What is a Superior Hypogastric Plexus block?
The hypogastric nerve plexus is located on either side of the spine in the area around the base of the spine. The location of these nerves brings sensation to the reproductive organs in the pelvis. It also sends sensory signals from lower abdominal organs as well, affecting the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testes, rectum, and descending colon. Pain coming from these organs or due to side effects from treatment, can benefit from a superior hypogastric plexus block.
Why is a Superior Hypogastric Plexus performed?
This procedure offers pain relief for people who struggle with side effects from oral pain medication, pelvic pain caused by cancer, and any pain coming from one of the affected organs listed above. The procedure itself is minimally invasive and short and it can also help avoid more invasive surgeries, if effective.
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
While some people experience only temporary relief from a superior hypogastric plexus block, 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.
If no pain relief occurs, this means that your pain is being caused by something else or originates elsewhere.
How is a Superior Hypogastric Plexus Block performed?
You will lie face down on the procedure table and a pillow will be placed under your abdomen to slightly flatten out your lower back. Two needles are inserted for this block using X-ray (fluoroscopic) guidance.
Once the needles are in place, the doctor will inject contrast dye in the area around the targeted nerves. This dye can be viewed in the X-ray and confirms proper placement of the injection. The doctor will then perform the block, using anesthetic only, or you may also receive a steroid.
What should I expect after a Superior Hypogastric Plexus Block?
Have a friend or family member drive you home on the day of your superior hypogastric plexus block. You may feel ‘odd’ after your block – maybe slightly warm but without your usual pelvic pain. This relief can feel strange and sometimes unsettling if you have chronic pain.
Take it easy on the day of your procedure. 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.
Use an ice pack if you experience soreness at the injection site. You may have a slight increase in pain on the day after your procedure, which is normal and should be followed by a continued decrease. Talk to your doctor if you feel no relief, or if pain intensifies.
This procedure has a low incidence of side effects. You may experience minor soreness, bruising, and slight bleeding at the injection site which should clear up in just a day or two. Some people may 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, including facial flushing, headache, insomnia, increased heart rate, hiccups, or a low fever. These are usually temporary and also will resolve within a day or two.
There is an exceedingly rare possibility of more serious side effects related to improper placement of the needles, which include: nerve injury and/or paralysis, puncture of surrounding organs, puncture of adjacent vessels, or bowel and bladder complications. These can be prevented by the use of X-ray guidance for the injection.
The risk of infection is also present, as with any procedure that punctures the skin. If you experience 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.
