Congestive Prostatitis

For various reasons, pathological processes, including inflammatory ones, can occur in the prostate gland, and congestive or congestive prostatitis refers to one of the clinical types most common in men under the age of 50.

Epidemiology

Given the lack of general epidemiological information on chronic non-bacterial prostatitis and chronic pelvic pain syndrome, experts, based on clinical statistics over the past decade, claim that chronic congestive prostatitis affects men of all ages, but the disease is most common at the age of 35-50 (with damage 9-16% of men of all ethnic groups), and it accounts for 80-90% of all cases of chronic prostatitis.

According to some estimates, 5 million new cases of prostatitis are diagnosed annually with a prevalence of 2.2–9.7% worldwide. In 5.4% of cases, chronic non-bacterial prostatitis is detected.

According to foreign urologists, in general, some 10-14% of men experience some symptoms similar to prostatitis. [1]

Causes of the congestive prostatitis

The development of a special form of pathological reaction in the form of congestive prostatitis, defined in modern terminology as  non-bacterial chronic prostatitis , prostatodynia, prostatosis or  non-inflammatory syndrome of chronic pelvic pain  (according to the classification of the American National Institute of Health, type III B prostatitis), is not associated with damage to the gland by pathogenic microorganisms, i.e. There is no invasive infectious agent. Thus, there is no formulation of the diagnosis - congestive bacterial prostatitis, despite the possibility of infection joining during the progression of stagnant processes. [2]

Read more about the classification of chronic prostatitis and its variants in the publication -  Prostatitis: types

Although the exact etiology of this disease has not yet been established, experts see the causes of congestive prostatitis (in Latin congestio means “accumulation”) in blood circulation problems in the prostate - impaired regional venous hemodynamics, as well as in stagnation of the secretion produced by the prostate, which leads to edema and prostatosis syndrome.

There is a causal relationship between this type of prostatitis and tissue irritation and violation of the integrity of urothelium caused by the accumulation of urine entering the prostate gland as a result of urethrostatic reflux; with insufficient testosterone (androgen deficiency) or defects in its receptors; with dystrophic or  diffuse changes in the parenchyma of the prostate gland ; with a previous bacterial infection, which at the time of the patient’s treatment is not detected in the relevant analyzes; with inflammation of the nerve endings of the prostate.

Risk factors

Among the factors predisposing to circulatory disorders and secretory congestion in the prostate gland, note:

• lack of physical activity and sedentary work;
• frequent hypothermia;
• abstinence and lack of regular sex;
• incomplete emptying of the gland during ejaculation;
• interruptions of sexual intercourse;
• frequent prolonged sexual intercourse, masturbation;
• the presence of cysts or calculi in the gland (with the development of pathological changes in the parenchyma);
• expansion of the veins in the pelvic organs, accompanied by venous congestion;
• problems with the intestines (tendency to constipation, inflammation of the colon, etc.);
• cystic formations of the urinary tract and impaired blood supply to the lower urinary tract;
• abdominal obesity and insulin resistance;
• disorders of the immune system;
• high stress level.

Stagnation in the prostate can be triggered by excessive consumption of caffeine (which speeds up urination), spicy food (which increases the acidity of urine) and, of course, alcohol, which can cause high-grade ectasia (persistent vasodilation) of the prostate gland with subsequent ischemia and deterioration of trophic tissue.

Pathogenesis

To date, the pathogenesis of chronically occurring congestive prostatitis / non-bacterial chronic prostatitis is explained by compression of the excretory ducts, acini and the prostatic part of the urethra due to an increase in the prostate gland and swelling of its parenchyma with stagnation of blood in it or an accumulation of secretion.

Several pathophysiological and biochemical mechanisms can be combined in the development of the pain syndrome accompanying non-infectious chronic congestive prostatitis. So, the researchers revealed involvement in the inflammatory process of the autoimmune response to prostate antigens (PAg), which increases the level of inflammatory mediators (pro-inflammatory cytokines) and immunocompetent prostate cells (Th1 helper cells, B lymphocytes, mast cells), which contribute to the activation of cellular immunity; oxidative stress is increasing, damaging prostate tissues and sperm proteins; increased secretion of neurotrophin, which stimulates neurons and causes nervous sensitization, which is likely to cause chronic pelvic pain. [3]

Symptoms of the congestive prostatitis

Symptoms of chronic congestive or congestive prostatitis can relate to the urethra, genitals and their functions, the rectum and general condition. This is urological pain or discomfort in the pelvic area associated with urination and / or sexual dysfunction.

And the first signs in most patients are manifested by difficulty urinating and a feeling of incomplete emptying of the bladder, as well as pain during urination and pressure in the perianal region. [4]

The list of the most characteristic symptoms also includes:

• frequent urination (pollakiuria), including at night;
• imperative (unbearable) urination;
• persistent or periodic dull and aching pains - in the perineum and groin, in the lower abdomen, in the penis and scrotum, in the rectum, in the coccyx and lower back;
• sexual dysfunction (lack of erection); [5]
• decreased libido, premature ejaculation, pain or burning sensation during ejaculation, partial anorgasmia;
• hemospermia (blood in semen).

Periodically slightly elevated temperature with congestive prostatitis is not excluded; general weakness and sleep disturbance; chronic fatigue syndrome; depression and anxiety disorders.

In case of congestion and the presence  of prostate stones  (which can block the ducts of the gland), congestive prostatitis with calcifications is determined. It also manifests itself as painful urination, discomfort in the perineum and penis, aching pain in the prostate during bowel movements and ejaculation.

See also -  Symptoms of chronic prostatitis.

Complications and consequences

Chronic stasis in the prostate causes not only urogenital problems, but can have significant consequences and complications both for its morphology and functions, and for male fertility (causing infertility).

Perhaps the development of the syndrome of intra-pelvic venous stasis, dystrophy and neuromuscular pathology (atony) of the prostate gland, ischemia or sclerotic tissue changes, the formation of parenchymal cysts or diverticulums.

According to oncologists, chronic prostatitis is closely associated with the development of prostate adenocarcinoma and colorectal cancer. [6]

Diagnostics of the congestive prostatitis

Diagnosis of congestive prostatitis / non-bacterial chronic prostatitis / prostatosis begins with a clarification of the anamnesis, fixing the patient's complaints and the features of his sexual life, physical examination of the genitals and  digital rectal examination of the  prostate gland.

Such tests are carried out as: general and biochemical blood tests; tests for STDs; PSA analysis - the level of a  prostatic specific antigen in the blood ; serum testosterone levels; urinalysis (including bacterial culture); microscopic analysis and bacterial seeding of prostate secretion; analysis of ejaculate. [7]

Instrumental diagnostics include:  transrectal ultrasound examination (TRUS) of the  prostate gland; Dopplerography of the pelvic organs and  ultrasound dopplerography of the vessels of the prostate gland ; Ultrasound of the bladder and cystotonometry; retrograde urethrography and uroflometry; electromyography of the pelvic floor muscles. In complex cases, resort to endocystoscopy, CT or MRI of the bladder, urinary tract, prostate and pelvic organs.

See more -  Diagnosis of chronic prostatitis.

Differential diagnosis

Differential diagnosis is designed to exclude other pathologies that cause similar symptoms: chronic cystitis , urethritis, neurogenic bladder dysfunction, bladder neck stenosis, urethral stricture , prostate hypertrophy, inflammation of the seminal follicle (colliculitis), etc. In addition, in the absence of pathogen and microflora in prostatic secretion, symptoms similar to signs of prostatitis are possible due to myalgia of muscle tension of the pelvic floor - myofascial syndrome of the pelvis.

Treatment of the congestive prostatitis

In the symptomatic treatment of congestive prostatitis - genitourinary pain in the absence of uropathogenic bacteria - drugs of various pharmacological groups are used. So, to normalize urination and reduce its pain, drugs of the group of antagonists of α-adrenergic receptors (alpha-blockers) are prescribed, which reduce the tone of the smooth muscles of the prostate gland, bladder neck and prostatic urethra: Adenorm (other trade names - Tamsulosin, Bazetam, Omix, Omniks, Ranoprost, Tamsonik, Urofrey), Alfuzosin (Dalfaz, Dalfuzin), Prazosin, Terazozin (Alfater, Kornam), Phentolamine hydrochloride (Alfinal), Doxazosin. These drugs are contraindicated in low blood pressure and liver failure. Their side effects are manifested in the form of nausea, vomiting, constipation, diarrhea, dizziness, headache, tachycardia, visual impairment, rhinitis, urticaria, etc. The dosage is determined by the attending physician. [8]

For the same purpose, anticholinergics (muscle relaxants) Tolperisone (Tolizor, Midokalm), Baclofen, Fesoterodin can be used. Their intake, in addition to nausea and vomiting, can cause patients a headache, muscle weakness, hypotensive effect.

To reduce dysuric symptoms with congestive prostatitis with calcifications and an enlarged prostate, medications can be prescribed that suppress the activity of the 5-α-reductase enzyme: Finasteride (Prosterida) or Avodart (Dutasteride) - one capsule per day. [9]

Can Ibuprofen be taken with congestive prostatitis? This non-steroidal anti-inflammatory drug with analgesic effect - due to potential side effects of drugs of this group (irritation and ulceration of the walls of the stomach) - can be used occasionally: with intense pain. For a detailed description of the contraindications of this drug and other side effects, see -  Ibuprofen .

Tricyclic antidepressants (at a minimum dosage) may relieve discomfort or pain; help relieve pain and normalize blood flow in the vessels of the prostate with antispasmodics (No-shpa, Bentsiklan or Galidor).

Reduces edema, stimulates metabolism and promotes normal hemodynamics in the prostate   ordinary pumpkin seed oil or Tykveol capsules (Garbeol, Granufink uno).

More useful information in the material -  Pathogenetic treatment of chronic prostatitis .

In the complex therapy of congestive prostatitis, physiotherapeutic treatment is also used, aimed at improving blood circulation in the prostate gland and trophism of its tissues. Details in publications:

• Physiotherapy for prostatitis 
• Treatment of chronic prostatitis: microwave microwave therapy
• Treatment of chronic prostatitis: magnetotherapy
• Laser therapy in the treatment of chronic prostatitis
• Prostate massage

The effectiveness of hyperbaric oxygenation in the treatment of patients with chronic congestive prostatitis has been proven. [10]

An alternative treatment recommends ingesting aloe juice (or consuming fresh plant leaves), onion juice diluted in half with water and eating raw pumpkin seeds.

For some patients, treatment of herbs and other medicinal plants helps to reduce the intensity of symptoms of congestive prostatitis. So, herbalists are advised to be treated with an aqueous extract of bearberry leaves (Arctostaphylos uva-ursi) and wintergreen (Pyrola umbellate); a decoction or extract of the roots and leaves of nettle; infusion of large plantain seeds (Plantago major) and white mustard (Sinapis alba); tincture of the root of galangal officinalis (Alpínia officinárum), a decoction of the ground parts of lush cloves (Dianthus superbus), mountaineer or knotweed (Polygonum aviculare), as well as narrow-leaved fireweed (Epilobium).

In addition, phytotherapy of dysuric symptoms can be recommended using an extract of palm fruit of serenium or sabal (Serenoa repens or Sabal serrulata), which contain capsules Prostamol Uno, Prostaplant, Palprostes, etc.

Used in therapy and homeopathy:

• drops Berberis-Homaccord, Populus compositium SR, Sabal-Homaccord, Gentos, Ursitab Edas-132;
• sublingual tablets Bioline Prostate with extracts of the Umbrellas umbrellas (Chimaphila umbellate), clematis straight (Clematis erecta), goldenrod (Solidago virgaurea) and sabal palm fruits.

Surgical treatment by transurethral interventions - laser incision of the prostate gland or its resection - is carried out only with the ineffectiveness of conservative therapy. And prostatic calculi are removed by lithotripsy (crushing stones with ultrasound, electromagnetic waves or a laser).

Prevention

There is no reliable way to prevent this disease from occurring, but some lifestyle changes can help reduce the risk of it. Those who have sedentary work should take short breaks to get up and walk for a few minutes.

As a general prevention of problems with the prostate gland, sports (with the exception of weightlifting and cycling), simple physical activities (except lifting weights) and regular sex are useful.

You need to control body weight, consume enough water, adhere to the principles of a healthy diet and stay away from alcohol, caffeine and spicy foods.

Forecast

It is difficult to give a prognosis of the disease, the exact etiology of which is still unclear, however, doctors are confident that congestive or congestive prostatitis does not pose a life threat. But the quality of life due to chronic pelvic pain, which can be treated with difficulty, is significantly reduced, and patients have to struggle with it for months or even years.