Treatment of prostatitis is a long-term process that requires a comprehensive examination of the patient. For proper treatment of patients 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 distinguish between acute and chronic inflammation in the gland, bacterial and aseptic process. Carrying out this differentiation allows you to determine the tactics of treatment.
In case of 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 out of 10 patients, since chronic prostatitis does not always have only a bacterial etiology.
Therefore, an extremely important aspect in the treatment of chronic prostatitis is the complex action on all known pathogenetic mechanisms of the disease.
In addition to antibacterial and anti-inflammatory treatment, physiotherapy and diet therapy are added. For a patient with chronic prostatitis, it is extremely important to correct the way of life, get rid of bad habits, stressful influences and normalize the psycho-emotional state.
Treatment of acute bacterial prostatitis
Mode and diet
- Bed rest.
- Sexual rest during treatment.
- Avoiding stressful effects of environmental factors (hypothermia, overheating, excessive insolation).
- Diet.
Antibacterial drugs
Appointment of antibiotic therapy is mandatory for acute bacterial prostatitis (ABP) and is recommended for chronic inflammation in the gland.
OBP is a serious infectious and inflammatory process, accompanied by severe pain, elevated temperature and increased fatigue of patients.
When ABP is diagnosed, the patient is given parenteral antibiotic therapy. Initially, broad-spectrum antibiotics are prescribed - penicillins, 3rd generation cephalosporins, fluoroquinolones.
At the beginning of therapy, a combination of one of the mentioned antibiotics with drugs from the group of aminoglycosides is possible. After stopping the acute process and normalizing the patient's condition, they switch to oral antibiotics and continue the therapy for 2-4 weeks.
If possible, before appointing empiric antibiotic therapy, it is recommended to make 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 pancreatic abscess, acute urinary retention), the patient is hospitalized.
In the absence of complications, fever can be treated on an outpatient basis with oral medications.
Operational interventions
Surgical treatment is indicated for complications of OBP. An abscess larger than 1 cm in diameter is an absolute indication for surgery.
A transrectal or perineal approach is used to drain a pancreatic abscess under transrectal ultrasound (TRUS) guidance.
There is evidence of the effectiveness of therapy with an abscess diameter of less than 1 cm.
With untimely drainage of a pancreatic abscess, it can spontaneously open, break through the purulent contents into the fatty tissue surrounding the rectum, with the development of paraproctitis. In case of paraproctitis, open drainage of the pararectal tissue is necessary.
About 1 in 10 patients with ABP develop acute urinary retention. As a rule, a suprapubic cystostomy is needed 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 control. Before the operation, the tube insertion site is punctured with a local anesthetic solution.
A small cut on 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.
Treatment of chronic bacterial prostatitis
Chronic bacterial prostatitis (CKD) is treated with lifestyle changes and medication. Of great importance are:
- Avoiding environmental stressors.
- Maintaining physical activity.
- Diet.
- Regular sexual activity without worsening.
- Use of barrier contraception.
Treatment
Fluoroquinolones are more 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.
Empiric 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 4-6 weeks after diagnosis. Oral 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 the identified 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 to:
- Leading 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 the positive dynamics of the disease, the reduction of symptoms, the prescribed therapy continues for up to 30-40 days. In addition to antibiotics to treat NCPPS, the following are also used:
- α1 - blockers.
- NSAIDs.
- Muscle relaxants.
- 5α reductase inhibitors. There is currently no evidence of the effectiveness of α1-blockers, muscle relaxants, and 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 during the entire period of therapy.
- Efficiency is not proven, but FTL is used: electrical stimulation, thermal, magnetic, vibration, laser, ultrasound therapy.
In NCPPS, healing, improving the quality of life of patients is doubtful and unlikely due to the low efficiency of most of the mentioned therapies.
Asymptomatic inflammation
The main goal of therapy for prostatitis type IV 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 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 contraception methods.
- Diet.
Drug therapy includes prescribing antibiotics with subsequent monitoring of effectiveness, i. e. fluoroquinolones, tetracyclines or sulfonamides for 30-40 days with control of PSA levels.
The criterion for the effectiveness of the therapy is the reduction of the PSA level 3 months after the antibiotic therapy.
Long-term elevated PSA levels in type IV prostatitis require repeat 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 drug concentration in the vessels of the small pelvis, around the pancreas.
As a rule, rectal suppositories complement the above-mentioned prostatitis treatment regimens, that is, they belong to adjuvant therapy.
| A group of drugs | Clinical effect |
|---|---|
| Suppositories based on NSAIDs | They reduce the synthesis of pro-inflammatory factors, reduce pain and stop fever. |
| Suppositories with antibacterial drugs | It is rarely used in the treatment of prostatitis. Doctors more often resort to intramuscular or intravenous antibiotics to treat bacterial prostatitis. |
| Suppositories with local anesthetics | In addition to local anesthetic action, 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 effect |
Diet and rational nutrition
Compliance with nutrition is a key 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 of the pancreas, the development of symptoms of prostatitis.
Dietary modification can lead to a significant improvement in quality of life while reducing disease symptoms.
The most common foods that worsen the symptoms of prostatitis are:
- Spicy food, spices.
- hot pepper.
- Alcoholic beverages.
- Sour food, marinades.
- Wheat.
- Gluten.
- Caffeine.
The function of the intestines and pancreas are interconnected: 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 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 suppression of pathological microflora, its replacement, synthesis of certain vitamins, aid in digestion and, as a result, maintenance of 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 the sensitivity 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 of them reach the intestines).
For best effect and more complete delivery, capsules with bacteria are suggested. 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, consuming pollutants.
Food allergies can also contribute to the development of prostatitis.
Many men notice an improvement in their condition, a reduction in disease 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 consequence of disturbed bowel function is a number of pathologies, including prostatitis.
In general, it is important to switch to a healthy diet and avoid foods that can cause inflammation of the pancreas. It is necessary to increase the consumption of products from the list below:
- Vegetables.
- Fruits (sour fruits should be avoided because they can worsen the symptoms of prostatitis).
- vegetable protein.
- Foods rich in zinc, zinc supplements.
- Omega-3 fatty acids (olives, olive and linseed oil, fish oil, marine fish contain unsaturated and polyunsaturated fatty acids in large quantities).
- Food rich in fiber (oatmeal, pearl barley).
Switching to a Mediterranean diet can lead to a significant reduction in the symptoms of pancreatitis. Reduced consumption of red meat, eating fish, beans, lentils, nuts that are low in saturated fat and cholesterol.
It is important to maintain adequate body hydration. A person should drink about 1. 5-2 liters of clean drinking water per day.
You should refrain from drinking carbonated drinks, coffee and tea. A patient with prostatitis should limit alcohol intake or stop drinking it completely.
We are changing the way of life
- Limiting 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, 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 reduction in the symptoms of chronic prostatitis. An important aspect is the rejection of sports, accompanied by pressure on the perineum (riding, cycling).
- Avoiding prolonged sitting. Pressure on the perineal region leads to stagnation of blood in the pelvis and secretion of the pancreas, which leads to aggravation of the disease.
- Restriction of thermal procedures (bath, sauna) during exacerbation of the disease. It is possible to visit the baths, saunas in short courses of 3-5 minutes upon entry during prostatitis remission. The possibility of going to the bath, sauna should be agreed with the doctor, 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 bath / douse yourself with cold water.
- Warm sitz baths lead to relief of symptoms of prostatitis. Regularly taking warm baths, with the whole body immersed in warm water, has a greater effect compared to baths where only the perineum and buttocks fall into the warm water. In the bathtub, there is greater relaxation of the muscles of the pelvic floor, reduction of pathological impulses from nerve fibers and, consequently, reduction of pain.
- Regular sexual activity. Regular ejaculation contributes to pancreatic secretion. Long-term absence of sexual activity, ejaculation leads to stagnation of the secret in the ducts of the pancreas and increases the risk of its infection, development of inflammation in the pancreatic stroma.
- The use of barrier contraceptive methods for casual sexual relations, the slightest suspicion of an STI in the patient and his sexual partner.
- A frequent issue that worries patients with prostatitis is the ability to maintain sexual activity. A patient with chronic prostatitis is not prohibited from sexual intercourse. In case of acute inflammation of the pancreas, sexual silence is recommended.
Success in the treatment of prostatitis does not belong exclusively to the doctor, but is the result of the joint work of the doctor and the patient.
If the patient adheres to all the recommendations and instructions of the doctor, reduces the risk factors for the recurrence of the disease, undergoes regular examinations, then with his 50% he contributes to the success of curing the disease.