Symptoms of prostatitis in men, causes and diagnoses

About 40 to 60% of clinic urological patients are patients with chronic prostatitis.Symptoms of prostatitis in men are often the cause of depressive conditions and changes in the psyche.

The disease that every third man suffers from over 25 to 30 years does not threaten life, but the difficulties of his diagnosis and his treatment determine a long chronic evolution and often lead to a handicap.

The idea of the functions of prostate, mechanisms and causes of inflammation development allow us to properly understand the symptoms and the need for timely treatment.

The functional value of the prostatic gland

Its main function is the secretion of a specific fluid (secret) 40 - 50 glands that form all the glandular tissue of the organ.The secret of 90 to 95% consists of water and main trace elements, phospholipids, amino acids of sperm, which give the sperm a specific odor, enzymes, proteins, citric acid and fructose.All components have their own goal and are strictly balanced.

The secret of the prostate provides:

1. The training and maintenance of a neutral or slightly alkaline environment in the urethra and sperm.This environment provides sperm for the life of sperm.
2. Sperm thinning, necessary to prevent the sperm bond with each other and ensure their promotion.In the process of intercourse, sperm mixed with prostate juice.
3. The viability of sperm: the substances contained in secrecy are a nutritious environment for germ cells, thanks to which they can be located for several days in the female genitals until the fertilization of the egg.
4. Protection of the genito-cross system against infection using zinc, sperm, polyamines and immunoglobulin A. The concentration of zinc in the prostate is 100 times higher than in other organs.It has a pronounced antimicrobial activity, accumulates in iron in the form of protein complexes and is in sperm in the free state;Spermine and polyamines also have a high anti-bacterial activity, and immunoglobulins are involved in the immune protection of the prostate and the urethra.

Prostate iron also participates:

• in hormonal metabolism by the transformation of testosterone from blood, into active dihydrotestosterone;The latter regulates the secretory activity of the gland;This process takes place with the participation of the same zinc;
• in the act of urination using smooth muscle fibers contained in the gland capsule;
• in the ejaculation process with the muscles of the bottom of the pelvis and the part of the urethra passing through the prostate;
• in the formation of the sensation of orgasm due to the vasation of the conduits passing along the lateral surface of the seed tuber;It contains receptors that transmit brain pulses during ejaculation.

Thus, the prostate, as well as participation in the general hormonal status of a man and guaranteeing its possibility of reproduction, protects the urogenitals from the aggression of microorganisms conditionally pathogenic and pathogenic.

Contractive causes and factors

The main cause of the inflammation of the prostate is to get pathogenic and conditional pathogenic microbes.In 60%, it is an E. coli.In recent studies, the role of the participation of gonococcal and trichomonna infections in inflammation is confirmed.In the event of a violation of the protective barrier of the gland and a decrease in local immune defense, the penetration of an infection such as yeasts, mycoplasms and urapapaplasma, herpes virus and cytomegalinir, microorganisms that cause respiratory diseases (in cases of sex).

For tuberculosis diseases, the dissemination of mycobacteria through the blood circulation in the prostate is possible.Isolated cases of tuberculosis prostatitis are found, but rarely.

Ways to penetrate the infection into the gland:

• Hematogen - with blood from other centers of infection;This happens through the venous vessels of the prostate, communicating with the veins of the penis, the testicle, the rectum, the bladder and the kidneys (including with the lesion of tuberculosis)
• Lymphogen - through the lymphatic vessels
• urethrogenic - through the urethra

Contributory factors:

1. The violation of the hormonal context, in particular, a decrease in the level of testosterone, following which the prostatic antimicrobial barrier is reduced.
2. Varicocele (expansion of the veins of the seed), hemorrhoids, varicose veins of the lower limbs.These diseases are the result of a genetic defect in venous valves, which leads to blood microcirculation disorders in the organs located in the basin, an increase in local temperature, reduced in normal (compared to the total body temperature) and the creation of favorable conditions for the vital activity of microorganisms.
3. Osteochondrosis, hernia of the lumbar column and other innervation disorders, a sedentary lifestyle.They can lead to prolonged (narrowing) spasms of the prostate vessels or, conversely, to their long -term expansion.The first leads to an alteration of blood supply, the second - to stagnant blood phenomena.
4. Poisoning is alcohol, leading to paralysis of small vessels and nicotine, contributing to their prolonged spasm.
5. Various infectious diseases, diabetes mellitus, frequent and long negative mental effects, stress states, sleep disorders - all of this helps reduce general immunity.

Types of prostatitis

Basically, the first symptoms of prostatitis are explained by the deterioration of blood supply to the gland due to inflammation or vascular spasm leading to oxygen deficiency, altered metabolic processes with the formation of underestimated disintegration products.They cause powerful irritation of a large number of nervous receptors associated with the ends of the nerves of the testicles, the bladder, the rectum, the penis, the muscles of the bottom of the basin.

In accordance with the classification proposed by the National Institute of Health (depending on the course of the inflammatory process), acute bacterial prostatitis is distinguished, which is rare (around 5% of all cases) and chronic prostatitis.The latter can develop after sharp, but in 90% - 98% of cases are primary.It is assumed that it leads to sexual disorders and infertility.

The chronic form is divided into:

• Bacterial.
• Abacterial or chronic pelvic pain (in the absence of bacteria in studies).It is in turn divided into inflammatory and non -inflammatory.
• Asymptomatic inflammatory (in the absence of obvious symptoms).

Clinical manifestations

Acute prostatitis

The acute course is caused by microorganisms and is characterized by almost simultaneous damage to all glandular lobules.The most common cause is Gonococcus.The inflammatory process can be in the form of an abscess or diffuse inflammation and not an inflammation.The most characteristic symptoms of acute prostatitis are as follows:

• High chills and body temperature (up to 38.5^O and above).
• Severe poisoning - weakness, ailments in joints, headache, increase in the frequency of the impulse, lack of appetite, etc.
• Severe pain in the perineum, in inguinal and lumbar areas.
• Using urination - Fréchente and false desire, pain and difficulty in urination, acute urinary retention.
• Belovoy or transparent discharge of the urethra.

An examination of the prostate finger through the rectum is impossible due to intense pain.In addition, it is contraindicated due to the possibility of dissemination (propagation) of infection in the blood and the development of a septic state.

Chronic prostatitis

The recommended classification reflects the fact that the signs of chronic prostatitis in men are very diversified and that the opinions of doctors on the causes and mechanisms of the development of the disease are largely different.The diagnosis is based on the patient's complaints, clinical examination on an examination of the gland's fingers through the rectum (rectal) and ultrasound examination.At the same time, the degree of pain, size and volume, contours, coherence uniformity and the presence of softening or sealing areas are assessed.

Partly the functional capacity of the organ and, above all, the presence or absence of inflammation process, as well as the form of the disease, allows you to assess the study of prostatic secretion.It is obtained as a result of a finger massage of a prostate with a subsequent bacteriological analysis of the material (secret), the conduct of the PCR (chain reaction by polymerase) to detect conditional pathogenic microorganisms and pathogens of sexual infections and an analysis of the spermogram.

General symptoms of various forms of chronic prostatitis:

1. Disfort or / and moderate pain in the form of "ailments" and severity in the perineum, which occur or intensify after having drunk alcoholic drinks, physical activity, sexual contact.Sometimes they pass a paroxysmal nature.
2. A feeling of discomfort and crusia in the urethra during urination or sexual contact, a minor discharge from the urethra serôle (mainly after a long -term delay in the urine).
3. A sudden desire to urinate (sometimes up to 3 times in 1 hour) and a feeling of insufficient emptying of the bladder, which is explained by a violation of the nervous regulation of the prostate, its muscle fibers and the bladder.
4. By reducing the ability to fertilize, which is caused by an increase in the acidity of secrecy, a decrease or lack of mobility of sperm, their agglutination (collage) with the heads.
5. Pain for orgasm or sensations erased of orgasm, ejaculation disorders, expressed in its premature or, conversely, in the excessive duration of sexual intercourse.These phenomena are associated with the inflammatory process in the field of the seminal tuber or with its healing following inflammation.

The information presented allows us to understand the need and the importance of the appropriate attraction to a qualified specialist in the event of certain symptoms and the abandonment of various non-traditional methods of self-medication.The treatment is only prescribed after a complete and in -depth examination in order to establish the cause and form of the disease.

Differential diagnosis

The differential diagnosis of acute prostatitis and distinctive signs of chronic prostatitis in men are reflected in the table:

The form of prostatitis	The main symptoms	Laboratory data
Acute bacterial	Acute start, intense pain in the crotch High temperature, poisoning, muddy, often with a mixture of blood, urine	Leukocytosis (increased number of leukocytes in the blood) ESR accelerated A large number of red blood cells and leukocytes in urine analysis Perhaps the presence of gonococci
Chronic bacterial	Pain in the pelvic floor of a moderate nature, Pain for ejaculation, Premature ejaculation, dysuria. Some symptoms may be absent	Red blood cells in a microscopic examination of the secret of the gland, E.Coli, enterobacteria, klebsell or other microorganisms on bacteriological examination of the ejacult
Chronic abacourish (chronic pelvic pain syndrome):	Pain in the basin of a moderately expressed nature for 3 months	In conventional studies, bacteria are not detected
inflammatory	Pronounced dysuric disorders, In 40 to 65% moderate pain at the bottom of the abdomen and in the genital zone of 3 months or more	The presence of leukocytes in the secret of the gland and in the third part of the urine during the Meares -Stadey test (study of 4 sequential parts of urine - "Gold Standard" of the laboratory diagnosis of chronic prostatitis laboratory)
non -inflammatory or stagnant (40% of patients with prostatitis)	Unexpressed pelvic pain and discomfort of 3 months or more. Dizurical disorders rarely.	Inflammation laboratory data is not detected
Asymptomatic inflammatory prostatitis	Clinical subjective symptoms are absent	The presence of signs of inflammation