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CHRONIC PELVIC PAIN IN WOMEN

Chronic pelvic pain (CPP) is a persistent, distressing, and severe pain of >6-month duration.
It occurs intermittently, cyclically, or situationally.
Localized to the pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks.
In women, CPP is not restricted to intercourse or menstruation and is not associated with pregnancy.
A complex problem that is both multifactorial & multidimensional.

Chronic%20pelvic%20pain%20in%20women Signs and Symptoms

Signs and Symptoms

Introduction

It is a symptom with a number of contributory factors and not a diagnosis; pathophysiology is complex and not well understood
- It is assumed that in the development of chronic pain, the nervous system is affected among others by inflammatory and chemical mediators and hormones

A complex problem that is both multifactorial and multidimensional
Chronic pelvic pain (CPP) mechanisms include acute pain that is in progress involving visceral or somatic tissue, chronic pain involving the central nervous system (CNS), and cognitive, behavioral, emotional, and sexual responses and mechanisms
CPP may be subdivided into specific disease-associated pain (conditions with well-defined pathology) and chronic pelvic pain syndrome (CPPS) (without obvious pathology)

Definition

CPP is a persistent, distressing, and severe pain of >6 months duration; occurs intermittently, cyclically, or situationally; localized to the pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks; and is severe enough to cause functional disability or need medical care
- In women, CPP is not restricted to intercourse or menstruation and is not associated with pregnancy

Etiology

The following are the common causes of CPP
Treatment is directed towards the specific condition and according to its specific guidelines

Gastrointestinal	Gynecological	Musculoskeletal
Irritable bowel syndrome (IBS)* Inflammatory bowel disease (IBD)* Abscess Chronic appendicitis Constipation* Diverticulitis* Neoplastic lesions Chronic intermittent bowel obstruction Hemorrhoids* Anal fissure* Proctitis	Endometriosis* Dysmenorrhea* Pelvic adhesions Pelvic inflammatory disease* Vulvodynia Chronic endometritis Adenomyosis Gynecologic malignancies Deformities/Prolapse Ovarian cysts Residual ovary syndrome Ovarian remnant syndrome Post-hysterectomy pain Pelvic congestion syndrome Fibroids or Leiomyomas*	Myofascial pain (trigger points) Pelvic floor myalgia and spasms/prolapse Pelvic girdle pain Coccygodynia Stress fractures Chronic back pain Disc disease Levator ani syndrome Hernias Musculoskeletal and connective tissue malignancies
Psychiatric/Neurological	Urological	Others
Depression* History of or current physical or sexual abuse Sleep disturbance Nerve entrapment syndrome Psychological stress (work, marital) Substance abuse Neurologic dysfunction Neuropathic pain* Somatoform pain disorders Schizophrenia*, schizotypal and delusional disorders	Interstitial cystitis Urethral syndrome Chronic urinary tract infection¹ Bladder stones or dysfunction Urolithiasis Urological malignancies	Infectious diseases Chronic pain syndromes Mesh infection Sickle cell disease Porphyria Hyperparathyroidism* Herpes zoster Heavy metal poisoning

*Please refer to the corresponding disease management chart for more information
¹Urinary Tract Infection in Women – Complicated or Urinary Tract Infection – Uncomplicated disease management charts

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Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.