where is the hypogastric plexus

Full Answer

How is the inferior hypogastric plexus formed?

The inferior hypogastric plexus is formed by the nerve fibers which originate from multiple sites: A hypogastric nerve on either side carries contributions from the superior hypogastric plexus (mainly sympathetic fibers) Pelvic splanchnic nerves (S2-S4) contribute with the parasympathetic efferent fibers to the plexus

Where does the hypogastric nerve start and end?

The hypogastric nerve starts at the fork of the superior hypogastric plexus: right and left plexus, continuing inferiorly bilaterally on the sides of the body, descending into the pelvis forming the inferior hypogastric plexus. The inferior hypogastric plexus forms a network of nerves that supply the viscera of the pelvic cavity.

What is a superior hypogastric plexus block used for?

What is a superior hypogastric plexus block? A superior hypogastric plexus block (SHPB) is a type of injection. It’s used to diagnose and treat pain in the lower part of the abdomen and the pelvis. Your brain sends information to the body through pathways known as nerves.

What is the prognosis of superior hypogastric plexus injury?

Superior hypogastric plexus injury may result in bladder dysfunction in females and either retrograde ejaculation or sterility, or both, in males. The superior hypogastric plexus is situated in the bifurcation of the aorta on the fifth lumbar vertebral body and the sacrum.

Where is hypogastric plexus located?

pelvisThe hypogastric plexus is a series of nerves that lie anterior to the lower lumbar vertebrae and then branch out to a number of minor plexi in the pelvis. This plexus system contains mainly sympathetic postganglionic nerves and afferent fibers.

What nerves make up the hypogastric plexus?

The inferior hypogastric plexus is formed by the contributions from the pelvic splanchnic nerves, sacral splanchnic nerves, and superior hypogastric plexus along with the afferent fibers from pelvic viscera. The hypogastric plexus contains both parasympathetic and sympathetic nervous fibers.

What does the hypogastric plexus do?

It is found on the lower part of your abdomen in front of the pelvis. The hypogastric plexus is where the nerves for many of the internal organs of the pelvis are located. Usually, people who have pain in these organs take medications for pain relief.

What is the function of the hypogastric nerve?

The main function of the hypogastric nerve is to connect the superior and inferior hypogastric plexuses. This way, it conveys the sympathetic inputs to the inferior hypogastric plexus, which then transmits it to the viscera of the pelvic cavity via its branches and subplexuses.

Which type of nerve fibers are carried through the inferior hypogastric plexus?

The sympathetic fibers in the inferior hypogastric plexus are vasomotor, motor to smooth muscle sphincters, and inhibitory to peristalsis. The majority of afferent pain fibers from the pelvis return to the CNS along sympathetic pathways.

What are the Erigenti nerves also called?

The pelvic splanchnic nerves, also known as nervi erigentes, are preganglionic (presynaptic) parasympathetic nerve fibers that arise from the S2, S3 and S4 nerve roots of the sacral plexus. These nerves form the parasympathetic portion of the autonomic nervous system in the pelvis.

What is the superior hypogastric plexus?

The superior hypogastric plexus is a complex web of neurons and fibers responsible for transmitting subconscious sensation and signals to and from the pelvic region. Once chronic pain develops in the pelvis, this plexus becomes a main source of sending unwanted pain signals to the brain.

What Is A Hypogastric Plexus Block?

Hypogastric plexus blocks are injections of medication that help relieve pelvic pain. The pain may come from the colon, bladder, lower intestines,...

How Is A Hypogastric Plexus Block done?

First, you’ll be given an intravenous medication to relax you. Then, you’ll lie on your stomach on an x-ray table.The doctor will numb an area of s...

How Effective Is A Hypogastric Plexus Block?

Some patients report pain relief within 30 minutes after the injection, but pain may return a few hours later as the anesthetic wears off. Longer t...

What Happens After The Procedure?

Your pelvic area may feel warm or “different,” and you may begin to feel less pelvic pain.You can continue your regular diet and medications immedi...

Is A Hypogastric Plexus Block Right For You?

A hypogastric plexus block may be right for you if you have chronic pelvic pain that does not respond to oral pain medication. These injections may...

What are the two parts of the hypogastric plexus?

The hypogastric plexus is divided into two parts: the superior hypogastric plexus and the inferior hypogastric plexus. Your healthcare provider will inject the medication onto parts of the plexus depending on the source of your pain. Cleveland Clinic is a non-profit academic medical center.

How to get rid of nerves in hip?

Insert needles into your back, near the hip bone. Inject dye to confirm that the medication will go to the correct spot. Inject pain medication, possibly including a steroid. Alcohol or phenol may also be injected to destroy the nerves in some cases.

What is a block in the pelvic area?

A hypogastric plexus block is a treatment where medications are injected onto a bundle of nerves near the bottom of your spine. When these nerves, called the hypogastric plexus, are blocked, they stop carrying information about pain in your pelvic area.

Why do you need a hypogastric plexus block?

You may need a hypogastric plexus block if the pain in your pelvic area is chronic and not relieved by oral medications.

How long does a hypogastric plexus block last?

How long the pain stays away is different for each patient. For some, the relief lasts weeks. For others, the relief lasts years. If the pain returns, you can discuss having another hypogastric plexus block with your healthcare provider.

How long does it take for a pelvic injection to work?

Longer term relief usually begins in two to three days, once the medication combined with the anesthetic begins to work.

Can hypogastric plexus block cause bleeding?

The risk of complication from a hypogastric plexus block is low. However, there could be bruising or soreness at the injection site. If present, this subsides in a few days. Serious complications, such as infection, nerve damage and bleeding are uncommon.

What is the lower half of the sympathetic cord?

Lower half of right sympathetic cord. (Hypogastric plexus labeled at bottom left.) The inferior hypogastric plexus ( pelvic plexus in some texts) is a network ( plexus) of nerves that supplies the organs of the pelvic cavity. The inferior hypogastric plexus gives rise to the prostatic plexus in males and the uterovaginal plexus in females.

Which plexus gives rise to the prostatic plexus?

The inferior hypogastric plexus gives rise to the prostatic plexus in males and the uterovaginal plexus in females. The inferior hypogastric plexus is a paired structure, meaning there is one on the left and the right side of the body.

Where is the plexus located?

The plexus is formed from: a continuation of the superior hypogastric plexus on either side, at the Sacrum#Promontory in the interiliac triangle. At this location, the presacral nerve sits in the middle in only 25% of people and is more commonly present on the left.

Which nerves contribute to the plexus?

pelvic splanchnic nerves (from the second, third, and fourth sacral nerves) also contribute parasympathetic efferent fibers to the plexus. From these plexuses numerous branches are distributed to the viscera of the pelvis . They accompany the branches of the internal iliac artery .

Can pelvic surgery cause urinary incontinence?

For this reason, injury to this structure can arise as a complica tion of pelvic surgeries and may cause urinary dysfunction and urinary incontinence. Testing of bladder function is used in that case to show a poorly compliant bladder, with bladder neck incompetence, and fixed external sphincter tone.

What is the inferior hypogastric plexus?

The inferior hypogastric plexus mediates sensation, such as pain, through the sympathetic chain for the lower abdominal and pelvic viscera. It is thought to be a major structure involved in numerous pelvic and perineal pain syndromes and conditions.

Why is the inferior hypogastric plexus a paired structure?

Because the inferior hypogastric plexus is a paired structure, injury is a commonly known complication of pelvic surgeries. Damage to the plexus can lead to urinary dysfunction, specifically urinary incontinence. The bladder will be non-compliant with a fixed external sphincter tone.

Why is it difficult to dissect the inferior hypogastric plexus?

Dissection of the inferior hypogastric plexus is difficult due to its location, the multiplicity of its sympathetic and parasympathetic roots, and the complex distribution of its terminal branches. The density of surrounding connective tissue also precludes the pelvic-perineal anatomy; therefore, it is difficult to determine the exact relationship between the nerves and pelvic connective tissue. The inferior hypogastric plexus lends its clinical relevance to various urogenital pain syndromes, including endometriosis, prostatitis, and chronic pain of the sacral region, postherpetic neuralgia, and rectal pain, among others.[2]  Therefore, any surgical procedure in this anatomical region must be met with due diligence, with respect to the underlying plexus that may be inadvertently damaged, thus causing a slew of related symptoms of the urogenital tract as well compromise of the pelvic autonomic innervation. [3][4]

What is the pelvic plexus?

The 'pelvic plexus,' more specifically known as the inferior hypogastric plexus, consists of a complex fibro-nervous structural network of afferent and efferent fibers providing function for the pelvic and perineal organs.

Where do the efferent fibers of the bladder come from?

The efferent fibers innervate the bladder and are situated superior and inferior. Fibers of the superior level arise from the hypogastric nerves at the ureterovesical junction, unlike the inferior level fibers that arise from the anterior plexus edge and approach the bladder neck at 5 and 7 o'clock positions.

Which plexus receives upper lumbar communication?

There are two sources of sympathetic contribution in the inferior hypogastric plexus; the largest contribution comes from the superior hypogastric plexus, purely containing sympathetic fibers and receives upper lumbar communication from the intermesenteric plexus and the L3 and L4 splanchnic nerves.

Where is the bladder innervated?

The bladder is innervated by the superior and inferior levels of the efferent fibers of the pelvic plexus. The superior level arose from the hypogastric nerves at the ureterovesical junction. The inferior level fibers arose from the anterior plexus edge of the bladder neck at 5 and 7 o'clock. Proximal seminal vesicle fibers follow the posterior (between the seminal vesicles and rectal fascia) and lateral (runs along the lateral wall of the seminal vesicles and the prostate) courses.

What is a superior hypogastric plexus block?

A superior hypogastric plexus block (SHPB) is a type of injection. It’s used to diagnose and treat pain in the lower part of the abdomen and the pelvis.

What is SHPB shot?

Chronic low abdominal or pelvic pain. Your healthcare provider may use SHPB to diagnose the cause of your pain. He or she can do so by injecting numbing medicine (local anesthetic) in the area to see if your pain improves. The shot helps to pinpoint the pelvic organs as the source of pain.

How does SHPB help with pain?

For example, an SHPB might help your pain if you have: Your healthcare provider may use SHPB to diagnose the cause of your pain. He or she can do so by injecting numbing medicine (local anesthetic) in the area to see if your pain improves. The shot helps to pinpoint the pelvic organs as the source of pain.

What organs pass through the plexus?

Nerves from several parts of the lower abdom en and pelvis pass through this plexus. That includes nerves from the following organs: Bladder or urethra. Lower intestines. Uterus, ovaries, or vagina. Prostate, testicles, or penis. During an SHPB, a healthcare provider will place needles in your back on both sides of the spine.

How long does pain last after a syringe injection?

It is common to have pain at the injection site for a day or two. Many people feel pain relief soon after the procedure. It might last a few hours, a few weeks, or longer depending on the medicines used.

How to do a SHPB?

But general steps for an SHPB might include the following: You will lie on your stomach on a procedure table. You may get medicine to help you relax (sedation). During the procedure, your heart rate, blood pressure, and oxygen level will be watched. You may get extra oxygen by a mask or nasal tubing.

Where do nerves send information?

Nerves also receive information from the body and send it to the proper regions of the brain. A nerve plexus is a place in the body where many different nerves intersect. Nerves that communicate some types of pain signals from the lower abdomen and pelvis pass through the superior hypogastric plexus on their way to the brain.