Superior Hypogastric Plexus Block
Pelvic pain is a challenging condition. Not only does a person suffering from this type of pain deal with the physical struggle of it, they may also feel embarrassment or upset at the location of the pain. It can be hard to describe pain in such intimate places—even worse when that pain becomes chronic and difficult to treat. A superior hypogastric plexus block can offer profound relief from pelvic pain, though. Here’s what you need to know.
What is a superior hypogastric plexus block?
A superior hypogastric plexus block is a type of nerve block that targets the nerve plexus located deep in your abdomen. The block itself is an injection of an anesthetic and a steroid that blocks pain signals from the nerves in this region.
This hypogastric nerve plexus is located on either side of the spine between the fifth lumbar vertebra and the third sacral vertebrae (the area around the base of the spine). The hypogastric plexus also interacts with the nerves from branches of the aortic plexus and fibers from the splanchnic nerves.
The location of this bundle of nerves brings sensation to the reproductive organs in the pelvis. It also sends sensory signals from lower abdominal organs as well. The physical structures that are innervated by the superior hypogastric plexus include the:
- Bladder
- Urethra
- Uterus
- Vagina
- Vulva
- Perineum
- Prostate
- Penis
- Testes
- Rectum
- Descending colon
Pain arising from these organs—or from treatment side effects—can be managed by a superior hypogastric plexus block.
How can a superior hypogastric plexus block help me?
One of the main superior hypogastric plexus block benefits is that it offers pain relief for people who struggle with side effects from oral pain medication.
The procedure itself is short and minimally-invasive and, if effective, can help you to avoid more invasive surgeries. This is true especially for pelvic pain that is caused by cancer.
But this block is not just for pain caused by cancer. Any pain that is coming from one of the affected organs listed above can be treated with superior hypogastric plexus block.
Some conditions that can be treated with this type of block include:
- Irritable bowel syndrome (IBS)
- Post-operative pain
- Chronic abdominal pain
- Endometriosis
- Chronic pelvic pain
- Interstitial cystitis
- Pelvic inflammatory disease (PID)
- Pain from radiation therapy
Essentially, if the pain originates in the area of the superior hypogastric plexus, this type of block might work for you.
Superior hypogastric plexus block research
For cancer pain, a superior hypogastric plexus block offered pain relief for almost 60% of participants in a 2020 research study. Nearly 50% of those patients remained pain-free at three months.
In women receiving a hysterectomy, another study found that a superior hypogastric plexus block reduced opioid use and while reducing pain significantly when compared to the control group.
Other significant research on superior hypogastric plexus block benefits include:
- For hard-to-treat endometriosis, this block reduced pain and improved patient quality of life
- Interstitial cystitis treated with a successful block opened the door for long term pain relief with radiofrequency ablation of this same nerve plexus
- Women who have severe pain due to cramping during perimenopause found profound relief with a superior hypogastric plexus block
Superior hypogastric plexus block benefits
Benefits of this block can be temporary for some people. Others experience months or even years of profound relief. Fortunately, the procedure is a low-risk, non-surgical treatment that, if successful the first time, will most likely continue to provide pain relief with repeat treatments.
In addition to its pain-relieving benefits, your doctor can use a superior hypogastric block as a diagnostic tool. If you experience pain relief of 50% or greater after a block, you may be a good candidate for a more permanent procedure (e.g., radiofrequency ablation).
If no pain relief occurs, this means that your pain is being caused by something else or originates elsewhere.
The superior hypogastric plexus block procedure
The superior hypogastric plexus block procedure is performed as an outpatient procedure. Most people do not require any IV sedation, but if you are worried about pain, talk to your doctor. They may offer you a mild oral sedative to take beforehand, or they might offer light IV sedation.
Once you are comfortable, you’ll lie face down on the exam table. You then place a pillow underneath your abdomen to slightly flatten out your lower back. This makes it easier to correctly position the injection. Your doctor cleans and sterilizes the area to be injected. Two needles are inserted for this block using X-ray (fluoroscopic) guidance.
Once the needles are in place, your doctor injects contrast dye in the area around the targeted nerves. This dye can be viewed in the X-ray and will confirm proper placement. Once everything is confirmed, your doctor will perform the block. You may receive an injection of anesthetic only, or you may also receive a steroid.
The procedure usually takes less than 15 minutes. Once your block is finished, you’ll move to recovery for a brief period. Your doctor will monitor your pain and vital signs (pulse, blood pressure, temperature) after the procedure. They will also check in to see if you are experiencing pain relief.
Side effects
One of the main benefits of this procedure is the low incidence of side effects. Many people experience minor soreness, bruising, and slight bleeding at the injection site. This should clear up in just a day or two.
Some people experience a temporary weakness in the legs. If you receive a steroid as part of the block, you may have some side effects related to that. These include:
- Facial flushing
- Headache
- Insomnia
- Increased heart rate
- Hiccups
- Low fever
These are usually temporary and also resolve within a day or two.
More serious and exceedingly rare side effects are related to improper placement of the needles. They can include:
- Nerve injury and/or paralysis
- Puncture of surrounding organs
- Puncture of adjacent vessels
- Bowel and bladder complications
These can be prevented by the use of X-ray guidance for the injection.
As with any procedure that punctures the skin, the risk of infection is also present. If you notice a sharp increase in pain, swelling, redness, and warmth at the injection site, or if you have a fever and generally feel unwell, call your doctor.
Recovery
On the day of your superior hypogastric plexus block, have a friend or family member drive you home. You may feel “off” after your block – maybe slightly warm and without your usual pelvic pain. If you have chronic pain, this relief can feel strange and sometimes unsettling.
Take it easy on the day of your procedure. Your doctor will have specific guidelines for your recovery, but in general you can eat and drink as you normally would immediately after your block. No driving for 24 hours, and no vigorous exercise, activity, or sex for 24 hours either.
If you experience soreness at the injection site, apply a cold pack for relief. Ask your doctor about taking over-the-counter pain medications, too.
You may experience a slight increase in pain on the day after your procedure. This is normal and should be followed by a continued decrease. Talk to your doctor if you feel no relief, or if pain intensifies.
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