Chronic%20pelvic%20pain Signs and Symptoms

Signs and Symptoms

Introduction

It is a symptom with a number of contributory factors & not a diagnosis; pathophysiology is complex & not well understood
- It is assumed that in the development of chronic pain, the nervous system is affected among others by inflammatory & chemical mediators & hormones
A complex problem that is both multifactorial & multidimensional
Chronic pelvic pain (CPP) mechanisms include acute pain that is in progress involving visceral or somatic tissue, chronic pain involving the CNS, & cognitive, behavioral, emotional, & sexual responses & mechanisms
CPP may be subdivided into specific disease-associated pain (conditions with well-defined pathology) & chronic pelvic pain syndrome (those without obvious pathology)

Chronic pelvic pain syndrome should be further subdivided into its corresponding phenotype

Definition

Chronic pelvic pain (CPP) is a persistent, distressing, & 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; & is severe enough to cause functional disability or need medical care
- In women, CPP is not restricted to intercourse or menstruation & is not associated with pregnancy

Etiology

The following are the common causes of chronic pelvic pain (CPP)
Treatment is directed towards the specific condition & according to its specific guidelines

The following are the common causes of CPP Treatment is directed towards the specific condition & according to its specific guidelines
Gastrointestinal:	Gynecological:	Musculoskeletal:	Psychiatric/Neurological:	Urological:	Others:
Irritable bowel syndrome*	Endometriosis*	Myofascial pain (trigger points)	Depression*	Interstitial cystitis	Infectious diseases
Inflammatory bowel disease*	Dysmenorrhea*	Pelvic floor myalgia & spasms/ prolapse	History of or current physical or sexual abuse	Urethral syndrome	Chronic pain syndromes
Abscess	Pelvic adhesions	Pelvic girdle pain	Sleep disturbance	Chronic urinary tract infection*¹	Mesh infection
Chronic appendicitis	Pelvic inflammatory disease*	Coccygodynia	Nerve entrapment syndrome	Bladder stones or dysfunction	Sickle cell disease
Constipation*	Vulvodynia	Stress fractures	Psychological stress (work, marital)	Urolithiasis*	Porphyria
Diverticulitis*	Chronic endometritis	Chronic back pain	Substance abuse	Urological malignancies	Hyperparathyroidism
Neoplastic lesions	Adenomyosis	Disc disease	Neurologic dysfunction	Chronic prostatitis	Herpes zoster
Chronic intermittent bowel obstruction	Gynecologic malignancies	Levator ani syndrome	Neuropathic pain*		Heavy metal poisoning
Hemorrhoids*	Deformities/Prolapse	Hernias	Somatoform pain disorders
Anal fissure*	Ovarian cysts	Musculoskeletal & connective tissue malignancies	Schizophrenia*, schizotypal & delusional disorders
Proctitis	Residual ovary syndrome
	Ovarian remnant syndrome
	Post-hysterectomy pain
	Pelvic congestion syndrome
	Fibroids or Leiomyomas*
*Please refer to the corresponding disease management chart for more information ¹Urinary Tract Infection – Complicated or Urinary Tract Infection – Uncomplicated management charts

Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.