Treatment of prostatitis is a time-consuming process that requires a thorough examination of the patient. The correct treatment of prostatitis patients needs to make an accurate diagnosis based on inspection, laboratory results and instrument research methods.
Physicians must distinguish between acute and chronic inflammation of glands, bacteria, and sterile processes. Making this distinction allows you to determine treatment strategies.
In acute inflammation, the risk of complications, treatment focuses on detoxification of the patient, antibacterial and anti-inflammatory therapy.
Antimicrobial therapy against chronic inflammation of the glands is used, but only positive results are seen in 1-2 out of 10 patients, as chronic prostatitis is not always of bacterial etiology only.
Therefore, an extremely important aspect of the treatment of chronic prostatitis is the complex influence on all known disease pathogenesis.
Add physical therapy and diet therapy on the basis of antibacterial and anti-inflammatory treatment. For patients with chronic prostatitis, it is extremely important to correct the lifestyle, get rid of bad habits, stress effects, and normalize the psycho-emotional state.
Treatment of Acute Bacterial Prostatitis
way and diet
- rest on bed.
- Sexual life rest during treatment.
- Avoid stressful effects of environmental factors (hypothermia, overheating, excessive sun exposure).
- diet.
antibacterial drugs
Antibiotic therapy is mandatory for acute bacterial prostatitis (ABP) and recommended for chronic inflammation of the gland.
OBP is a severe infectious and inflammatory process with severe pain, fever and increased patient fatigue.
When a diagnosis of ABP is made, the patient will be treated with parenteral antibiotics. Initially, broad-spectrum antibiotics are prescribed - penicillins, third-generation cephalosporins, fluoroquinolones.
At the beginning of treatment, one of the listed antibiotics can be combined with aminoglycosides. After the acute process has stopped and the patient's condition has returned to normal, they will switch to oral antibiotics and continue treatment for 2-4 weeks.
If possible, bacterial culture of urine to determine flora and susceptibility to antimicrobial agents is recommended before empiric antibiotic therapy is prescribed.
Usually, at the time of diagnosis of ABP and severe intoxication, infusion therapy is required, and with complications of the disease (pancreatic abscess formation, acute urinary retention), the patient requires hospitalization.
In the absence of complications, fever can be treated as an outpatient with oral medications.
operational intervention
Surgical treatment is indicated for complications of OBP. Abscesses larger than 1 cm in diameter are absolute indications for surgery.
Transrectal or perineal access is used to drain pancreatic abscesses under control of transrectal ultrasound (TRUS).
There is evidence that it is effective in treating abscesses smaller than 1 cm in diameter.
With undrained pancreatic abscess, it may open spontaneously, the purulent contents enter the fatty tissue around the rectum, and develop pararectitis. For pararectitis, open drainage of the pararectal tissue is necessary.
Acute urinary retention occurs in approximately one in ten patients with ABP. Often, a suprapubic cystostomy is needed to remove it (placement of a urinary catheter can be painful and increases the risk of CKD).
In most cases, a trocar cystostomy is performed under local anesthesia and ultrasound control. Before surgery, the tube insertion site is punctured with a local anesthetic solution.
Make a small incision in the skin with a scalpel. Under ultrasound guidance, a trocar is inserted into the bladder cavity, and a catheter is inserted into the bladder through the trocar.
Treatment of Chronic Bacterial Prostatitis
Chronic bacterial prostatitis (hereinafter referred to as CKD) is treated through lifestyle changes and medication. It is very important to:
- Avoid environmental stressors.
- Stay physically active.
- diet.
- Regular sexual activity, no exacerbations.
- Use barrier contraception.
medical treatement
Fluoroquinolones are more commonly used to treat chronic bacterial prostatitis (CKD).
This group of drugs is preferred due to favorable pharmacokinetic properties, antibacterial activity against Gram-negative bacterial groups, including Pseudomonas aeruginosa.
Empiric antibiotic therapy for CKD is not recommended..
The duration of treatment is selected according to the specific clinical situation, the condition of the patient and the presence of symptoms of intoxication.
In CKD, the duration of antibiotic therapy is 4-6 weeks after diagnosis. The oral route of administration for high doses of drug is preferred. Tetracyclines are prescribed if CKD is caused by intracellular bacteria.
Antimicrobial therapy against established pathogens includes the following drugs as prescribed.
Chronic Pelvic Pain Syndrome (CPPS)
Treatment of nonbacterial pancreas inflammation can be done on an outpatient basis.
Patients are advised to:
- Live an active lifestyle.
- Have regular sex (at least 3 times/week).
- Barrier contraception.
- diet.
- Rule out alcohol.
Although there is no bacterial component, a two-week course of treatment may be prescribed for NCPPS.
With active disease dynamics, symptoms lessen and prescribed treatment is continued for up to 30-40 days. In addition to antibiotics used to treat NCPPS, the following medicines are used:
- α1-blocker.
- NSAIDs.
- Muscle relaxants.
- 5α-reductase inhibitors. Currently, there is no evidence of the effectiveness of α1-blockers, muscle relaxants, or 5α-reductase inhibitors.
- For long-term treatment of NCPPS, herbal preparations can be prescribed: Saw Palmetto Extract, Pygeum africana, Phleum pretense, Corn.
- Prostate massage. With NCPPS, the pancreas can be massaged up to 3 times a week throughout the treatment period.
- Efficiency has not been proven, but FTL is used: electrical stimulation, heat, magnetism, vibration, laser, ultrasound therapy.
In NCPPS, cure, improvement of patient's quality of life is questionable and unlikely due to poor efficacy of most of the listed therapies.
asymptomatic inflammation
The main goal of treating type IV prostatitis is to normalize the level of prostate-specific antigen (PSA) as it rises. If the PSA level is normal, no treatment is needed..
Treatment for this type of prostatitis does not require a hospital stay, but is done on an outpatient basis.
Nondrug therapies include:
- active lifestyle.
- Eliminates the effects of stress on the body (hypothermia, sun exposure), which suppress the activity of the body's immune system.
- Use a barrier method of contraception.
- diet.
Drug therapy consists of prescribed antibiotics with subsequent monitoring of effectiveness, i. e. fluoroquinolones, tetracyclines, or sulfonamides, for 30-40 days with control of PSA levels.
Treatment effectiveness was defined as a decrease in PSA levels 3 months after antibiotic treatment.
Chronically elevated PSA levels in type IV prostatitis require repeated prostate biopsies to rule out prostate cancer.
rectal suppositories
The main advantages of using rectal suppositories for the treatment of prostatitis are higher bioavailability compared to oral medications and the highest concentration of the drug is produced in the small pelvic vessels surrounding the pancreas.
As a rule, rectal suppositories are an addition to the above-mentioned treatment regimens for prostatitis, that is, they belong to adjuvant therapy.
| drug group | clinical effect |
|---|---|
| Suppositories based on NSAIDs | They lead to a decrease in the synthesis of pro-inflammatory factors, reduce pain and stop fever. |
| suppositories containing antimicrobials | It is rarely used to treat prostatitis. More commonly, doctors treat bacterial prostatitis with intramuscular or intravenous antibiotics. |
| local anesthetic suppository | In addition to their local anesthetic effect, they also have an anti-inflammatory effect and improve pancreatic microcirculation. Mainly used in proctology. |
| herbal suppositories | Topical anti-inflammatory, analgesic and antiseptic action. |
| Suppositories based on peptides of animal origin | Nootropic effect |
Diet and Proper Nutrition
Compliance with dietary habits 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 prostatitis symptoms.
Dietary modifications can significantly improve quality of life while reducing disease symptoms.
The most common foods that can aggravate prostatitis symptoms are:
- Spicy food, spices.
- Spicy chili.
- Alcoholic beverages.
- Sour foods, marinades.
- wheat.
- gluten.
- caffeine.
Bowel function and pancreas are interrelated: as bowel problems develop, symptoms of prostatitis develop, and vice versa.
An important aspect in the prevention of the development of prostatitis, ie in the prevention of recurrence of interstitial inflammation of the gland in the chronic course, is the intake of probiotics.
Probiotics are preparations containing bacteria that live in a healthy gut. The main role of probiotics is to suppress the diseased microbial flora, replace it, synthesize certain vitamins, help digestion, and thus 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 the susceptibility of the bacteria to the action of the gastric acid environment (most bacteria die in the stomach under the action of hydrochloric acid, only a few reach the intestine).
For best results and more complete delivery, capsules with bacteria have been proposed. The capsule travels through the aggressive environment of the stomach and dissolves in the gut, leaving the bacteria intact.
The development of pancreas inflammation can lead to a lack of zinc in the body, which eats up pollutants.
Food allergies may also contribute to the development of prostatitis.
Many men noticed improvements in their condition, with less disease symptoms when switching to a wheat- and gluten-free diet.
Gluten is a protein in wheat that can cause chronic inflammation in the small intestine and lead to malabsorption. The result of impaired bowel function is a number of conditions, including prostatitis.
In general, it's important to switch to a healthy diet and avoid foods that trigger inflammation of the pancreas. It is necessary to increase the consumption of products from the following list:
- vegetable.
- Fruits (acid fruits should be avoided as they can aggravate prostatitis symptoms).
- plant protein.
- Foods high in zinc, zinc supplementation.
- Omega-3 fatty acids (olive, olive and flaxseed oils, fish oils, sea fish contain high amounts of unsaturated and polyunsaturated fatty acids).
- High-fiber foods (oatmeal, pearl barley).
Transitioning to a Mediterranean diet can significantly reduce symptoms of pancreatic inflammation. Cut back on red meat and eat more fish, beans, lentils, and nuts, which are high in saturated fat and cholesterol.
It is important to keep your body well hydrated. A man needs to drink about 1. 5-2 liters of clean drinking water every day.
You should avoid soda, coffee, and tea. People with prostatitis need to limit their alcohol intake or stop it altogether.
we change the way we live
- Limit the effects of stressful environments that may lead to a weakened patient's immune system.
- Normalization of the psycho-emotional state. It leads to improved symptoms due to increased pain thresholds, improved immune system function, and less fixation of the patient on the disease.
- physical activities. Regular exercise without excessive exercise can lead to a reduction in chronic prostatitis symptoms. An important aspect is the refusal of sports, accompanied by perineal pressure (horse riding, cycling).
- Avoid prolonged sitting. Compression of the perineum can lead to stagnation of blood in the pelvis and secretion of the pancreas, leading to aggravation of the condition.
- Limit thermal procedures (baths, saunas) during exacerbations of the disease. During prostatitis remission, visits to the hammam, sauna can be done in short sessions of 3-5 minutes per entry. The possibility to go to the bath, sauna should be agreed with the attending physician, each case is individual and requires a special method of treatment. Under no circumstances should you jump into the cold pool/soak yourself in cold water after the steam room.
- A warm sitz bath can relieve the symptoms of prostatitis. Taking regular warm baths and immersing the whole body in warm water is more effective than bathing only the perineum and buttocks in warm water. In the bath, the muscles of the pelvic floor are more relaxed, the pathological impulses of the nerve fibers are reduced, and therefore the pain is reduced.
- Have regular sexual activity. Regular ejaculation contributes to the secretion of the pancreas. Prolonged absence of sexual activity, ejaculation leads to secret stagnation in the pancreatic duct and increases the risk of its infection, the development of inflammation of the interstitium of the pancreas.
- Casual sexual intercourse using a barrier method of contraception with the slightest suspicion of a sexually transmitted infection in the patient and her sexual partner.
- A frequent concern for patients with prostatitis is the possibility of maintaining sexual activity. Patients with chronic prostatitis do not prohibit sexual life. For acute inflammation of the pancreas, it is recommended to take a break from sexual life.
The success of the treatment of prostatitis does not belong entirely to the attending physician, but the result of the joint efforts of doctors and patients.
If the patient follows all the doctor's recommendations and prescriptions, reduces risk factors for disease recurrence, and gets regular check-ups, then he contributes 50% to the success of the cure.