Sometimes the pain in the lower abdomen and pelvis is so severe that it is hard to put into words. Do you struggle with pain that is so severe that it is difficult to perform daily activities even with medication? Today we are going to talk about a specific treatment method used to control this type of long-term pain. This is called the `Hypogastric Plexus Block`.
What is Hypogastric Plexus Block?
Simply put, this is a special injection that is given to control pain. In our lower back, there is a nerve bundle, a place where many nerves that carry pain signals related to the lower abdomen and pelvic area come together to the brain. This is called the `Hypogastric Plexus`.
Think of it like a big telephone pole with a bunch of wires connected to it. All the pain signals coming from your lower abdomen, uterus, bladder, or surrounding organs go to your brain through this bundle of nerves. So, what you do in this treatment is, you use an X-ray to find exactly where that bundle of nerves is, and you inject a drug into it. This drug temporarily or long-term puts the nerves that carry the pain signals to sleep. That means the pain signals stop traveling. This is what we call a `block`.
What types of pain is this treatment most commonly used for?
Doctors usually recommend this treatment for people with chronic pelvic pain that is difficult to control with oral painkillers. It is particularly effective for pain in the following areas:
- Bladder
- Colon
- Uterus or ovaries
- Prostate or testicles
The table below lists several medical conditions that may require this treatment.
| Medical condition | Description |
|---|---|
| Cancer | Severe pain caused by abdominal cancer. |
| Endometriosis | Severe, chronic pelvic pain in women. |
| Interstitial Cystitis | A painful condition in the bladder. |
| Pain after surgery or radiation therapy | Long-term pain after abdominal surgery or radiation therapy. |
| Other chronic conditions | Pain caused by conditions such as Irritable Bowel Syndrome (IBS) and Pelvic Inflammatory Disease. |
How should I prepare before treatment?
If you undergo this treatment, your doctor will give you a set of specific instructions. The main ones are:
- You will be asked to completely abstain from eating and drinking for several hours before the treatment.
- Some medications you are taking (especially blood thinners like Aspirin and Warfarin) may need to be stopped a day or two in advance. However, this should only be done under the supervision of your doctor. Never stop or start any medication without your doctor's advice.
- After treatment, you will be so light-headed that you will not be able to drive yourself. Therefore, it is essential to arrange for someone to drive you home and back.
How the treatment works step by step
This treatment usually takes about 30 minutes and is performed by a doctor who specializes in pain management.
The important thing is that you are not put to sleep during this treatment. You are only given a sedative (sedation) intravenously. Since you are awake, the doctor can talk to you and perform the treatment.
| Steps | What is happening? |
|---|---|
| 1. Preparation | You will be asked to lie on your stomach on an X-ray table. Then a cannula will be inserted into a vein in your arm and a medicine will be given to make you feel relaxed. |
| 2. Skin numbness | The area of the lower back where the needle will be inserted is cleaned and a local anesthetic is injected into the area. |
| 3. Needle insertion | With the help of an X-ray (fluoroscopy) machine, the doctor inserts two very fine needles into your lower back and guides them to the exact location of the nerve plexus. |
| 4. Location confirmation | To make sure the needles are in the right place, a little dye is injected and an X-ray is taken to confirm. |
| 5. Medicine injection | Once the location is confirmed, a painkiller (often a numbing medicine and a steroid) is injected around the nerve bundle. In cases such as cancer, a nerve-destroying solution of alcohol or phenol may also be injected for long-term relief. |
What happens after treatment?
After the treatment, you will be kept under observation for about half an hour and then allowed to go home within an hour.
- Pain relief: Most people experience significant pain relief within 30 minutes of the injection. It is normal for the pelvic area to feel a little warm or "different."
- Side effects: The injection site may be slightly sore and bruised for two to three days. This is normal.
- Rest: It is important to rest for 24 hours after going home. Do not engage in any heavy work or exercise. You can resume your normal activities the next day.
How long does the pain relief last?
This depends on the type of medication you are given. If you are given a numbing medicine alone, the relief will last for a few hours or a few days. If you are given a steroid, the pain relief may last for weeks to months. Some people need to have several injections to get the best results.
When should I call the doctor?
The risk of serious complications associated with this treatment is very low. However, if you experience any of the following symptoms, you should contact your doctor immediately .
- If the pain increases instead of decreasing.
- If you get a fever .
- If the injection site is severely painful, swollen, or red .
- If you feel weakness in your legs .
Living with chronic pain can have a big impact on your mental and physical health. So there's no need to "put up with" the pain. If you're not getting relief from regular painkillers, talk to your doctor about specific treatments like these.
Take-Home Message
- Hypogastric Plexus Block is a specialized injection treatment used for severe pain in the lower abdomen and pelvic area that cannot be controlled with other medications.
- This controls pain by temporarily or long-term disabling a cluster of nerves that carry pain signals to the brain.
- This is a treatment method performed by a specialist, with very low risk, and can be completed in a short time.
- This can be a successful solution for many conditions, such as endometriosis, cancer pain, and post-surgical pain.
- If you also suffer from chronic pelvic pain, talk to your doctor to see if this treatment method is right for you.
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