A superior hypogastric plexus block may help evaluate or temporarily reduce selected lower abdominal, pelvic, or visceral pelvic pain patterns.
Learn how Dr. Siefferman performs superior hypogastric plexus blocks to help diagnose and treat chronic pelvic pain by targeting the nerves that transmit pain from the pelvis.
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Hi, I’m Dr. Jason Siefferman, interventional pain specialist and medical director at Manhattan Pain Medicine. A superior hypogastric plexus block targets the sympathetic ganglia that are responsible for integrating all sensation from the lower abdomen and pelvic visceral organs. This includes bowel, bladder, uterus, and abdominal wall lining.
So if there is any pain that we suspect generating from these sources, we can do this nerve block to see if we think there’s endometriosis; this is a good test to see which pain may be coming from endometriosis. This is something that is done at the surgical center. The patient’s laying on their stomach. I use X-ray guidance. I enter on either side of the low back. I guide the needles next to the spine.
So this is not an injection into the spine, but the sympathetic chain runs right next to the vertebral bodies. So, it’s going through muscle soft tissue to get to that nerve chain there. We use contrast to confirm the location and then local anesthetic to turn it off. The local anesthetic only lasts an hour, but the reboot effect from this injection may last much longer. The information we get from this injection tells us whether or not there is pain coming from the internal organs, and how long it lasts also tells us about how active the pain generators are. So, it helps us get a better understanding of what’s driving the patient’s pain, where it’s coming from, and what a reasonable next step might be.
A superior hypogastric plexus block is a targeted sympathetic nerve block that may help evaluate or temporarily reduce selected lower abdominal, pelvic, or visceral pelvic pain patterns. The superior hypogastric plexus carries pain signals from pelvic structures and may be clinically relevant in some patients with chronic pelvic pain, endometriosis-related pain, fibroid-related pain, pelvic organ pain overlap, or complex pelvic pain.
At Manhattan Pain Medicine, superior hypogastric plexus block NYC care begins with diagnosis-first evaluation. The goal is to determine whether symptoms suggest visceral pelvic pain pathway involvement or whether another pain generator may be more important.
MPM specialists evaluate whether a superior hypogastric plexus block may be appropriate by carefully mapping pelvic and lower abdominal pain patterns. Pelvic pain may involve visceral pelvic nerves, pelvic floor dysfunction, pudendal neuralgia, endometriosis, fibroids, bowel or bladder conditions, constipation, pelvic dystonia, PGAD-related distress, orthopedic pain, neurologic pain, CRPS overlap, or central sensitization.
MPM reviews pain location, triggers, symptom timing, prior imaging, surgical history, gynecology, urology, colorectal, GI, neurology, and pelvic floor therapy history before determining whether this block, a pudendal nerve block, ganglion impar block, pelvic floor injections, sympathetic blocks, neuromodulation, or another care pathway may be appropriate.
Patients often search for a superior hypogastric plexus block in Manhattan when chronic pelvic or lower abdominal pain has not improved with medication, pelvic floor therapy, gynecology care, urology care, colorectal evaluation, GI care, or prior pain procedures. Symptoms may involve deep pelvic aching, lower abdominal pain, organ-related pelvic pain overlap, endometriosis-related pain, fibroid-related pain, constipation-related pelvic pain overlap, or complex pelvic pain that has multiple contributors.
MPM approaches superior hypogastric plexus blocks as precision tools, not standalone cures. A block may provide temporary relief or help clarify whether visceral pelvic sympathetic pathways are contributing to symptoms. Even short-term improvement can be clinically useful because it may guide next steps. Depending on the response, care may include pelvic floor therapy, medication management, pain psychology, additional nerve blocks, sympathetic blocks, spinal cord stimulation, dorsal root ganglion stimulation, or broader neuromodulation planning when appropriate.
Superior hypogastric plexus blocks fit within MPM’s Pelvic Pain, Complex Chronic Pain, and Autonomic dysfunction expertise because chronic pelvic pain often involves overlapping visceral, nerve, pelvic floor, autonomic, musculoskeletal, and nervous system contributors. A patient may have endometriosis-related pain, fibroid-related pain, pelvic floor dysfunction, pudendal neuralgia overlap, pelvic dystonia, PGAD-related distress, constipation-related pelvic pain, CRPS overlap, or central sensitization.
MPM uses superior hypogastric plexus blocks within a coordinated, diagnosis-first framework. A block may provide temporary relief or help clarify whether visceral pelvic sympathetic pathways are contributing to symptoms. Treatment planning may also include pelvic floor therapy, medication management, pain psychology, gynecology, urology, colorectal or GI care, sympathetic blocks, peripheral nerve blocks, neuromodulation, or other advanced pain treatments when clinically appropriate.
Before a superior hypogastric plexus block, MPM reviews the diagnosis, pelvic pain pattern, lower abdominal symptoms, medical history, medications, prior procedures, risks, alternatives, and post-procedure instructions. The block is directed toward the superior hypogastric plexus region, which is involved in pain signaling from pelvic structures. Image guidance is typically used to support procedural planning and medication placement.
Patients may feel pressure, brief discomfort, temporary numbness, warmth, soreness, or a short pain flare after the procedure. Relief, if it occurs, may be temporary and may last hours, days, weeks, or longer depending on the diagnosis, medication used, and patient response. Some patients may not respond. MPM reviews the response to determine whether visceral pelvic sympathetic pathways appear clinically meaningful and whether additional care should be considered.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
A superior hypogastric plexus block is a targeted sympathetic nerve block that may help evaluate or temporarily reduce selected lower abdominal, pelvic, or visceral pelvic pain patterns. The superior hypogastric plexus carries pain signals from pelvic structures. At MPM, this block is considered only after diagnosis-first evaluation to determine whether the patient’s symptoms suggest visceral pelvic pathway involvement or whether another pelvic, nerve, bowel, bladder, gynecologic, orthopedic, or centralized pain source may be more important.
The superior hypogastric plexus is a network of nerves located deep in the lower abdomen and pelvis, near the front of the lower spine. It helps transmit pain signals from pelvic structures. Because this region is anatomically complex, a superior hypogastric plexus block requires careful procedural planning, image guidance, and patient selection. MPM reviews anatomy, symptoms, medical history, and safety factors before recommending this procedure.
A superior hypogastric plexus block may help evaluate selected lower abdominal, visceral pelvic, pelvic organ, or deep pelvic pain patterns. It may be considered when symptoms suggest involvement of pelvic sympathetic pain pathways. It is not used for every type of pelvic pain. Pain from pudendal neuralgia, pelvic floor dysfunction, ganglion impar pathways, bowel or bladder disease, endometriosis, fibroids, orthopedic conditions, or central sensitization may require different evaluation or treatment.
A superior hypogastric plexus block may help selected chronic pelvic pain patients when symptoms suggest visceral pelvic sympathetic pathway involvement. It does not cure chronic pelvic pain and is not appropriate for every pelvic pain condition. MPM evaluates whether the pain pattern is more consistent with endometriosis, fibroids, pelvic floor dysfunction, pudendal neuralgia, bowel or bladder conditions, orthopedic pain, neurologic pain, CRPS overlap, or central sensitization before recommending a block.
A superior hypogastric plexus block may be considered for selected patients with endometriosis-related pelvic pain when symptoms suggest visceral pelvic pain pathway involvement. It does not treat or remove endometriosis itself and does not replace gynecology care, hormonal management, surgery evaluation, or other medical treatment when needed. MPM considers the full clinical picture, including pelvic floor dysfunction, nerve pain, bowel symptoms, bladder symptoms, and central sensitization.
A superior hypogastric plexus block may be considered for selected pelvic pain patterns where fibroid-related pain or pelvic organ pain overlap may be contributing. It does not shrink fibroids or replace gynecology evaluation. Fibroid-related symptoms can include bleeding, pressure, pain, urinary symptoms, or reproductive concerns that require appropriate medical evaluation. MPM considers whether pain appears visceral, pelvic floor-related, nerve-related, musculoskeletal, or centralized before recommending treatment.
A superior hypogastric plexus block may be considered for selected lower abdominal pain patterns when symptoms suggest pelvic visceral or sympathetic pain pathway involvement. Lower abdominal pain can also come from GI, urinary, gynecologic, vascular, infectious, musculoskeletal, neurologic, or emergency causes. MPM screens for red flags and reviews prior evaluations before determining whether this block, GI care, gynecology, urology, imaging, medication management, or another pathway is more appropriate.
A superior hypogastric plexus block can be diagnostic, therapeutic, or both. A diagnostic block may help determine whether the superior hypogastric plexus pathway is contributing to pelvic or lower abdominal pain. A therapeutic block is intended to reduce symptoms for a period of time. Relief is often temporary and varies by patient. MPM reviews the location, timing, degree, and duration of relief before recommending next steps.
A superior hypogastric plexus block targets visceral pelvic sympathetic pain pathways. A pudendal nerve block targets the pudendal nerve, which is more associated with perineal, genital, rectal, sitting-related, and pudendal nerve territory symptoms. These blocks are not interchangeable. MPM determines the appropriate target based on pain location, triggers, nerve territory, pelvic floor findings, bowel or bladder symptoms, and clinical diagnosis.
A superior hypogastric plexus block is often considered for selected lower abdominal, visceral pelvic, or pelvic organ pain patterns. A ganglion impar block is more often considered for selected tailbone, perineal, rectal, anal, genital, or lower pelvic pain patterns. MPM compares these targets during pelvic pain mapping and selects the approach based on symptoms, anatomy, diagnosis, and prior treatment response.
Relief varies by diagnosis, medication used, pain pathway, and patient response. Some patients may experience relief for hours or days, while others may notice longer improvement. Some patients may not respond. Relief is not guaranteed and is often temporary. MPM uses the response to determine whether the superior hypogastric plexus pathway appears clinically meaningful and whether additional care should be considered.
Temporary relief can still provide useful diagnostic information. It may suggest that visceral pelvic sympathetic pathways are contributing to pain. Depending on the response, MPM may consider pelvic floor therapy, medication management, pain psychology, additional nerve blocks, sympathetic blocks, spinal cord stimulation, dorsal root ganglion stimulation, or other neuromodulation options. If relief is limited or absent, the diagnosis may need further refinement.
A superior hypogastric plexus block may provide information that helps guide broader treatment planning in selected pelvic pain cases. If relief suggests a specific pelvic pain pathway, MPM may consider whether spinal cord stimulation, dorsal root ganglion stimulation, or other neuromodulation options should be discussed. These decisions are not automatic and depend on diagnosis, anatomy, prior response, safety factors, and patient goals.
Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, vascular injury, nerve irritation, bowel or bladder changes, local anesthetic toxicity, steroid-related side effects when steroids are used, incomplete relief, temporary relief only, or no relief. MPM reviews risks before treatment. Severe pelvic or abdominal pain, fever, heavy bleeding, blood in stool or urine, new weakness, inability to urinate, or rapidly worsening symptoms require urgent evaluation.
A superior hypogastric plexus block may not be appropriate when symptoms do not suggest visceral pelvic sympathetic pathway involvement, when another diagnosis should be evaluated first, or when risks outweigh potential benefit. It is not a replacement for pelvic floor therapy, gynecology, urology, colorectal evaluation, GI evaluation, oncology care, neurology, medication management, pain psychology, surgery, neuromodulation evaluation, or emergency care when needed.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If you are considering a superior hypogastric plexus block in NYC for chronic pelvic pain, lower abdominal pain, endometriosis-related pain, fibroid-related pain, pelvic organ pain overlap, or complex pelvic pain, MPM can help determine whether this treatment may be appropriate. Your evaluation will consider your symptoms, diagnosis, prior care, safety factors, and treatment goals before any recommendation is made.
A superior hypogastric plexus block is a targeted sympathetic nerve block that may be considered for selected patients with lower abdominal, pelvic, or visceral pelvic pain patterns. The superior hypogastric plexus is a network of nerves that helps carry pain signals from pelvic structures. In some patients, this pathway may contribute to chronic pelvic pain, endometriosis-related pain, fibroid-related pain, pelvic organ pain overlap, post-surgical pelvic pain, or complex pelvic pain.
At Manhattan Pain Medicine (MPM), superior hypogastric plexus block NYC care begins with diagnosis-first evaluation. The goal is to determine whether the superior hypogastric plexus is a clinically reasonable target and whether the block may provide diagnostic information, temporary relief, or both.
The superior hypogastric plexus carries pain signals from pelvic structures and is part of the autonomic nervous system. When pelvic pain has a deep, visceral, lower abdominal, or organ-related quality, this pathway may be considered as part of the evaluation.
However, pelvic pain is rarely simple. Pain may come from endometriosis, fibroids, pelvic floor dysfunction, pudendal neuralgia, pelvic dystonia, bowel disease, bladder pain, constipation, orthopedic pain, nerve entrapment, post-surgical changes, CRPS overlap, or central sensitization. More than one pain source may be present at the same time.
MPM does not treat superior hypogastric plexus block as a general pelvic pain injection. The evaluation begins with careful symptom mapping. This may include pain location, menstrual or hormonal patterns, bowel symptoms, bladder symptoms, sitting tolerance, genital or rectal symptoms, lower abdominal pain, surgical history, trauma history, imaging, medications, pelvic floor therapy, gynecology care, urology care, colorectal or GI evaluation, and prior procedures.
This information helps determine whether pain appears visceral, somatic, pelvic floor-related, nerve-related, inflammatory, orthopedic, neurologic, or centralized. It also helps MPM compare the superior hypogastric plexus block with other targets, including pudendal nerve block, ganglion impar block, pelvic floor injections, peripheral nerve blocks, sympathetic blocks, spinal cord stimulation, dorsal root ganglion stimulation, or broader neuromodulation.
A superior hypogastric plexus block may be considered for selected chronic pelvic pain patients when symptoms suggest lower abdominal or visceral pelvic pathway involvement. The block may provide temporary relief or help clarify whether the superior hypogastric plexus is contributing to symptoms.
This procedure does not cure chronic pelvic pain. It also does not replace gynecology, urology, colorectal, GI, pelvic floor, neurology, oncology, or surgical evaluation when those are needed. Instead, it may be one part of a coordinated care plan for selected patients.
Patients with endometriosis, fibroids, or pelvic organ pain overlap may ask whether a superior hypogastric plexus block can help. In selected cases, the block may be considered when pain appears to involve visceral pelvic pathways. However, it does not remove endometriosis, shrink fibroids, treat infection, address bowel or bladder disease, or replace appropriate specialty care.
MPM evaluates whether pain is likely related to pelvic organ signaling, pelvic floor dysfunction, pudendal nerve involvement, musculoskeletal mechanics, post-surgical changes, or central sensitization. This helps determine whether a block is appropriate or whether another treatment pathway should come first.
Different pelvic nerve blocks target different pain pathways. A pudendal nerve block may be more relevant for pain in the pudendal nerve territory, including selected genital, rectal, perineal, or sitting-related symptoms. A ganglion impar block may be more relevant for selected tailbone, perineal, rectal, anal, genital, or lower pelvic pain patterns. A superior hypogastric plexus block is more often considered for selected visceral pelvic or lower abdominal pain patterns.
MPM uses pelvic pain mapping to determine which target best matches the symptoms. The appropriate procedure depends on diagnosis, anatomy, prior treatment response, safety factors, and care goals.
A superior hypogastric plexus block may be diagnostic, therapeutic, or both. A diagnostic block may help determine whether visceral pelvic sympathetic pathways are contributing to pain. If relief occurs in the expected region, that response may support the superior hypogastric plexus as a meaningful pain pathway.
A therapeutic block is intended to reduce symptoms for a period of time. Relief may last hours, days, weeks, or longer, and some patients may not respond. MPM reviews the degree, timing, location, and duration of relief before recommending next steps.
If a superior hypogastric plexus block provides temporary relief, MPM may consider whether the patient would benefit from pelvic floor therapy, medication management, pain psychology, additional sympathetic blocks, peripheral nerve blocks, spinal cord stimulation, dorsal root ganglion stimulation, or other neuromodulation options. If the block does not help, the care team may reassess whether the symptoms are more consistent with pudendal neuralgia, pelvic floor dysfunction, endometriosis, fibroids, bowel or bladder disease, orthopedic pain, neurologic pain, or central sensitization.
Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, vascular injury, nerve irritation, bowel or bladder changes, local anesthetic toxicity, steroid-related side effects when steroids are used, incomplete relief, temporary relief only, or no relief.
Patients should seek urgent evaluation for fever, spreading redness, severe pelvic or abdominal pain, rectal bleeding, blood in stool or urine, new bowel or bladder dysfunction, inability to urinate, saddle anesthesia, new weakness, heavy bleeding, pregnancy-related pain, unexplained weight loss, cancer-related red flags, severe allergic reaction, or rapidly worsening symptoms.
For selected patients, a superior hypogastric plexus block may be an important step in understanding lower abdominal and pelvic pain pathways. MPM’s role is to determine whether the block is appropriate, safe, and aligned with a coordinated pelvic pain care plan.
