Treatment of prostatitis is a lengthy 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 examinations, 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. The realization of this differentiation allows to determine the tactics of treatment.
In acute inflammation, the risk of complications, the emphasis in treatment is on patient detoxification, antibacterial and anti-inflammatory therapy.
Antibacterial therapy for chronic inflammation in the gland is used, but it 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 treatment.
- Avoid stressful effects of environmental factors (hypothermia, overheating, excessive insolation).
- Dieting.
antibacterial drugs
Indication of antibiotic therapy is mandatory for acute bacterial prostatitis (ABP) and is recommended for chronic inflammation in the gland.
PBO is a severe infectious and inflammatory process, accompanied by severe pain, fever and increased patient fatigue.
When the diagnosis of PBA 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, it is possible to combine one of the listed antibiotics with drugs from 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 appointing empirical 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 diagnosing ABP and severe intoxication, the need for infusion therapy, with complications of the disease (pancreas abscess formation, 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 greater than 1 cm in diameter 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 an abscess diameter of less than 1 cm.
With premature drainage of a pancreatic abscess, it can spontaneously open, a rupture of purulent contents in the fatty tissue around the rectum, with the development of paraproctitis. With paraproctitis, open drainage of the pararectal tissue is necessary.
Approximately 1 in 10 patients with ABP develops acute urinary retention. As a rule, a suprapubic cystostomy is needed to eliminate it (the placement of a urinary catheter can be painful and increase the risk of developing CKD).
Most often, trochar 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 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 introduced 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:
- Avoid environmental stressors.
- Maintenance of physical activity.
- Dieting.
- Regular sexual activity without exacerbation.
- Use of barrier contraception.
Medical treatment
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.
Empirical 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 to 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)
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 treatment 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 NPCP, the following are used:
- α1 - blockers.
- Ines.
- Muscle relaxants.
- 5α reductase inhibitors. At present, there is no evidence for the effectiveness of α1-blockers, muscle relaxants, 5α-reductase inhibitors.
- With long-term treatment of NCPPS, it is possible to prescribe herbal preparations: extract of Serenoa repens, Pygeum africanum, Phleum pretense, Zea mays.
- Prostate massage. With NCPPS, it is possible to massage the pancreas up to 3 times a week for the entire period of therapy.
- Efficiency has not been proven, but FTL is used: electrical stimulation, thermal therapy, magnetic, vibration, laser, ultrasound.
In the NCPPS, a cure, the improvement in the patients' quality of life is doubtful and unlikely due to the low efficacy 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, sunstroke), which suppress the activity of the body's immune system.
- Use of barrier methods of contraception.
- Dieting.
Drug therapy includes the indication 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 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 greater 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 above-described prostatitis treatment regimens, that is, they belong to adjuvant therapy.
| group of drugs | clinical effect |
|---|---|
| NSAID-based suppositories | 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 turn 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. |
| herbal suppositories | Local anti-inflammatory, analgesic and antiseptic action. |
| Suppositories based on animal polypeptides | 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 quality of life by reducing disease symptoms.
The most common foods that aggravate the symptoms of prostatitis are:
- Spicy food, spices.
- Spicy pepper.
- Alcoholic beverages.
- Acidic foods, marinades.
- Wheat.
- Gluten.
- Caffeine.
Bowel function and the pancreas are interrelated: with the development of bowel problems, symptoms of inflammation of the prostate gland may occur, 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 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, consequently, 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 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 reach the intestine).
For the best effect and most complete delivery, capsules with bacteria have been proposed. The capsule passes through the harsh environment of the stomach and dissolves 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 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's 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 the products from the list below:
- Vegetables.
- Fruits (acidic fruits should be avoided as they can aggravate the symptoms of prostatitis).
- vegetable protein.
- Foods rich in zinc, zinc supplements.
- Omega-3 fatty acids (olives, olive and linseed oil, fish oil, sea fish contain unsaturated and polyunsaturated fatty acids in large quantities).
- Fiber-rich foods (oats, pearl barley).
The transition to the Mediterranean diet can lead to a significant reduction in symptoms of inflammation in the pancreas. Reduced consumption of red meat, eating fish, beans, lentils, nuts, which are low in saturated fat and cholesterol.
It is important to maintain proper hydration of the body. A man needs to drink about 1. 5-2 liters of clean drinking water per day.
You must refrain from drinking soda, coffee and tea. A patient with prostatitis needs to limit alcohol intake or stop drinking altogether.
We change the way of life
- Limitation of stressful environmental influences, which can lead to 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, improvement 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 (horse riding, cycling).
- Avoiding sitting for a long time. Pressure in the perineal region leads to stagnation of blood in the pelvis and secretion from 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 entrance during 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 a steam room / douse yourself with cold water.
- Warm sitz baths lead to relief of prostatitis symptoms. Regular intake of warm baths, with 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, there is greater relaxation of the pelvic floor muscles, a decrease in pathological impulses from 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 their 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 for patients with prostatitis is the possibility of maintaining 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 joint work between the doctor and the patient.
If the patient complies with all the doctor's recommendations and prescriptions, reduces the risk factors for the recurrence of the disease, undergoes regular examinations, then by this he contributes his 50% to the successful cure of the disease.