positive effect only in 1-2 patients out of 10, because chronic prostatitis does not always have a bacterial etiology alone.
Therefore, a very important aspect in the treatment of chronic prostatitis is a complex effect on all known pathogenetic mechanisms of the disease.
Physiotherapy and diet therapy are added to antibacterial and anti-inflammatory treatment. It is very important for chronic prostatitis patients to correct their lifestyle, get rid of bad habits, the influence of stress, and normalize their psycho-emotional state.
Treatment for acute bacterial prostatitis
Mode and diet
- Rest in bed.
- Sexual rest during treatment.
- Avoiding the effects of stress from environmental factors (hypothermia, overheating, excessive insolation).
- Dieting.
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 patient fatigue.
When the diagnosis of ABP is made, the patient is given parenteral antibiotic therapy. Initially, broad-spectrum antibiotics are prescribed - penicillin, 3rd generation cephalosporins, fluoroquinolones.
At the beginning of therapy, a combination of one of the listed antibiotics with drugs of the aminoglycoside group is possible. After stopping the acute process and normalizing the patient's condition, they are transferred to oral antibiotics and continue therapy for 2-4 weeks.
If possible, before the appointment of empirical antibiotic therapy, it is recommended to perform a urine bacterial culture 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.
If there are no complications, fever is possible outpatient treatment with oral medication.
Operative intervention
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 pancreatic abscess under transrectal ultrasound (TRUS) control.
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 may open spontaneously, the penetration of purulent contents into the fatty tissue around the rectum, with the development of paraproctitis. With paraproctitis, open drainage of pararectal tissue is required.
About 1 in 10 patients with ABP experience acute urinary retention. As a rule, a suprapubic cystostomy is required to eliminate it (the placement 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 tube insertion site is pricked with a local anesthetic solution.
Small skin incisions are made with a scalpel. Under ultrasound guidance, a trocar is inserted into the bladder cavity, where a urinary catheter is passed into the bladder.
Management of chronic bacterial prostatitis
Chronic bacterial prostatitis (hereafter referred to as CKD) is treated with lifestyle changes and medications. The most important are:
- Avoid environmental stress.
- Maintain physical activity.
- Dieting.
- Frequent sexual activity without severity.
- 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 in CKD is not recommended..
The duration of therapy is selected based on specific clinical conditions, 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 drug administration in high doses is preferred. If CKD is caused by intracellular bacteria, drugs from the tetracycline group are prescribed.
Antibacterial therapy for established pathogens includes the appointment of the following drugs.
Chronic pelvic pain syndrome (CPPS)
Therapy of the abacterial form of pancreatic inflammation can be carried out on an outpatient basis.
Patients are advised:
- Lead an active lifestyle.
- Regular sex life (at least 3 r / week).
- barrier contraceptives.
- Dieting.
- Exclusion of alcohol.
Despite the absence of a bacterial component, it is possible to prescribe a two-week course of therapy for NCPPS.
With the positive dynamics of the disease, a decrease in symptoms, the prescribed therapy is continued for up to 30-40 days. In addition to antibiotics for the treatment of NCPPS, the following are used:
- α1 - blocker.
- NSAIDs.
- Relax the muscles.
- 5α reductase inhibitor. 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: Extracts 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 therapy period.
- Efficiency has not been proven, but FTL is used: electrical stimulation, heat, magnetic, vibration, laser, ultrasound therapy.
In NCPPS, a cure, improvement in the patient's quality of life is doubtful and unlikely due to the low effectiveness 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) with its increase. With a normal PSA level, no therapy is needed..
Treatment of this type of prostatitis does not require hospitalization and is carried out on an outpatient basis.
Non-drug therapies include:
- Active lifestyle.
- Elimination of the effect of stress on the body (hypothermia, insolation), which suppresses the activity of the body's immune system.
- Use of barrier contraceptive methods.
- Dieting.
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 therapy is a decrease in PSA level 3 months after antibiotic therapy.
Long-term high 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 the higher bioavailability compared to the oral form of the drug and the creation of the highest concentration of the drug in the small pelvic canal, around the pancreas.
As a rule, rectal suppositories complete the prostatitis treatment regimen presented above, that is, they belong to adjunctive therapy.
| Drug group | Clinical effects |
|---|---|
| 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 in the treatment of prostatitis. Most often, doctors use intramuscular or intravenous antibiotics to treat bacterial prostatitis. |
| Suppositories with local anesthetic | In addition to the local anesthetic effect, they have an anti-inflammatory effect, improving microcirculation in the pancreas. Main use 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 diet is the main thing in the treatment of chronic prostatitis. Certain types of products, the body's allergic reaction to them, can lead to the development of inflammation in the pancreas, the development of prostatitis symptoms.
Diet modification can lead to a significant improvement in quality of life while reducing disease symptoms.
The most common foods that worsen prostatitis symptoms are:
- Spicy food, spices.
- Hot pepper.
- Alcoholic drinks.
- Sour food, pickles.
- Wheat.
- Gluten.
- Caffeine.
The functions of the intestine and pancreas are interconnected: with the development of problems with the intestine, symptoms of prostate inflammation 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 this disease, is the intake of probiotics.
Probiotics are preparations that contain bacteria that live in a healthy gut. The main effect of probiotics is the suppression of pathological microflora, its replacement, the synthesis of certain vitamins, helps in digestion and, as a result, the maintenance of the human immune system.
Most often, a person uses probiotics in the form of fermented milk products - kefir, yogurt, sour cream, fermented baked milk. The main disadvantage of this form is the vulnerability of bacteria from the action of the acidic environment of the stomach (most bacteria die in the stomach under the action of hydrochloric acid and only a small number of them reach the intestine).
For the best effect and a more complete delivery, capsules with bacteria have been suggested. Capsules pass through the aggressive stomach environment and dissolve in the intestines, keeping the bacteria intact.
The development of inflammation in the pancreas can cause a lack of zinc in the body, consuming pollutants.
Food allergies can also contribute to the development of prostatitis.
Many men note an improvement in their condition, a decrease in disease symptoms 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 trigger inflammation in the pancreas. It is necessary to increase the use of products from the list below:
- Vegetables.
- Fruits (Sour fruits should be avoided because they can worsen the symptoms of prostatitis).
- vegetable protein.
- Foods high in zinc, zinc supplements.
- Omega-3 fatty acids (olive, olive and flaxseed oil, fish oil, marine fish contain polyunsaturated and polyunsaturated fatty acids in large quantities).
- Foods high in fiber (oats, pearl barley).
The transition to a Mediterranean diet can lead to a significant reduction in the symptoms of inflammation in the pancreas. Reduce consumption of red meat, eat fish, beans, lentils, nuts, which are low in saturated fat and cholesterol.
It is important to maintain adequate body hydration. A man should drink about 1. 5-2 liters of clean drinking water every day.
You should refrain from drinking soda, coffee and tea. Prostatitis patients need to limit alcohol intake or stop drinking it altogether.
We change the way of life
- Limit the influence of a stressful environment, which can lead to a weakening of the patient's immune system.
- Normalization of psycho-emotional state. It leads to an increase in symptoms due to an increase in the pain threshold, an increase in the function of the immune system, and less fixation of the patient on his illness.
- Physical activity. Regular exercise without excessive exercise leads to a decrease in symptoms of chronic prostatitis. An important aspect is the rejection of sports, accompanied by pressure on the perineum (riding, cycling).
- Avoid prolonged sitting. Pressure on the perineal area leads to stagnation of blood in the pelvis and pancreatic secretion, which leads to aggravation of the disease.
- Limit thermal procedures (baths, saunas) during disease exacerbation. It is possible to visit baths, saunas in a short course of 3-5 minutes per entry during remission of prostatitis. The possibility of going to the bathroom, sauna should be agreed with the attending physician, each case is individual and requires a special approach to treatment. Never jump into a pool of cold water after the steam room / douse yourself with cold water.
- Bathing with warm water leads to relief of prostatitis symptoms. Taking regular warm baths, with full body immersion in warm water, has a greater effect than bathing, where only the perineum and buttocks fall into warm water. In the bathroom, there is greater relaxation of the pelvic floor muscles, a decrease in pathological impulses from nerve fibers and, as a result, a decrease in pain.
- Frequent sexual activity. Frequent ejaculation contributes to pancreatic secretion. Prolonged absence of sexual activity, ejaculation leads to stagnation of secretions in the pancreatic ducts and increases the risk of infection, the development of inflammation in the pancreatic stroma.
- The use of barrier contraceptive methods for casual sexual intercourse, the slightest suspicion of STI in the patient and his sexual partner.
- An issue that often worries prostatitis patients is the possibility of maintaining sexual activity. Chronic prostatitis patients are not prohibited from having sex. Sexual rest is recommended for acute inflammation in the pancreas.
Success in the treatment of prostatitis does not belong exclusively to the attending physician, but is the result of joint work between the physician and the patient.
If the patient complies with all the recommendations and prescriptions of the doctor, reduces the risk factors for the recurrence of the disease, regularly undergoes examinations, then, thus, he contributes 50% to the success of curing the disease.