Hypogastric Plexus

The hypogastric plexus is a complex autonomic nerve network located in the pelvic region. It plays a central role in innervating pelvic viscera, including the bladder, rectum, prostate, uterus, and genital organs. The plexus is divided into superior and inferior parts and contains both sympathetic and parasympathetic fibers, as well as visceral afferents. It serves as a critical communication hub between the abdominal and pelvic autonomic systems.

Structure

The hypogastric plexus consists of two main components:

• Superior hypogastric plexus: Located anterior to the lower abdominal aorta and L5 vertebral body
• Inferior hypogastric plexus (right and left): Located on either side of the rectum, converging from the superior plexus and pelvic splanchnic nerves

It contains a mix of nerve fibers:

• Sympathetic fibers: From lumbar splanchnic nerves (L1–L2)
• Parasympathetic fibers: From pelvic splanchnic nerves (S2–S4)
• Visceral afferents: For pain and reflex sensation from pelvic organs

Location

Connections

• Superior hypogastric plexus → Hypogastric nerves → Inferior hypogastric plexus
• Inferior hypogastric plexus communicates with:
  • Pelvic splanchnic nerves (parasympathetic)
  • Sacral splanchnic nerves (sympathetic)
  • Organ-specific subplexuses (e.g., vesical, prostatic, uterovaginal, rectal)

Function

• Autonomic Regulation: Supplies sympathetic and parasympathetic innervation to pelvic organs
• Visceral Reflexes: Transmits afferent signals for bladder fullness, rectal distension, sexual function
• Organ-Specific Branches: Forms subsidiary plexuses for bladder, prostate, uterus, rectum, and erectile tissues

Clinical Significance

• Pelvic Surgery Risk: Injury to the plexus during hysterectomy, prostatectomy, or colorectal surgery may impair bladder and sexual function
• Nerve-Sparing Techniques: Used in prostate and gynecologic surgeries to preserve autonomic control
• Pain Pathways: Chronic pelvic pain may involve abnormal afferent activity through the plexus