The inferior hypogastric plexus is the principal autonomic plexus of the pelvis, formed bilaterally by the superior hypogastric plexus descending hypogastric nerves from above, the sacral sympathetic trunk fibres from the sacral ganglia, and the pelvic splanchnic nerves (S2-S4) carrying parasympathetic preganglionic fibres. It lies on the lateral walls of the rectum and bladder and distributes mixed autonomic fibres to all pelvic organs including the bladder, rectum, uterus, vagina, prostate, and erectile tissue.
| Origin | Hypogastric nerves (sympathetic), pelvic splanchnic nerves (S2-S4, parasympathetic) and sacral splanchnic nerves |
|---|---|
| Course | Lies on each side of the rectum, bladder base and vagina or prostate within the pelvic fascia, distributing fibres along the visceral branches of the internal iliac artery to the pelvic organs |
| Sensory |
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The inferior hypogastric (pelvic) plexus lies on the side wall of the pelvis just outside the mesorectal fascia, so it is at risk during total mesorectal excision (TME) for rectal cancer. Injury causes bladder dysfunction, sexual dysfunction (erectile and ejaculatory problems in men, arousal and orgasm problems in women) and defaecation problems. Nerve-sparing TME keeps the dissection exactly on the mesorectal fascia. The plexus is also at risk in radical hysterectomy when the cardinal and uterosacral ligaments are divided, which is the basis of nerve-sparing hysterectomy, and in radical prostatectomy.
Division of the inferior hypogastric plexus during rectal cancer surgery produces bladder areflexia requiring catheterisation, erectile dysfunction in males, and female sexual dysfunction, motivating nerve-sparing techniques that preserve the plexus by sharp dissection in the precise TME plane.
Sympathetic denervation of the bladder neck through injury to the superior hypogastric plexus or hypogastric nerves causes failure of bladder neck closure during ejaculation, producing retrograde ejaculation, a common complication of anterior lumbar spine surgery and para-aortic node dissection.
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