Treatment of prostatitis is a process that takes a lot of time and requires a comprehensive examination of the patient. For the proper management of a patient with prostate, 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 in the gland, bacterial and aseptic process. Making this differentiation allows you to determine treatment tactics.
In acute inflammation, the risk of complications, the emphasis in treatment is on detoxification of the patient, antibacterial and anti-inflammatory therapy.
Antibacterial therapy is used for chronic inflammation in the gland, but it leads to a positive effect only in 1-2 patients out of 10, since chronic prostatitis does not always have only one 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.
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 influences and normalize his psycho-emotional state.
Treatment of acute bacterial prostatitis
Mode and diet
- Bed rest.
- Sexual abstinence during the course of treatment.
- Avoiding the stressful effects of environmental factors (hypothermia, overheating, excessive isolation).
- 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 serious infectious and inflammatory process, accompanied by severe pain, fever and increased fatigue of the patient.
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 group of aminoglycosides is possible. After the termination of the acute process and the normalization of the patient's condition, they switch to oral antibiotics and continue the therapy for 2-4 weeks.
If possible, before prescribing empiric antibiotic therapy, it is recommended to carry out a bacterial culture of urine to determine the flora and sensitivity to antibacterial drugs.
As a rule, when ABP and severe intoxication are diagnosed, the need for infusion therapy, with complications of the disease (formation of an abscess of the pancreas, acute retention of urine), the patient is hospitalized.
In the absence of complications, outpatient treatment with oral medication is possible.
Operative 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 the pancreatic abscess under transrectal ultrasound (TRUS) guidance.
There is evidence of the effectiveness of therapy with abscesses less than 1 cm in diameter.
With premature drainage of a pancreatic abscess, it can open spontaneously, a penetration of purulent contents into the fatty tissue surrounding the rectum, with the development of paraproctitis. With paraproctitis, open drainage of the pararectal tissue is necessary.
Approximately 1 in 10 patients with ABP develop 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 site of the insertion of the tube 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 (hereinafter referred to as CKD) is treated with lifestyle changes and medications. Of great importance are:
- Avoiding environmental stressors.
- Maintaining physical activity.
- Diet.
- Regular sexual activity without irritation.
- Use of barrier contraception.
Medical treatment
Fluoroquinolones are most often 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 the specific clinical situation, the patient's condition and the presence of intoxication symptoms.
In CKD, the duration of antibiotic therapy is 4-6 weeks after diagnosis. The route of oral administration of drugs in high doses is preferred. If 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 bacterial form of inflammation of the pancreas can be carried out on an outpatient basis.
The patient is advised to:
- Lead an active lifestyle.
- Regular sex 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 therapy for NCPPS.
With a positive dynamics of the disease, a decrease in symptoms, the prescribed therapy continues up to 30-40 days. In addition to antibiotics for the treatment of NCPPS, the following are used:
- α1 - blocker.
- 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, 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 up to 3 times a week during the entire period of therapy.
- Efficacy has not been proven, but FTL is used: electrical, thermal, magnetic stimulation, vibration, laser, ultrasound therapy.
In NCPPS, a cure, improving the quality of life of patients is doubtful and impossible 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) as it increases. With a normal PSA level, no therapy is required..
Treatment of this type of prostatitis does not require hospitalization and is performed on an outpatient basis.
Drug-free therapy includes:
- An active lifestyle.
- Elimination of stressful effects on the body (hypothermia, isolation), which suppress 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, namely fluoroquinolones, tetracyclines or sulfonamides for a period of 30-40 days with PSA level control.
The criterion for the effectiveness of the therapy is the reduction of the PSA level 3 months after antibiotic therapy.
Long-term elevated PSA levels in type IV prostatitis require repeat prostate biopsies to rule out prostate cancer.
Rectal suppositories
The main advantage of using rectal suppositories in the treatment of prostatitis is a higher bioavailability compared to oral forms of drugs and the creation of a higher 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 adjunctive therapy.
| Drug group | Clinical effect |
|---|---|
| Suppositories based on NSAID | 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 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 food
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 disease symptoms.
The most common foods that worsen prostatitis symptoms are:
- Spicy food, spices.
- Spicy pepper.
- Alcoholic drink.
- Sour foods, marinades.
- Wheat.
- Gluten.
- Caffeine.
The function of the intestines and the pancreas are interconnected: with the development of problems with the intestines, the 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 preparations containing bacteria that live in a healthy gut. The main effects of probiotics are suppressing the pathological microflora, replacing it, synthesizing some vitamins, helping digestion and, as a result, maintaining 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 bacteria die in the stomach under the action of hydrochloric acid and only a small number of them reach the intestine).
For better effect and more complete distribution, capsules with bacteria have been proposed. The capsule passes through the aggressive environment of the stomach and is digested in the intestine, keeping the bacteria intact.
The development of inflammation in the pancreas can lead to a lack of zinc in the body, 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 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 intestinal 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 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 worsen prostatitis symptoms).
- vegetable protein.
- Foods high in zinc, zinc supplements.
- Omega-3 fatty acids (olives, olive and linseed oils, fish oil, sea fish contain polyunsaturated and polyunsaturated fatty acids in large quantities).
- Foods rich in fiber (oatmeal, pearl barley).
Switching to the Mediterranean diet can lead to a significant reduction in the symptoms of inflammation in the pancreas. Reducing the consumption of red meat, eating fish, beans, lentils, nuts, which are poor in saturated fat and cholesterol.
It is important to maintain proper 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 prostate should limit the intake of alcohol or completely stop it.
We change the way of life
- 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 the pain threshold, improvements 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 decrease in the symptoms of chronic prostatitis. An important aspect is the refusal of sports, accompanied by pressure on the perineum (driving, cycling).
- Avoiding sitting for a long time. Pressure in the perineal region leads to stagnation of blood in the pelvis and secretion of the pancreas, leading to an aggravation of the disease.
- Restriction 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 for entry during remission of prostatitis. 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. In no case should you jump into a pool of cold water after the steam room / splash yourself with cold water.
- Warm sitz baths lead to relief of prostatitis symptoms. Taking regular warm baths, with the immersion of the whole body in warm water, has a greater effect compared to baths, where only the perineum and buttocks fall into warm water. In the bath, a greater relaxation of the pelvic muscles is observed, a decrease in pathological impulses from the nerve fibers and, as a result, a decrease in pain.
- Regular sexual activity. Regular ejaculation contributes to pancreatic secretion. Prolonged lack of sexual activity, ejaculation leads to stagnation of secretion in the ducts of the pancreas and increases the risk of its infection, the development of inflammation in the stroma of the pancreas.
- 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 prostate patients is the ability to maintain sexual activity. A patient with chronic prostatitis is not forbidden to have sex. Sexual abstinence is recommended for acute inflammation in the pancreas.
Success in the treatment of prostatitis does not belong exclusively to the participating doctor, but is the result of the joint work of the doctor and the patient.
If the patient implements all the recommendations and prescriptions of the doctor, reduces the risk factors for the recurrence of the disease, undergoes regular examinations, then, in this way, he contributes 50% to the success of curing the disease.