Research Of Correlation Of Anorectal Dysfunction And Chronic Prostatitis

Male Chronic prostate(Chronic Prostatitis, CP) usually occurs with Chronic inflammation of the prostate, high incidence of a disease in the male population, the clinical manifestations of urinary frequency, urgency, weak stream, sustaining and persistent abdominal and pelvic pain. As a very common symptoms in young adults, the national institutes of health have a clearly defined on prostatitis, part of prostatitis pathogenesis is still not clear, however, the pathogenesis of chronic prostatitis mechanism are yet needed to be further researched. The current classification for prostatitis is Acute prostatitis, CPI, Chronic prostatitis CPII, Chronic inflammatory prostatitis CPIIIa; CPIV CPIIIb and asymptomatic prostatitis. Still, chronic non-inflammatory prostatitis CPIIIb does not only manifest symptoms of urinary tract, at the same time also manifest comorbid chronic pelvic pain syndrome, erectile dysfunction, and other discomfort. This type of prostatitis, however, by lacking of laboratory diagnosis, chronic, inflammatory prostatitis the diagnose CPIIIb the diagnosis and treatment are intractable. A large number of clinical cases of chronic prostatitis often not necessarily associated with prostate infection and inflammation stimulation, and not even necessarily to associate with the prostate and bladder outlet obstruction. Over the past 15 years a lot of research has focus resources on the chronic prostatitis CPIIIb, not just because of prostatitis caused by urinary tract symptoms are very common, but also thanks to the difficulties in diagnosing and treating the problem.Because of prostatitis is relatively complex, research on the mechanism related to the diagnosis and treatment of prostate disease has never stopped. In fact except inflamma tion and infection, autoimmune and other causes of voiding dysfunction, as well as chronic inflammation caused by nerve, mental disorder that are blamed to associated with the pathogenesis of chronic prostatitis attacks, at the same time have a view of pel vic floor muscle spasms is considered a relatively important factor of chronic prostatitis CPIIIb pelvic pain. Pelvic floor muscle spasm in pelvic floor skeletal muscle spasmodic lesions caused by excessive stress to the perineum, causing pelvic floor myofascial pain. And urethral sphincter as an important part of the pelvic floor muscle, skeletal muscle, the muscle tone change can cause chronic prostate CP under the same urinary tract symptoms; At the same time, the muscles of the pelvic floor muscle spasms in fascia pain was found and prostatitis CP range caused by chronic pain and no difference. And pelvic pain and occurs, there is no link between infection and inflammation of the prostate, with the diagnosis of pelvic pain, chronic prostatitis is usually 1 year after treatment symptoms worsen trend. But the pelvic floor muscle tone change and lower urinary tract symptoms pathogenic relationship between each other is not clear.At the same time, along with the complication of chronic pelvic pain syndrome involves multiple system cause the symptoms of a very wide range, from anxiety, tension to the chronic fatigue syndrome. The digestive tract symptoms and lower urinary tract symptoms of common attacks is becoming more and more attention; Reports have pointe d out that such as irritable bowel syndrome of constipation, endless defecate, and the occurrence of chronic, inflammatory prostatitis attacks were positively correlated.So we adopt defecation angiography revealed through observation of chronic, inflammatory prostatitis diagnosed with straight anal function form, evaluation of patients with pelvic floor function. Hope to chronic, inflammatory prostatitis treatment provides a new train of thought.Method:Section1: Select patients from clinic of the urology department who chiefly complaining about urinary frequency, urgency, discomfort of pelvic region and diagnosed as Chronic prostatitis. Each of their urinary symptoms were assessed by IPSS scoring system, other examining method as Urinary Ultrasonic scan, EPS analysis, Urinary analysis were applied for ascertain the diagnose. Defecography were enrolled to observe and analyze their anorectal form and its indication to the pelvic floor function.Section2: Defecographic results of Patients diagnosed as CPIIIb and Asymptomatic volunteers were compared. Patients with symptomatic CPIIIb were also request to complete the urinary dynamic analysis. Data of Pdet Qmax and FDV were analyzed with their Anorectal angle and perineum level.Section3: Randomly select CP IIIb patients into two groups treated with tamsulosin 0.2mg/QD or combo therapy of Celecoxib 2mg/Bid. Improvement of their symptoms were recorded at the first visit, second visit to the forth visit with intermission of two weeks.Result1. A very high incidents of anorectal abnormities including non-relaxing puborectalis syndromes and rectal mucosal prolapse were discovered among patients diagnosed with chronic prostatitis of both inflammatory type and non-inflammatory type,and no difference of its distribution were notified among different degrees of LUTS symptoms.2.In comparing with asymptomatic volunteers, anorectal angle and perineum level in defecating phase and their mobility level of patients of chronic prostatitis were minor, and PdetQmax and FDV were correlated with perineum level and anorectal angle to some extent.3.Combo treatment of celecoxib and tamsulosin were significantly superior to single administered tamsulosin. IPSS scoring of urinary frequency, urgency, painful discomfort and Qo L improvement were more evidently.Conclusion1.RMP and PMS were the main anorectal abnormality in patients of chronic prostatitis, and anorectal abnormalities were the may be an independent cause for onset of Lower urinary tract symptoms.2.Pelvic dysfunction and alteration in pelvic perineum muscle tension maybe the culprit of symptom of CPIIIB, thus PMS may elevate pelvic tension and urethra outlet resistance and interrupt proprioceptive sensation of bladder that led to symptoms as urinary frequencies and urgencies.3.Combo treatment of celecoxib and tamsulosin may exert greater effect on relaxing spastic muscle and attenuating symptoms and enhance patients Qol in a better manner.