Treatment of prostatitis is a slow process that requires a complete 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 treatment tactics.
In acute inflammation, the risk of complications, the emphasis in treatment is on detoxification of the patient, antibacterial and anti-inflammatory therapy.
Antibacterial therapy is used for chronic inflammation in the gland, but it brings 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 pathogenic mechanisms of the disease.
Physiotherapy and diet therapy are added to the antibacterial and anti-inflammatory treatment. It is extremely important for a patient with chronic prostatitis to correct her lifestyle, get rid of bad habits, stressful influences and normalize her psycho-emotional state.
Treatment of acute bacterial prostatitis
mode and diet
- Bed rest.
- Sexual rest during the course of treatment.
- Avoid the stressful effects of environmental factors (hypothermia, overheating, excessive insolation).
- Diet.
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 severe infectious and inflammatory process, accompanied by severe pain, fever, and increased fatigue of the patient.
When the diagnosis of ABP is made, the patient receives parenteral antibiotic therapy. Initially, broad-spectrum antibiotics are prescribed: penicillins, third-generation cephalosporins, fluoroquinolones.
At the beginning of therapy, a combination of one of the listed antibiotics with drugs from 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, before the appointment of empirical antibiotic therapy, it is recommended to conduct a bacterial culture of urine to determine the flora and sensitivity to antibacterial drugs.
As a rule, when ABP and severe intoxication are diagnosed, 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 PBO. 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 abscesses less than 1 cm in diameter.
With premature drainage of a pancreatic abscess, it can open spontaneously, a breakthrough of purulent contents into the fatty tissue surrounding the rectum, with the development of paraproctitis. With paraproctitis, open drainage of the pararectal tissue is necessary.
Approximately 1 in 10 patients with ABP develop acute urinary retention. As a rule, a suprapubic cystostomy is required to remove it (insertion 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 guidance. Before the operation, the tube insertion site is perforated with a local anesthetic solution.
A small incision is made in the skin 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 (hereafter referred to as CKD) is treated with lifestyle changes and medications. Of great importance are:
- Avoid environmental stressors.
- Maintenance of physical activity.
- Diet.
- Regular sexual activity without exacerbation.
- Use of barrier contraceptives.
Medical treatment
Fluoroquinolones are most commonly used in the treatment of chronic bacterial prostatitis (CKD).
This group of drugs is preferred due to its good pharmacokinetic characteristics, antibacterial activity against gram-negative flora, including P. aeruginosa.
Empirical antibiotic therapy is not recommended in CKD..
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 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:
- Lead an active lifestyle.
- Regular sexual life (at least 3 r / week).
- barrier contraception.
- Diet.
- 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 continues for up to 30-40 days. In addition to antibiotics for the treatment of NCPPS, the following are used:
- α1 - blockers.
- NSAIDS.
- Muscle relaxants.
- 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 during the entire therapy period.
- Efficacy has not been proven, but FTL is used: electrostimulation, thermal, magnetic, vibration, laser, ultrasonic therapy.
In NCPPS, the cure, the 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, therapy is not required..
Treatment of this type of prostatitis does not require hospitalization and is performed on an outpatient basis.
Non-drug therapy includes:
- Active lifestyle.
- Elimination of stressful effects on the body (hypothermia, heat stroke), which suppress the activity of the body's immune system.
- Use of barrier contraceptive methods.
- Diet.
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 monitoring 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 repeat prostate biopsies to rule out prostate cancer.
rectal ovules
The main advantage of using rectal suppositories in the treatment of prostatitis is increased 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.
| 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. 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. Main use in proctology. |
| Herbal Suppositories | Local anti-inflammatory, analgesic and antiseptic action. |
| Suppositories based on polypeptides of animal origin | organotropic action |
Diet and rational nutrition.
Diet compliance 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 disease symptoms.
The most common foods that exacerbate the symptoms of prostatitis are:
- Spicy food, spices.
- Spicy pepper.
- Alcoholic drinks.
- Acidic foods, marinades.
- Wheat.
- Gluten.
- Caffeine.
Intestinal function and the 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 the prevention of the development of prostatitis, in the prevention of 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 that contain bacteria that live in a healthy intestine. The main effects of probiotics are the suppression of pathological microflora, its replenishment, 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 to 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).
To get the best effect and a 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, when eating contaminants.
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 intestinal 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 following list:
- Vegetables.
- Fruits (acidic fruits should be avoided as they can aggravate the symptoms of prostatitis).
- vegetal protein.
- Foods rich in zinc, zinc supplements.
- Omega-3 fatty acids (olives, olive and flaxseed oils, fish oil, sea fish contain large amounts of unsaturated and polyunsaturated fatty acids).
- High fiber foods (oats, 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 low in saturated fat and cholesterol.
It is important to maintain adequate body hydration. A man needs to drink between 1. 5 and 2 liters of clean drinking water a day.
You should refrain from drinking soft drinks, 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 to his illness.
- Physical activity. Regular exercise without excessive exercise leads to a decrease in the symptoms of chronic prostatitis. An important aspect is the refusal of sports, accompanied by pressure on the perineum (horse riding, cycling).
- Avoid sitting for a long time. Pressure on the perineal region causes stagnation of blood in the pelvis and discharge from the pancreas, which leads 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 the remission of prostatitis. The possibility of going to the bath, sauna must 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 relieve the symptoms of prostatitis. 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 a greater relaxation of the pelvic floor muscles, a decrease in pathological impulses from nerve fibers and, consequently, a decrease in pain.
- habitual sexual activityRegular ejaculation contributes to the secretion of the pancreas. The prolonged absence of sexual activity, ejaculation leads to stagnation of the secret in the ducts of the pancreas and increases the risk of infection, the development of inflammation in the stroma of the pancreas.
- The use of barrier contraceptive methods for casual sexual relations, the slightest suspicion of an STI in a patient and her sexual partner.
- A topic of frequent concern for 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 treating 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, he reduces the risk factors for recurrence of the disease, undergoes regular examinations and thus contributes his 50% to the success of curing the disease.