Treatment of prostatitis is a time-consuming process that requires a comprehensive examination of the patient. For the correct management of 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 make a distinction between acute and chronic inflammation in the gland, bacterial and aseptic process. Carrying out this differentiation allows you to determine the tactics of treatment.
In acute inflammation, the risk of complications, the emphasis in treatment is on detoxification of the patient, 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, 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.
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 for acute bacterial prostatitis
Mode and diet
- Bed rest.
- Sexual rest during the course of treatment.
- Avoidance of stressful effects of 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 - penicillins, 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, prior to the appointment of empirical antibiotic therapy, it is recommended to perform a bacterial culture of the urine 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 (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 medication.
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 the pancreatic abscess under the control of transrectal ultrasound (TRUS).
There is evidence of the effectiveness of therapy with abscess diameter less than 1 cm.
With untimely drainage of a pancreatic abscess, it may spontaneously open, a breakthrough of purulent contents into the fatty tissue surrounding the rectum, with the development of paraproctitis. With paraproctitis, open drainage of 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 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 (hereinafter referred to as CKD) is treated with lifestyle changes and medications. Of great importance are:
- Avoidance of environmental stressors.
- Maintaining physical activity.
- Dieting.
- Regular sexual activity without exacerbation.
- 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 the specific clinical situation, the patient's condition, 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. 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 abacterial form of inflammation of the pancreas can be carried out on an outpatient basis.
The patient is advised:
- Leading an active lifestyle.
- Regular sex life (at least 3 r / week).
- barrier contraception.
- 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 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 relaxers.
- 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 throughout the entire period of therapy.
- Efficiency has not been proven, but FTL is used: electrical stimulation, thermal, magnetic, vibration, laser, ultrasound therapy.
In NCPPS, a cure, improvement in the quality of life of patients 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 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, insolation), which suppress the activity of the body's immune system.
- Use of methods of barrier contraception.
- 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 control of the PSA level.
The criterion for the effectiveness of 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 a 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 prostatitis treatment regimens presented above, that is, they belong to adjuvant therapy.
| Drug group | Clinical effect |
|---|---|
| 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. 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 action. |
| Suppositories based on polypeptides of animal origin | Organotropic action |
Diet and rational nutrition
Compliance with the diet is a key 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, the development of symptoms of prostatitis.
Dietary modification can lead to a significant improvement in the quality of life while reducing the symptoms of the disease.
The most common foods that exacerbate prostatitis symptoms are:
- Spicy food, spices.
- Spicy pepper.
- Alcoholic drinks.
- Sour foods, marinades.
- Wheat.
- Gluten.
- Caffeine.
Bowel function and pancreas are interrelated: with the development of problems with the intestines, symptoms of inflammation of the prostate can develop and vice versa.
An important aspect in preventing 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 intestine. The main effects of probiotics are the suppression of pathological microflora, its replacement, the synthesis of certain vitamins, aid in 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 vulnerability of bacteria from 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 number of them reach 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 intestines, 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 note 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 trigger inflammation in the pancreas. It is necessary to increase the consumption of products from the list below:
- Vegetables.
- Fruits (Acid fruits should be avoided as they can aggravate prostatitis symptoms).
- vegetable protein.
- Foods high 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).
- Foods high in fiber (oatmeal, pearl barley).
The transition to the Mediterranean diet can lead to a significant reduction in the symptoms of inflammation in the pancreas. Reduced consumption of red meat, eating fish, beans, lentils, nuts, which are poor 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 refrain from drinking soda, coffee and tea. A patient with prostatitis needs to limit alcohol intake or stop drinking it altogether.
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 rejection of sports, accompanied by pressure on the perineum (riding, cycling).
- Avoiding prolonged sitting. Pressure on the perineal region leads to stagnation of blood in the pelvis and secretion of the pancreas, leading to an exacerbation of the disease.
- Limitation 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 the remission of prostatitis. The possibility of going to the bath, 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 of cold water after the steam room / douse yourself with cold water.
- Warm sitz baths lead to relief of symptoms of prostatitis. Regular intake of warm baths, with immersion of the entire body in warm water, has a greater effect in comparison with baths, where only the perineum and buttocks fall into warm water. In the bath, there is a greater relaxation of the pelvic floor muscles, a decrease in pathological impulses from 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 ducts of the pancreas and increases the risk of its infection, the development of inflammation in the stroma of the pancreas.
- 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 to patients with prostatitis is the possibility of maintaining sexual activity. A patient with chronic prostatitis is 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 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 recurrence of the disease, regularly undergoes examinations, then, thereby, he contributes his 50% to the success of curing the disease.