The superior hypogastric plexus is a bundle of nerves in front of your lower spine that carries pain signals from your pelvic organs (bladder, bowel, uterus, ovaries, prostate). Targeting it aims to reduce pelvic or lower abdominal pain, though individual results vary. There are several treatment options, used only as far as needed:

• Local anaesthetic: numbs the area immediately, helping confirm the response.
• Pulsed radiofrequency (pulsed RF): short bursts of energy applied to the same nerves without destroying them, aiming for longer-lasting effect.
• Thermal radiofrequency or neurolytic agent: used in some cases, particularly for cancer-related pain, to provide longer-lasting relief.

This procedure may help if you have:

• Chronic pelvic or lower abdominal pain, including endometriosis-related pain
• Pelvic pain related to gynaecological, urological, or colorectal cancer
• Pelvic pain following surgery or radiation treatment

It isn't possible to guarantee how any individual will respond. As a general guide:

• Local anaesthetic: works within minutes and wears off after a few hours — a good early sign of response.
• Pulsed RF: effect usually begins after a couple of weeks and may last for a few months.

This procedure is generally considered safe when performed under X-ray guidance, though as with any medical procedure the degree of benefit varies and cannot be guaranteed.

Common, minor effects:

• Temporary low blood pressure for a short period, which can cause light-headedness on standing
• Temporary warmth or a change in skin temperature in the legs, as the nearby sympathetic nerves are affected
• Temporary soreness at the injection site
• Temporary rise in blood sugar for 1-2 days if steroid is used, particularly if you have diabetes

Rare, more serious risks:

• Infection or bleeding at the injection site
• Temporary bladder or bowel changes, or blood in the urine (haematuria), given the proximity to these organs
• Nerve injury, or injury to nearby blood vessels, the ureters, bladder, or bowel, which is rare with X-ray guidance
• Allergic reaction to the local anaesthetic or contrast dye
• Small increased lifetime risk from the X-ray exposure used to guide the procedure
• Serious sedation or anaesthetic complications, very rarely including stroke or death
• Minimal or no improvement in pain

• Tell us about any blood-thinning medication (e.g. warfarin, Xarelto, Plavix) well in advance — special arrangements may be needed and you may be asked to pause these under guidance
• Tell us if you are, or might be, pregnant — this procedure uses X-ray guidance
• Tell us about any allergies, including to contrast dye, local anaesthetics, or reactions to previous injections or anaesthesia
• You will usually be asked to fast for 6 hours beforehand
• Bring a list of your current medications
• Arrange for someone to drive you home afterwards

• You will lie face-down (prone) on the procedure table
• The skin over the treatment area is cleaned with antiseptic
• Local anaesthetic numbs the skin before the main needle is placed
• Needles are placed on both sides of your spine, with contrast dye used to confirm correct position before treatment
• The procedure usually takes 30-45 minutes

• You will be monitored briefly in recovery before going home
• Some soreness at the injection sites is common for 1-3 days — simple pain relief (e.g. paracetamol) usually helps
• You may remove the small dressing after 24 hours, keeping the area clean and dry
• You may feel light-headed on standing for a day or two — stand up slowly and ask for help if needed
• Avoid strenuous activity or heavy lifting for 24-48 hours
• If you were sedated, avoid driving, operating machinery, or making important legal or financial decisions for 24 hours
• Continue your regular medications unless specifically advised otherwise

Contact your GP, Total Pain Clinic, or your nearest Emergency Department if you notice:

• Increasing redness, swelling, or discharge at the injection site
• Fever or feeling generally unwell
• New weakness, numbness, or loss of bladder/bowel control
• Severe pain not settling with simple pain relief

A review appointment is usually arranged 2-4 weeks after your procedure to discuss how you responded and plan next steps — please call Total Pain Clinic reception to schedule this if it hasn't already been arranged. Please ask your doctor any questions before you proceed; you will be asked to sign a consent form if you agree to go ahead.