Treatment of prostatitis is a process that takes a long time and requires a thorough examination of the patient. In order to properly manage a patient with 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, bacterial and aseptic process in the gland. Making this distinction allows you to determine the tactics of treatment.
In acute inflammation, the risk of complications, the emphasis in treatment is detoxification of the patient, antibacterial and anti-inflammatory therapy.
Antibacterial therapy is used for chronic inflammation in the gland, but it has a positive effect in only 1-2 out of 10 patients, because chronic prostatitis does not always have only a bacterial etiology.
Therefore, an extremely important aspect in the treatment of chronic prostatitis is the complex effect on 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 with chronic prostatitis to correct his lifestyle, get rid of bad habits, stressful effects, and normalize his psycho-emotional state.
Treatment of acute bacterial prostatitis
Mode and diet
- Bed rest.
- Sexual rest during treatment.
- Prevention of stressful effects of environmental factors (hypothermia, overheating, excessive insolation).
- Diet.
Antibacterial drugs
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. First, broad-spectrum antibiotics are prescribed - penicillins, 3rd generation cephalosporins, fluoroquinolones.
It is possible to combine one of the antibiotics listed at the beginning of therapy 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 therapy for 2-4 weeks.
If possible, before the empiric antibiotic therapy is prescribed, it is recommended to conduct a urine bacterial culture to determine the flora and sensitivity to antibacterial drugs.
As a rule, when ABP and severe intoxication are diagnosed, the patient is hospitalized with the need for infusion therapy, complications of the disease (formation of pancreatic abscess, acute urinary retention).
In the absence of complications, outpatient treatment of temperature with oral medication is possible.
Operational interventions
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 a pancreatic abscess under transrectal ultrasound (TRUS) guidance.
There is evidence of the effectiveness of therapy with abscesses less than 1 cm in diameter.
If the pancreatic abscess is not drained in time, it can open spontaneously, the purulent contents spill into the fatty tissue surrounding the rectum, with the development of paraproctitis. With paraproctitis, open drainage of the pararectal tissue is necessary.
About 1 in 10 patients with ABP develop acute urinary retention. As a rule, a suprapubic cystostomy is required to remove it (insertion of a urinary catheter can be painful and increases the risk of developing CKD).
Often, trocar cystostomy is performed under local anesthesia and ultrasound control. Before the operation, the place where the tube is inserted is punctured with a local anesthetic solution.
A small incision is made in the skin with a scalpel. Under ultrasound guidance, a trocar is inserted into the bladder cavity, through which a urinary catheter is inserted into the bladder.
Treatment of chronic bacterial prostatitis
Chronic bacterial prostatitis (hereafter CKD) is treated with lifestyle changes and medications. Of great importance is:
- Avoid environmental stress.
- Maintaining physical activity.
- Diet.
- Regular sexual activity without exacerbation.
- Use of barrier contraception.
Treatment
Fluoroquinolones are more commonly used to treat chronic bacterial prostatitis (CKD).
This group of drugs is preferred due to good pharmacokinetic properties, antibacterial activity against Gram-negative flora, including P. aeruginosa.
Empiric antibiotic therapy is not recommended in CKD..
The duration of therapy is selected based on the specific clinical situation, the patient's condition and the presence of signs of intoxication.
The duration of antibiotic therapy in CKD is 4-6 weeks after diagnosis. The oral way of taking drugs in high doses is preferred. If CKD is caused by intracellular bacteria, drugs from the tetracycline group are prescribed.
Antibacterial therapy for an identified pathogen includes the appointment of the following drugs.
Chronic Pelvic Pain Syndrome (CPPS)
Therapy of the abacterial form of inflammation of the pancreas can be carried out on an outpatient basis.
The patient is recommended:
- Lead an active lifestyle.
- Regular sexual life (at least 3 r / week).
- barrier contraception.
- Diet.
- Elimination of alcohol.
Despite the absence of a bacterial component, it is possible to prescribe a two-week course of therapy for NCPPS.
Positive dynamics of the disease, the therapy determined by the reduction of symptoms is continued for 30-40 days. In addition to antibiotics, the following are used to treat NCPPS:
- α1 - blockers.
- NSAIDs.
- Muscle relaxants.
- 5α reductase inhibitors. 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: Serenoa repens extract, Pygeum africanum, Phleum pretense, Zea mays.
- Prostate massage. During the entire period of therapy with NCPPS, it is possible to massage the pancreas up to 3 times a week.
- Effectiveness is not proven, but FTL is used: electrical stimulation, thermal, magnetic, vibration, laser, ultrasound therapy.
Recovery in NCPPS, improving the quality of life of patients is doubtful and impossible due to the low effectiveness of most of the listed treatments.
Asymptomatic inflammation
The main goal of therapy for type IV prostatitis is to normalize the level of prostate-specific antigen (PSA) with its increase. A normal PSA level does not require any treatment..
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) that suppress the activity of the body's immune system.
- Use of barrier contraceptive methods.
- Diet.
Drug therapy includes the appointment of antibiotics, i. e. fluoroquinolones, tetracyclines or sulfonamides, with subsequent monitoring of effectiveness for 30-40 days with PSA level control.
The criterion of the effectiveness of the therapy is the reduction of the PSA level after 3 months of antibiotic therapy.
Prolonged 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 higher bioavailability compared to oral forms of drugs and creation of the highest concentration of the drug in the small vessels of the pelvis, around the pancreas.
As a rule, rectal suppositories complement the prostatitis treatment regimens presented above, that is, they belong to adjunctive therapy.
| Drug group | Clinical impact |
|---|---|
| Suppositories based on NSAIDs | They reduce the synthesis of pro-inflammatory factors, reduce pain and stop fever. |
| Suppository with antibacterial preparations | It is rarely used in the treatment of prostatitis. More often, doctors use intramuscular or intravenous antibiotics to treat bacterial prostatitis. |
| Suppository with local anesthetics | In addition to the local anesthetic effect, they have an anti-inflammatory effect, improve microcirculation in the pancreas. Main use in proctology. |
| Herbal suppositories | It has a local anti-inflammatory, analgesic and antiseptic effect. |
| Suppositories based on polypeptides of animal origin | Organotropic effect |
Diet and rational nutrition
Compliance with the diet is the main point 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 and the development of symptoms of prostatitis.
Changing the diet can significantly improve the quality of life in addition to reducing the symptoms of the disease.
The most common foods that aggravate prostatitis symptoms are:
- Spicy foods, spices.
- Hot pepper.
- Alcoholic beverages.
- Sour foods, marinades.
- wheat.
- Gluten.
- Caffeine.
Intestinal function and the pancreas are related to each other: with the development of problems in the intestines, symptoms of inflammation of the prostate can develop, and vice versa.
Taking probiotics is an important aspect in preventing the development of prostatitis, preventing the recurrence of inflammation in the stroma of the gland during the chronic course of the disease.
Probiotics are preparations containing healthy intestinal bacteria. The main effect of probiotics is to suppress the pathological microflora, to change it, to synthesize certain vitamins, to help the digestive process and, as a result, to maintain the human immune system.
Often, a person consumes probiotics in the form of fermented milk products - kefir, yogurt, sour cream, fermented baked milk. The main drawback of these forms is the sensitivity of bacteria to the effect of the acidic environment of the stomach (most bacteria die in the stomach under the influence of hydrochloric acid, and only a small part of them reaches the intestine).
Capsules with bacteria have been suggested for best effect and more complete delivery. The capsule passes through the aggressive environment of the stomach and dissolves in the intestines, keeping the bacteria intact.
The development of inflammation in the pancreas can lead to a lack of zinc in the body and the consumption of pollutants.
Food allergies can also contribute to the development of prostatitis.
Many men note that their condition improves and symptoms of the disease decrease when they switch to a diet that refuses to eat wheat and gluten.
Gluten in wheat can cause chronic inflammation in the small intestine and cause malabsorption. The result of intestinal dysfunction is a number of pathologies, including prostatitis.
In general, it is important to eat a healthy diet and avoid foods that trigger inflammation in the pancreas. It is necessary to increase the consumption of products from the following list:
- Vegetables.
- Fruits (Acid fruits should be avoided as they can aggravate the symptoms of prostatitis).
- vegetable protein.
- Foods high in zinc, zinc supplements.
- Omega-3 fatty acids (olive, olive and linseed oils, fish oil, marine fish contain large amounts of unsaturated and polyunsaturated fatty acids).
- Foods rich in fiber (oatmeal, pearl barley).
Switching to a Mediterranean diet can significantly reduce the symptoms of inflammation in the pancreas. Reducing the consumption of fish, beans, lentils, nuts, and red meat, which are poor in saturated fat and cholesterol.
It is important to keep the body adequately hydrated. A man should drink about 1. 5-2 liters of clean drinking water per day.
You should avoid drinking soda, coffee and tea. A patient with prostatitis should limit or completely stop drinking alcohol.
We are changing our lifestyle
- Limitation of stressful environmental influences that can cause weakening of the patient's immune system.
- Normalization of psycho-emotional state. This leads to an improvement in symptoms due to increased pain threshold, improved immune system function and less fixation on the patient's 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 perineum (horse riding, cycling).
- Avoid sitting for long periods of time. Pressure on the perineal region leads to stagnation of blood in the pelvis and secretion of the pancreas, causing exacerbation of the disease.
- Restriction of thermal procedures (bath, sauna) during exacerbation of the disease. During the remission period of prostatitis, it is possible to visit baths and saunas in short courses of 3-5 minutes at each entrance. The possibility of going to the bath, sauna should be agreed with the attending physician, each case requires an individual and special approach to treatment. In no case should you jump into the cold water pool after the steam room / wash yourself with cold water.
- Hot sitz baths relieve the symptoms of prostatitis. Regularly taking a hot bath with the whole body immersed in hot water is more effective than baths where only the perineum and buttocks are exposed to hot water. In the bath, the muscles of the pelvic floor are more relaxed, the pathological impulses from the nerve fibers decrease and, as a result, the pain decreases.
- Regular sexual activity. Regular emptying helps the pancreas to secrete. Long-term lack of sexual activity, ejaculation leads to stagnation of secret in the ducts of the pancreas and increases its risk of infection, development of inflammation in the stroma of the pancreas.
- The use of barrier contraceptive methods for casual intercourse, the slightest suspicion of STI in the patient and his sexual partner.
- A problem that often worries patients with prostatitis is the ability to maintain sexual activity. A patient with chronic prostatitis is not forbidden to have sex. During acute inflammation in the pancreas, sexual rest is recommended.
Success in the treatment of prostatitis does not belong only to the doctor, but is the result of the joint work of the doctor and the patient.
If the patient follows all the recommendations and prescriptions of the doctor, reduces the risk factors for recurrence of the disease, undergoes regular examinations, then he contributes 50% to the success of the treatment of the disease.