Superior Hypogastric Plexus Block in Palm Coast, FL

There is a bony ledge low in your spine where the lumbar vertebrae meet the sacrum, and the pain fibers from your pelvic organs lie draped across it like a net. That’s the surface this block treats.

What it treats

This block addresses deep pelvic pain originating in the organs rather than the pelvic wall:

The pain that fits is visceral: deep, cramping or dragging, spreading past wherever you’d put a hand to show someone. It’s used for chronic pelvic pain continuing past a gynecologic or urologic workup, and for pelvic pain arising from cancer involving these organs.

How it works

Sensation from the bladder, uterus, prostate, rectum, and surrounding structures doesn’t reach the spine along a single nerve. It gathers first into the superior hypogastric plexus — a diffuse sheet of sympathetic fibers lying over the sacral promontory at the L5–S1 junction — and continues upward from there.

That shape governs the procedure. A knot of nerve tissue can be hit; a sheet has to be covered. What decides whether this block works is how widely the medication washes across that surface — which is why contrast is watched spreading over the ledge, and why the injection is often done from both sides to reach the sheet’s full width. Success here is a question of area, not aim.

Dr. Manuel López, a board-certified pain management and rehabilitation physician, works under continuous image guidance throughout. The promontory is a crowded shelf: the iliac vessels cross it, the sacral nerve roots emerge below it, the disc sits at its upper edge, and the flare of the pelvic bone partly blocks the way in.

What to expect

This is an outpatient procedure, and you’ll need a driver.

• Before: you’re placed face down with support beneath the abdomen, flattening the inward curve of the low back and opening the angle of approach toward the promontory. The skin low on the back is cleaned and numbed.
• During: the needle is angled past the flare of the pelvic bone toward the front of the L5–S1 junction. Contrast goes in first and is watched washing across the ledge; the medication follows once that spread looks right. A second side, if used, is done the same way.
• After: you’re observed. Blood pressure occasionally dips as a sympathetic network relaxes, so it’s checked before you leave; a temporary sense of pelvic warmth or fullness is likewise anticipated rather than a sign of trouble.

Dr. López asks you to track the deep, borderless part of your pain, since that’s what this block targets.

Is it right for you?

Dr. López weighs this option when:

• Deep pelvic pain has persisted after gynecologic or urologic evaluation
• The pain is diffuse and organ-like rather than confined to one nerve’s territory
• Cancer involving the pelvic organs is generating pain medication isn’t controlling well
• Pelvic floor therapy has helped partially and something targeted is needed

Each review item ties back to this ledge. Prior pelvic or spinal surgery and previous radiation matter most: scarring and shifted anatomy change how far medication spreads across the sheet, and sometimes close the approach entirely. Advanced disc collapse at that level narrows the corridor the needle travels. Anticoagulants and bleeding disorders come up because the iliac vessels run over the target; infection near the entry site rules out any spinal approach.

Cover the sheet, quiet the pelvis

If your pelvic pain is deep and borderless rather than confined to one spot, the surface it crosses can be reached.

Call (386) 222-7746 or request an appointment.