Treatment of prostatitis is a time-consuming process that requires a thorough examination of the patient. For the correct management of patients with prostatitis, an accurate diagnosis is required based on examination, laboratory results, and instrumental study methods.
It is important for the physician to distinguish between acute and chronic inflammation in the gland, bacteria, and aseptic process. Making this distinction allows you to define treatment tactics.
In acute inflammatory conditions, the risk of complications, the focus of treatment is on patient detoxification, antibacterial and anti-inflammatory therapy.
Antibacterial therapy for chronic prostatitis is used, but only leads to a positive effect in 1-2 patients out of 10, since chronic prostatitis is not always the only cause. caused by bacteria.
Therefore, an extremely important aspect of the treatment of chronic prostatitis is the complex effect on all known pathogenesis of the disease.
Physical therapy and dietary therapy are added for antibacterial and anti-inflammatory treatment. It is extremely important for patients with chronic prostatitis to adjust their lifestyle, get rid of bad habits, stressful influences, normalize the psycho-emotional state.
Treatment of acute bacterial prostatitis
Diet and Diet
- Rest in bed.
- Rest sexually during treatment.
- Avoid the stressful effects of environmental factors (hypothermia, overheating, excessive sun exposure).
The appointment of antibiotic therapy is mandatory for acute bacterial prostatitis (ABP) and is recommended for chronic inflammation of the gland.
OBP is a severe inflammatory process, accompanied by severe pain, fever, and increased fatigue in the patient.
When a diagnosis of ABP was made, the patient was treated with parenteral antibiotics. Initially, broad-spectrum antibiotics are prescribed - penicillins, 3rd generation cephalosporins, fluoroquinolones.
At the beginning of treatment, one of the antibiotics listed can be combined with drugs of the aminoglycoside group. After stopping the acute process and normalizing the patient's condition, they are switched to oral antibiotics and continued treatment for 2-4 weeks.
If possible, before empiric antibiotic therapy is indicated, a urine culture should be performed to determine flora and antimicrobial susceptibility.
As a rule, when ABP and severe intoxication are diagnosed, it is necessary to treat with fluids, with complications of the disease (forming pancreatic abscess, acute urinary retention), the patient must be hospitalized.
In the absence of complications, fever can be treated as an outpatient with oral medications.
Surgical treatment is indicated for complications of OBP. Abscesses with a diameter of more than 1 cm are absolute indications for surgery.
A transrectal or perineal approach is used to drain a pancreatic abscess under transrectal ultrasound (TRUS) control.
There is evidence of effectiveness in the treatment of abscesses less than 1 cm in diameter.
With untimely drainage of the pancreatic abscess, it can open on its own, the infiltration of purulent substances into the fatty tissue around the rectum, with the development of pleurisy. With pararectal inflammation, open drainage of the pararectal tissue is necessary.
About 1 in 10 patients with ABP develop acute urinary retention. As a rule, a suprapubic cystectomy is required to remove it (catheterization can be painful and increase the risk of developing CKD).
Typically, the trocar stoma is performed under local anesthesia and under ultrasound control. Before surgery, the tube site was 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 inserted into the bladder.
Treatment of chronic bacterial prostatitis
Chronic bacterial prostatitis (hereinafter referred to as CKD) is treated with lifestyle changes and medication. Of great importance are:
- Avoid environmental stressors.
- Maintain physical activity.
- Regular sexual activity without exacerbations.
- Use barrier contraception.
Fluoroquinolones are more commonly used in the treatment of chronic bacterial prostatitis (CKD).
This group of drugs is preferred due to its good pharmacokinetic properties, antibacterial activity against gram-negative bacteria, including P. aeruginosa.
Empiric antibiotic therapy in CKD is not recommended..
The duration of treatment is selected based on the specific clinical situation, the patient's condition and the presence of symptoms of toxicity.
In CKD, the duration of antibiotic therapy is 4-6 weeks after diagnosis. Oral administration of the drug in high doses is preferred. If CKD is caused by intracellular bacteria, drugs from the tetracycline group are prescribed.
Antibacterial therapy for identified pathogens includes the appointment of the following drugs.
Chronic pelvic pain syndrome (CPPS)
Treatment of the bacterial form of pancreatitis can be done on an outpatient basis.
Patients are advised to:
- Lead an active lifestyle.
- Regular sex life (at least 3 r/week).
- contraceptive barrier.
- Exclude alcohol.
Although there is no bacterial component, a two-week course of treatment for NCPPS can be prescribed.
With the positive dynamics of the disease, relief of symptoms, the prescribed therapy is continued for up to 30-40 days. In addition to antibiotics to treat NCPPS, the following are used:
- α1 - blocker.
- Muscle relaxants.
- 5α reductase inhibitor. Currently, there is no evidence for the efficacy of α1 blockers, muscle relaxants, and 5α reductase inhibitors.
- For long-term treatment of NCPPS, herbal preparations can be prescribed: 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 for the duration of treatment.
- Efficacy has not been proven, but FTL is used: electrical, thermal, magnetic, vibration, laser, ultrasonic stimulation.
In NCPPS, a cure or improvement in the patient's quality of life is questionable and unlikely due to the low efficacy of most of the therapies listed.
The primary goal of treatment for type IV prostatitis is to normalize prostate-specific antigen (PSA) levels with its elevation. With normal PSA levels, no treatment is needed..
Treatment of this type of prostatitis does not require hospitalization and is done on an outpatient basis.
Non-drug therapies include:
- Active lifestyle.
- Eliminates the effects of stress on the body (hypothermia, heat stroke) that suppress the activity of the body's immune system.
- Use barrier methods of contraception.
Drug therapy consists of the appointment of antibiotics with subsequent monitoring of effectiveness, namely fluoroquinolones, tetracyclines or sulfonamides for a period of 30-40 days with control of PSA levels.
The efficacy endpoint of therapy was a reduction in PSA levels 3 months after antibiotic treatment.
Long-term elevated PSA levels in type IV prostatitis necessitate multiple prostate biopsies to rule out prostate cancer.
The main advantage of using rectal suppositories in the treatment of prostatitis is the higher bioavailability compared to the oral form and the production of the highest concentration of the drug in the vessels of the small pelvis, around the prostate gland. pancreas.
As a rule, rectal suppositories complement the prostatitis regimen presented above, that is, they belong to adjuvant therapy.
|drug group||clinical efficacy|
|Suppositories based on NSAID||They lead to a decrease in the synthesis of inflammatory factors, analgesia, and antipyretic.|
|Suppositories with antibacterial drugs||It is rarely used in the treatment of prostatitis. Typically, doctors use antibiotics intramuscularly or intravenously to treat bacterial prostatitis.|
|Suppositories with local anesthetic||In addition to the local anesthetic effect, they also have an anti-inflammatory effect, improve microcirculation in the pancreas. Main use in proctology.|
|Plant-based suppositories||Local anti-inflammatory, analgesic and antiseptic effect.|
|Suppositories based on polypeptides of animal origin||organic action|
Proper diet and nutrition
Dietary adherence is an important point in the treatment of chronic prostatitis. Certain types of products, the body's allergic reaction to them, can lead to the development of inflammation in the pancreas, the development of symptoms of prostatitis.
Dietary adjustments can lead to significant improvements in quality of life while reducing symptoms of the disease.
The most common foods that aggravate prostatitis symptoms are:
- Spicy, spiced food.
- Spicy pepper.
- Acoholic drink.
- Sour foods, sauces.
Bowel and pancreatic function are interrelated: with the development of bowel problems, prostatitis symptoms can develop and vice versa.
An important aspect in the prevention of the development of prostatitis, in the prevention of recurrence of inflammation in the stroma of the gland during the chronic course of the disease, is the use of probiotics.
Probiotics are preparations containing bacteria that live in the healthy gut. The main effect of probiotics is to inhibit the pathological microflora, replace it, synthesize some vitamins, aid in digestion and, as a result, maintain 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 that the bacteria are easily damaged by the acidic environment of the stomach (most bacteria die in the stomach under the action of hydrochloric acid and only a few of them reach the intestines). ).
For the best effect and a more complete supply, capsules containing the bacteria have been suggested. The capsule passes through the active 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, ingesting pollutants.
Food allergies can also contribute to the development of prostatitis.
Many men report an improvement in their condition and a reduction in their symptoms 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 cause pancreatitis. It is necessary to increase product consumption from the list below:
- Fruits (Acid fruits should be avoided as they can worsen prostatitis symptoms).
- vegetable protein.
- Zinc-rich foods, zinc supplements.
- Omega-3 fatty acids (olive, olive and flaxseed oils, fish oils, marine fish contain polyunsaturated and unsaturated fatty acids in large quantities).
- Foods rich in fiber (oatmeal, pearl barley).
Switching to a Mediterranean diet can lead to a significant reduction in inflammatory symptoms in the pancreas. Reduce your consumption of red meat, eat fish, beans, lentils, nuts and seeds that 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 water per day.
You should limit drinking soda, coffee and tea. A patient with prostatitis needs to limit alcohol intake or stop drinking altogether.
We change the way we live
- Limit stressful environmental influences, which can lead to weakening of the patient's immune system.
- Normalization of psycho-emotional state. It leads to an improvement in symptoms due to increased pain thresholds, improved immune system functioning, and fewer patients getting sick.
- Physical activity. Regular non-exercising exercise will reduce the symptoms of chronic prostatitis. An important aspect is the refusal of sports that are accompanied by pressure on the perineum (riding, cycling).
- Avoid sitting for long periods of time. Pressure on the perineum leads to stagnation of pelvic blood and pancreatic secretions, leading to exacerbations of the disease.
- Limit thermal procedures (bath, sauna) during exacerbations of the disease. It is possible to visit the baths, saunas in short courses of 3-5 minutes per entry during the period of remission of prostatitis. The ability to take a 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 of cold water after a steam room / splash cold water on yourself.
- Taking a warm bath helps relieve symptoms of prostatitis. Taking regular warm baths, soaking the whole body in warm water, has a greater effect than taking a bath in which only the perineum and buttocks are soaked in warm water. In the bath, the pelvic floor muscles are more relaxed, reducing pathological impulses from nerve fibers and, as a result, pain.
- Regular sexual activity. Regular ejaculation contributes to the promotion of pancreatic secretion. Prolonged periods of sexual inactivity and ejaculation lead to stagnation of secretions in the pancreatic ducts and increase the risk of infection and development of inflammation in the stroma of the pancreas.
- The use of barrier methods of contraception for casual sex, the slightest suspicion of an STI in the patient and his sexual partners.
- An issue frequently concerned by patients with prostatitis is the ability to remain sexually active. 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 belongs not only to the attending physician, but is the result of the joint efforts of the doctor and the patient.
If the patient adheres to all recommendations and instructions of the doctor, minimizes the risk factors for disease recurrence, and has regular check-ups, then it has contributed 50% of his/her contribution to the successful cure of the disease.