Treatment of prostatitis is a time-consuming process that requires a comprehensive examination of the patient. For the proper management of a patient with prostatitis, it is necessary to make an accurate diagnosis based on the 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. Carrying out this differentiation allows you to determine the course of treatment.
In acute inflammation, the risk of complications, the emphasis of 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 in only 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 pathogenic 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
Function and diet
- Bed rest.
- Sexual rest during treatment.
- Avoiding stressful effects of environmental factors (hypothermia, overheating, excessive sunlight).
- Dieting.
Antibacterial drugs
The appointment of antibiotic treatment 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 ABP is diagnosed, the patient is given parenteral antibiotic therapy. Initially, broad-spectrum antibiotics are prescribed - penicillins, 3rd generation cephalosporins, fluoroquinolones.
At the beginning of treatment, it is possible to combine one of the mentioned antibiotics 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 treatment for 2-4 weeks.
If possible, before the appointment of empiric antibiotic therapy, it is recommended to conduct a bacterial culture of the urine to determine the flora and sensitivity to antibacterial drugs.
As a rule, when diagnosing ABP and severe poisoning, the need for infusion therapy, with complications of the disease (pancreatic abscess formation, acute urinary retention), the patient is hospitalized.
In the absence of complications, outpatient treatment with oral medication is possible.
Functional interventions
Surgical treatment is indicated for complications of OBP. An abscess with a diameter greater 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 for the effectiveness of treatment with an abscess diameter of less than 1 cm.
With untimely drainage of a pancreatic abscess, it can open spontaneously, a discovery of purulent contents in the fatty tissue surrounding the rectum, with the development of paraproctitis. With paraproctitis, open drainage of the paraanal tissue is necessary.
About 1 in 10 patients with ABP develop acute urinary retention. A suprapubic cystostomy is usually required to remove it (insertion of a urinary catheter can be painful and increase the risk of CKD).
Most often, trocar cystostomy is performed under local anesthesia and under ultrasound guidance. Before the operation, the insertion point of the tube is punctured with a local anesthetic solution.
A small incision in the skin 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.
Treatment of chronic bacterial prostatitis
Chronic bacterial prostatitis (hereafter referred to as CKD) is treated with lifestyle changes and medications. Of great importance are:
- Avoiding environmental stressors.
- Maintaining physical activity.
- Dieting.
- Regular sexual activity without arousal.
- Use of barrier contraception.
Medical care
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 CKD is not recommended..
The duration of treatment is selected based on the specific clinical situation, the condition of the patient and the presence of symptoms of poisoning.
In CKD, the duration of antibiotic treatment is 4-6 weeks after diagnosis. The oral route of drug administration 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)
Treatment of the bacterial 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 treatment for NCPPS.
With positive dynamics of the disease, reduction of symptoms, the prescribed treatment is continued for up to 30-40 days. In addition to antibiotics to treat NCPPS, the following are used:
- a1 - inhibitors.
- NSAIDs.
- Muscle relaxants.
- 5α reductase inhibitors. Currently, there is no data on 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 treatment.
- Effectiveness has not been proven, but FTL is used: electrical stimulation, thermal, magnetic, vibration, laser, ultrasound therapy.
In NCPPS, treatment, improvement of patients' quality of life is doubtful and unlikely due to the low efficacy of most of the reported treatments.
Asymptomatic inflammation
The main goal of treatment for type IV prostatitis is to normalize the level of prostate-specific antigen (PSA) by increasing it. With a normal PSA level, no treatment is required..
The treatment of this type of prostatitis does not require hospitalization and is carried out in outpatient clinics.
Non-drug treatment includes:
- Active lifestyle.
- Elimination of stressful effects on the body (hypothermia, sunshine), which suppress the activity of the body's immune system.
- Use of barrier contraceptive methods.
- Dieting.
Drug treatment 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 the treatment is the reduction of the PSA level 3 months after antibiotic treatment.
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 the 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 adjunctive therapy.
| Drug group | Clinical effect |
|---|---|
| Suppositories based on NSAIDs | They lead to a reduction 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 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 |
Nutrition 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.
Diet modification can lead to a significant improvement in quality of life while reducing the symptoms of the disease.
The most common foods that make prostatitis symptoms worse are:
- Spicy food, spices.
- Spicy pepper.
- Alcoholic beverage.
- Sour foods, marinades.
- Wheat.
- Gluten.
- Caffeine.
The function of the intestine and the pancreas are interconnected: with the development of problems with the intestines, symptoms of inflammation of the prostate may develop, and vice versa.
An important aspect in preventing the development of prostatitis, in preventing the recurrence of inflammation in the gland layer 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 the suppression of the pathological microflora, its replacement, the synthesis of certain vitamins, aid in digestion and, therefore, the maintenance of the human immune system.
Most often, a person consumes probiotics in the form of fermented dairy 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 the best effect and the most complete delivery, capsules with bacteria have been suggested. 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 reduction 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 reduced 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 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 oil and linseed oil, fish oil, marine fish contain unsaturated and polyunsaturated fatty acids in large quantities).
- Foods rich in fiber (oatmeal, pearl barley).
Switching to a Mediterranean diet can lead to a significant reduction in the symptoms of inflammation in the pancreas. Reduced consumption of red meat, consumption of fish, beans, lentils, nuts, which are 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 should limit their alcohol intake or stop drinking it altogether.
We change the way of life
- Limiting 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 reduction 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 in the perineal area leads to stagnation of blood in the pelvis and secretion of the pancreas, leading to an exacerbation of the disease.
- Limitation of thermal processes (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. Under no circumstances should you jump into a pool with cold water after a steam bath / shower with cold water.
- Warm sitz baths lead to relief from prostatitis symptoms. Taking regular hot baths, with the whole body immersed in hot water, has a greater effect compared to baths, where only the perineum and buttocks fall into hot water. In the bath there is a greater relaxation of the muscles of the pelvic floor, a reduction of pathological impulses from the nerve fibers and consequently a reduction of pain.
- Regular sexual activity. Regular ejaculation contributes to pancreatic secretion. The 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 lining of the pancreas.
- The use of barrier contraceptive methods for casual sexual intercourse, the slightest suspicion of an STD in a patient and his sexual partner.
- A frequent issue that concerns 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 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, undergoes regular examinations, then, in this way, he contributes 50% to the success of the treatment of the disease.