Treatment of prostatitis is a time-consuming 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 examination, test results and methods of instrumental research.
It is important for the doctor to distinguish between acute and chronic inflammation in the gland, bacterial and aseptic process. Achieving this differentiation allows you to determine treatment tactics.
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 of the gland is used, but has a positive effect only in 1-2 out of 10 patients, since chronic prostatitis does not always have 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 dietetics are added to antibacterial and anti-inflammatory treatments. 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 of acute bacterial prostatitis
Fashion and diet
- Rest in bed.
- Sexual rest during treatment.
- Avoidance of the stressful effects of environmental factors (hypothermia, overheating, excessive insolation).
- Go on a diet.
The appointment of antibiotic therapy is mandatory for acute bacterial prostatitis (AAP) and is recommended for chronic inflammation of the gland.
OBP 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 treatment, a combination of one of the listed antibiotics with drugs from the group of aminoglycosides is possible. After stopping the acute process and normalizing the patient's condition, he is transferred to oral antibiotics and continues treatment for 2-4 weeks.
If possible, before the appointment of empirical antibiotic therapy, it is recommended to perform 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 (formation of an abscess of the pancreas, acute urinary retention), the patient is hospitalized.
In the absence of complications, fever is a possible outpatient treatment with oral medications.
Surgical treatment is indicated for complications of PBO. An abscess of more 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 treatment with an abscess diameter of less than 1 cm.
With untimely drainage of a pancreatic abscess, it can open spontaneously, a breakthrough of purulent contents in the fatty tissue surrounding the rectum, with the development of paraproctitis. With paraproctitis, open drainage of the pararectal tissue is necessary.
About 1 in 10 patients with PBA develop acute urinary retention. Usually, a suprapubic cystostomy is needed to remove it (placing a urinary catheter can be painful and increase the risk of developing CRF).
Most often, trocar cystostomy is performed under local anesthesia and under ultrasound guidance. Before the operation, the tube insertion site is 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 passed into the bladder.
Management of chronic bacterial prostatitis
Chronic bacterial prostatitis (hereafter referred to as CKD) is treated with lifestyle changes and medication. Of great importance are:
- Avoid environmental stressors.
- Maintenance of physical activity.
- Go on a diet.
- Regular sexual activity without exacerbation.
- Use of 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 characteristics, antibacterial activity against gram-negative flora, including P. aeruginosa.
Empirical antibiotic therapy in CKD is not recommended..
The duration of treatment is selected depending 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)
Treatment of the abacterial form of inflammation of the pancreas can be carried out on an outpatient basis.
The patient is informed:
- Lead an active lifestyle.
- Regular sexual life (at least 3 r/week).
- barrier contraception.
- Go on a diet.
- Excluding 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 treatment is continued for up to 30-40 days. In addition to antibiotics for the treatment of NCPPS, the following are used:
- α1 - blockers.
- Muscle relaxants.
- 5α reductase inhibitors. Currently, 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 per week for the duration of the therapy.
- Effectiveness has not been proven, but FTL is used: electrical, thermal, magnetic stimulation, vibration, laser, ultrasound therapy.
In the NCPPS, a cure, an improvement in the quality of life of patients is doubtful and unlikely due to the low efficacy of most of the listed therapies.
The main goal of treatment of type IV prostatitis is to normalize the level of prostate-specific antigen (PSA) with its increase. With a normal PSA level, no therapy is needed..
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, insolation), which suppress the activity of the body's immune system.
- Use of barrier contraceptive methods.
- Go on a diet.
Pharmacotherapy 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 of treatment efficacy is a reduction 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.
The main advantage of using rectal suppositories in the treatment of prostatitis is 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 treatment regimens for prostatitis presented above, that is, they belong to the adjuvant therapy.
|Drug group||Clinical effect|
|NSAID suppositories||They cause 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 use 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 polypeptides of animal origin||Organotropic action|
Rational diet and 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 of 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 exacerbate prostatitis symptoms are:
- Spicy food, spices.
- Spicy pepper.
- Alcoholic beverages.
- Acid foods, marinades.
Intestinal function and the pancreas are interdependent: with the development of intestinal problems, 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 stroma of the gland during the chronic course of the disease, is the intake of probiotics.
Probiotics are preparations containing bacteria that live in a healthy gut. The main effects of probiotics are the suppression of pathological microflora, its replacement, the synthesis of certain vitamins, the aid in digestion and, therefore, 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 acid environment of the stomach (most bacteria die in the stomach under the action of hydrochloric acid, and only a small number of themreach the intestine).
For a better effect and a more complete delivery, capsules containing bacteria have been proposed. The capsule passes through the harsh 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 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 of the pancreas. It is necessary to increase the consumption of the products of the list below:
- 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 flax oils, fish oil, sea fish contain unsaturated and polyunsaturated fatty acids in large quantities).
- Foods rich in fiber (oatmeal, pearl barley).
Transitioning to the Mediterranean diet can lead to a significant reduction in symptoms of pancreatic inflammation. 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 drinking water per day.
You should refrain from drinking soda, coffee and tea. A patient with prostatitis should limit alcohol intake or stop drinking it altogether.
We change the way of life
- Limitation of stressful environmental influences that 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 a reduction in the patient's fixation on his disease.
- 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 (riding, cycling).
- Avoid prolonged sitting. Pressure on the perineal region leads to stagnation of blood in the pelvis and secretion from the pancreas, leading to exacerbation of the disease.
- Limitation of thermal acts (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 of cold water after the hammam / douse yourself with cold water.
- Hot sitz baths relieve the symptoms of prostatitis. Regular taking of hot baths, with immersion of the whole body 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 greater relaxation of the muscles of the pelvic floor, a decrease in pathological impulses of nerve fibers and, as a result, 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 its infection, the development of inflammation in the stroma of the pancreas.
- The use of barrier contraceptive methods for casual sex, the slightest suspicion of STIs in a patient and his sexual partner.
- A common concern in 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 in case of acute inflammation of 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 follows all the recommendations and prescriptions of the doctor, reduces the risk factors for the recurrence of the disease, regularly undergoes examinations, then he contributes up to 50% to the successful cure of the disease.