What is prostatitis and what forms are there?
The prostate gland produces part of the seminal fluid and is involved in the mechanism of urination. When inflamed, it swells, compresses the urethra and irritates the nerve endings of the small pelvis - hence the pain and urinary disorders.
In modern urology, there are four categories of prostatitis, and this is not a formality: treatment directly depends on the category.
- Acute bacterial prostatitis - violent onset, high temperature, severe pain; requires immediate treatment, sometimes in a hospital
- Chronic bacterial prostatitis is a recurrent course with a proven bacterial cause, often associated with recurrent urinary tract infections
- Chronic prostatitis/chronic pelvic pain syndrome is the most common form; there is pain and discomfort, but no bacteria are found; the leading role is played by muscle spasm of the pelvic floor, circulatory disorders and neurogenic mechanisms
- Asymptomatic inflammatory prostatitis - discovered incidentally during examination for another reason and usually does not require treatment
Symptoms of prostatitis
Manifestations consist of three groups: pain, urinary disorders and sexual disorders.
- Pain and discomfort in the perineum, lower abdomen, sacrum, scrotum, penis; often worsens with prolonged sitting
- Frequent urination, especially at night
- Cutting and burning when urinating
- Weak stream, feeling of incomplete emptying
- Imperative urges
- Painful ejaculation, discomfort after intercourse
- Decreased libido, deterioration in erection quality
- Deterioration of sperm parameters with prolonged inflammation
- In the acute form - high fever, chills, severe weakness
The peculiarity of the chronic form is its wave-like course: periods of exacerbation after hypothermia, stress, alcohol or a long trip are replaced by relative well-being. This is what creates the feeling that the disease is “either there or not.”
Causes and risk factors
- Bacterial infection, most often intestinal flora, coming from the urethra or bladder
- Sexually transmitted infections - as a cause of urethritis with subsequent involvement of the prostate
- Congestion in the pelvis during sedentary work, prolonged driving, inactivity
- Irregular sex life: both prolonged abstinence and excessive activity with interrupted acts
- Hypothermia, especially local
- Chronic constipation
- Smoking and alcohol abuse, spicy foods in large quantities
- Stress and chronic pelvic floor muscle tension
- History of bladder catheterization and endoscopic interventions
- Reduced immunity, diabetes mellitus
Why is prostatitis dangerous?
- Prostate abscess is an abscess that requires opening and drainage
- Acute urinary retention due to swelling of the gland
- Spread of infection to the epididymis - epididymitis and orchitis
- Chronication of the process with prolonged pain syndrome
- Decreased fertility and deterioration of sperm parameters
- Sexual disorders and associated decrease in quality of life
- Urosepsis in severe acute course
It is important to know: prostatitis does not turn into prostate cancer and is not its cause. However, inflammation increases PSA levels, which can mimic an oncological picture, so the analysis is repeated after treatment.
Diagnostics: what needs to be examined
The goal is to understand whether there is a bacterial infection, evaluate the condition of the prostate, and rule out other causes of pelvic pain and urinary disorders.
- Examination by a urologist with digital rectal examination (not performed if an acute purulent process is suspected due to the risk of spreading infection)
- General urine analysis and three-glass sample
- Microscopy and culture of prostate secretions or urine culture after massage of the gland
- Urethral swab and tests for sexually transmitted infections using PCR
- TRUS of the prostate - assessment of the structure, identification of abscess, calcifications, gland volume
- Ultrasound of the bladder with determination of residual urine
- PSA - in older men and with a suspicious picture
- Uroflowmetry for severe urination disorders
- Spermogram when planning pregnancy
- NIH-CPSI Questionnaire for Objective Assessment of Symptoms and Treatment Progress
Treatment of prostatitis
The treatment regimen differs fundamentally depending on the form. There is no universal course “for prostatitis”.
- Acute bacterial prostatitis: antibiotics selected taking into account culture, painkillers, plenty of fluids, rest; in severe cases - hospitalization and intravenous therapy
- Chronic bacterial prostatitis: long course of antibiotic penetrating into prostate tissue, strictly based on culture results
- Chronic pelvic pain syndrome: alpha-blockers, anti-inflammatory drugs, muscle relaxants, work with the pelvic floor muscles, physiotherapy, if necessary, drugs that affect the neuropathic component of pain
- Prostate abscess: opening and draining the abscess - this process is not allowed conservatively
- Acute urinary retention: urine diversion with a catheter or trocar cystostomy
- Additionally: lifestyle correction, treatment of constipation, regular physical activity, avoidance of alcohol and hypothermia
Separately, about prostate massage: it can be used for some forms of chronic prostatitis as prescribed by a doctor, but is strictly contraindicated for acute inflammation, abscess and suspected tumor.
Why treatment sometimes doesn't work
A common situation: a man has completed several courses of antibiotics, but the pain remains. Usually the reason is one of three.
- Диагноз поставлен без обследования, и на самом деле речь идёт о синдроме хронической тазовой боли, при котором антибиотики бесполезны
- Не выявлена сопутствующая проблема: стриктура уретры, камень мочевого пузыря, гиперактивный мочевой пузырь, патология тазобедренного сустава или позвоночника, проктологическое заболевание
- Не устранены поддерживающие факторы: сидячая работа без перерывов, хронические запоры, переохлаждение, стресс и постоянное напряжение мышц тазового дна
That is why, in case of long-term complaints, it makes sense not to repeat the next course at random, but to undergo a full examination by a urologist with an assessment of all possible causes.
Prevention
- Avoid hypothermia, especially prolonged sitting in the cold
- Take breaks and stretch during sedentary work and long periods of driving
- Maintain regular physical activity: walking, swimming, pelvic floor exercises
- Use barrier contraception and promptly treat sexually transmitted infections
- Avoid chronic constipation
- Have regular sex life without long periods of abstinence
- Limit alcohol and very spicy foods
- Be examined by a urologist at least once a year, and after 45–50 years - with PSA monitoring
Where is prostatitis treated in Tashkent
For high-quality treatment of prostatitis, you need a clinic where you can be examined by a urologist in one visit, take tests, including culture of prostate secretions and PCR for infections, and do TRUS, and in case of complications, get inpatient care.
In Tashkent, such examination and treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic. Here, both outpatient therapy for chronic forms and hospitalization for acute bacterial prostatitis and its complications are possible.
It is worth bringing the results of previous tests and a list of medications that you have already taken to your appointment - this helps to avoid repeated courses and choose treatment more accurately. Addresses, telephone numbers and online registration are below on the page.
