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 formulate 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 in the gland, bacterial and aseptic process. Making this differentiation allows you to determine the tactics of treatment.
In acute inflammation, the risk of complications, the emphasis in treatment is on the patient's detoxification, antibacterial and anti-inflammatory therapy.
Antibacterial therapy is used for chronic inflammation in the gland, but leads to 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 pathogenic mechanisms of the disease.
Physiotherapy and diet therapy are added to the antibacterial and anti-inflammatory treatment. It is extremely important for a patient with chronic prostatitis to correct his lifestyle, get rid of bad habits, stressful influences, and normalize his psycho-emotional state.
Treatment for acute bacterial prostatitis
Mode and diet
- Bed rest.
- Sexual rest during the course of treatment.
- Avoid the stressful effects of environmental factors (hypothermia, overheating, excessive sunstroke).
- Diet.
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 severe 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: penicillins, third-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 empiric antibiotic therapy, it is recommended to take a bacterial culture of urine to determine the flora and sensitivity to antibacterial drugs.
As a rule, during 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), the patient is hospitalized.
In the absence of complications, fever is possible outpatient treatment with oral medications.
Operational 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 the pancreatic abscess under the supervision of transrectal ultrasound (TRUS).
There is evidence of the effectiveness of therapy for abscess diameters of less than 1 cm.
With premature drainage of a pancreatic abscess, it can open spontaneously, a breakthrough of purulent contents into the fatty tissue surrounding the rectum, with the development of paraproctitis. With paraproctitis, open drainage of the pararectal tissue is required.
About 1 in 10 patients with ABP develop acute urinary retention. Usually, a suprapubic cystostomy is required to eliminate it (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 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 referred to as CKD) is treated with lifestyle changes and medications. Of great importance are:
- Avoid environmental stressors.
- Maintain physical activity.
- Diet.
- Regular sexual activity without exacerbations.
- Use of barrier contraception.
Medical treatment
Fluoroquinolones are most 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 chronic kidney disease is not recommended..
The duration of therapy is selected depending on the specific clinical situation, the patient's condition and the presence of symptoms of intoxication.
In chronic kidney disease, the duration of antibiotic therapy is 4-6 weeks after diagnosis. The oral route of administering high-dose drugs is preferred. If chronic kidney disease 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 nonbacterial form of pancreatic inflammation can be carried out on an outpatient basis.
The patient is advised:
- Lead an active lifestyle.
- Regular sex life (at least 3 r / week).
- barrier contraception.
- Diet.
- Alcohol exclusion.
Despite the absence of a bacterial component, a two-week course of therapy can be prescribed for NCPPS.
With a 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 - blockers.
- NSAIDs.
- Muscle relaxants.
- 5α reductase inhibitors. At the moment, there is no evidence of the effectiveness of α1 - blockers, muscle relaxants, 5α reductase inhibitors.
- With long-term treatment of NCPPS, herbal preparations can be prescribed: Serenoa repens extract, Pygeum africanum, Phleum pretense, Zea mays.
- Prostatic massage. With NCPPS it is possible to massage the pancreas up to 3 times a week for the entire period of therapy.
- Efficiency has not been proven, but FTL is used: electrical, thermal, magnetic stimulation, vibration, laser, ultrasound therapy.
In NCPPS, a cure, improvement in patients' quality of life is doubtful and unlikely due to the poor efficacy of most of the therapies listed.
Asymptomatic inflammation
The main goal of therapy for type IV prostatitis is to normalize the level of prostate specific antigen (PSA) by increasing it. With a normal PSA level, 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 (hypothermia, heatstroke), which suppress the activity of the body's immune system.
- Use of barrier methods of contraception.
- Diet.
Drug therapy involves the appointment of antibiotics with subsequent monitoring of the 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 antibiotic therapy.
Long-term elevated PSA levels in type IV prostatitis require repeated prostate biopsies to rule out prostate cancer.
Rectal suppositories
The main advantage of using rectal suppositories in the treatment of prostatitis is higher bioavailability compared to oral forms of drugs and the creation of the highest concentration of the drug in the vessels of the small pelvis, around the pancreas.
As a rule, rectal suppositories complement the above presented prostatitis treatment regimens, that is, they belong to adjuvant therapy.
| drug group | Clinical effect |
|---|---|
| NSAID-based suppositories | 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. 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. |
| Plant-based suppositories | Local anti-inflammatory, analgesic and antiseptic action. |
| Suppositories based on polypeptides of animal origin | Organotropic action |
Rational diet and nutrition
Compliance with the diet is a key point in the treatment of chronic prostatitis. Some types of products, an allergic reaction of the body to them, can lead to the development of inflammation in the pancreas, the development of symptoms of prostatitis.
Dietary modification can lead to a significant improvement in quality of life by reducing the symptoms of the disease.
The most common foods that exacerbate prostatitis symptoms are:
- Spicy food, spices.
- Hot pepper.
- Alcoholic beverages.
- Acidic foods, marinades.
- Grain.
- Gluten.
- Caffeine.
Intestinal function and the pancreas are interrelated: with the development of problems with the intestines, symptoms of inflammation of the prostate gland may develop, and vice versa.
An important aspect in the prevention of the development of prostatitis, in the prevention of recurrence of inflammation in the stroma of the gland in the chronic course of the disease is the intake of probiotics.
Probiotics are preparations containing bacteria that live in a healthy gut. The main effects of probiotics are the suppression of pathological microflora, its replacement, the synthesis of some vitamins, aid in digestion and, consequently, 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 bacteria to the action of the acidic environment of the stomach (most of the bacteria die in the stomach under the action of hydrochloric acid and only a small part reaches the intestine).
For the best effect and more complete delivery, capsules with bacteria have been proposed. The capsule passes through the aggressive environment of the stomach and dissolves in the intestine, keeping the bacteria intact.
The development of inflammation in the pancreas can lead to a lack of zinc in the body by eating pollutants.
Food allergies can also contribute to the development of prostatitis.
Many men note an improvement in their condition, a decrease 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 bowel function is a number of pathologies, including prostatitis.
In general, it's important to switch to a healthy diet and avoid foods that can trigger pancreatic inflammation. It is necessary to increase the consumption of products from the following list:
- Vegetables.
- Fruits (sour fruits should be avoided as they can aggravate the symptoms of prostatitis).
- vegetable proteins.
- Foods rich in zinc, zinc supplements.
- Omega-3 fatty acids (olives, olive and linseed oils, fish oil, sea fish contain unsaturated and polyunsaturated fatty acids in large quantities).
- Fiber-rich foods (oatmeal, pearl barley).
Switching to the Mediterranean diet can lead to a significant reduction in symptoms of inflammation in the pancreas. Reduction in the consumption of red meat, consumption of fish, beans, lentils, dried fruit, low in saturated fat and cholesterol.
It is important to maintain adequate hydration of the body. A man needs to drink about 1. 5-2 liters of clean drinking water per day.
You should avoid drinking soda, coffee and tea. A patient with prostatitis must limit alcohol intake or stop drinking it altogether.
Let's change the way we live
- Limitation of stressful environmental influences, which can lead to a weakening of the patient's immune system.
- Normalization of the psycho-emotional state. It leads to an improvement in symptoms due to an increase in pain threshold, improvements in the functioning of the immune system and less fixation of the patient on his disease.
- Physical activity. Regular exercise without excessive exercise leads to a decrease in the symptoms of chronic prostatitis. An important aspect is the refusal of sports, accompanied by pressure on the perineum (horse riding, cycling).
- Avoid prolonged sitting. Pressure on the perineal region leads to stagnation of blood in the pelvis and pancreatic secretion, leading to an exacerbation of the disease.
- Limitation of thermal procedures (bath, sauna) during an exacerbation of the disease. It is possible to visit baths, saunas in short courses of 3-5 minutes per admission during prostatitis remission. 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 plunge into a pool of cold water after the steam room / douse yourself with cold water.
- Hot sitz baths lead to the relief of prostatitis symptoms. Regular taking of hot baths, with immersion of the whole body in warm water, has a greater effect than baths, where only the perineum and buttocks fall into the 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, consequently, a decrease in pain.
- Regular sexual activity. Regular ejaculation contributes to the secretion of the pancreas. Prolonged absence of sexual activity, ejaculation leads to stagnation of the secret in the pancreatic ducts and increases the risk of its infection, the development of inflammation in the pancreatic stroma.
- The use of barrier contraceptive methods for casual sexual intercourse, the slightest suspicion of an STI in a patient and his sexual partner.
- A frequent issue of concern for 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 of the pancreas.
Successful treatment of prostatitis does not belong exclusively to the treating doctor, but is the result of the joint work of the doctor 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, thus, thereby, he contributes his 50% to the successful treatment of the disease.