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Inferior hypogastric plexus

The inferior hypogastric plexus, also known as the pelvic plexus or pelvic ganglion, is a paired collection of nerve fibers situated on each side of the rectum in males, or on sides of the rectum and vagina in females. The inferior hypogastric plexus is formed by the contributions from the pelvic splanchnic nerves, sacral splanchnic nerves, and superior hypogastric plexus along with the afferent fibers from pelvic viscera.

The hypogastric plexus contains both parasympathetic and sympathetic nervous fibers. The main function of this plexus is to supply the pelvic and perineal organs. Understanding the anatomy of this plexus is crucial to preventing iatrogenic injuries during abdominopelvic surgeries that can be life-threatening.

This article will discuss the anatomy and function of the inferior hypogastric plexus.

Key facts about the inferior hypogastric plexus
Location Each side of the colon, anterolateral to the mesocolon, posterolateral to the reproductive organs
Branches Postganglionic sympathetic fibers, visceral afferent fibers, preganglionic and postganglionic parasympathetic fibers
Supply Both sexes: Portion of rectum, distar ureter, urinary bladder
Males: Ductus deferens, prostate, seminal vesicles
Females: Uterus, Fallopian tubes, ovaries and vagina
Contents
  1. Origin and course
  2. Branches and innervation
  3. Clinical relations
    1. Inferior hypogastric plexus injury
  4. Sources
+ Show all

Origin and course

The inferior hypogastric plexus is embedded within the extraperitoneal connective tissue on each side of the rectum. In males, the plexus is positioned posterolaterally to the seminal vesicles, prostate and the base of the urinary bladder. In females, each plexus is positioned laterally to the uterine cervix, vaginal fornix and the urinary bladder.

The inferior hypogastric plexus is formed by the nerve fibers which originate from multiple sites:

  1. A hypogastric nerve on either side carries contributions from the superior hypogastric plexus (mainly sympathetic fibers)
  2. Sacral splanchnic nerves, which emerge from the sympathetic trunk (T10-L2)
  3. Pelvic splanchnic nerves (S2-S4) contribute with the parasympathetic efferent fibers to the plexus
  4. Afferent visceral fibers from the pelvic viscera

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Branches and innervation

The inferior hypogastric plexus gives numerous pelvic branches which supply the pelvic viscera directly, or more commonly, indirectly by providing fibers for smaller plexuses located in the walls of the organs (e.g. middle rectal plexus, the prostatic plexus, and the uterovaginal plexus also known as Frankenhäuser ganglion).

These branches are:

  • postganglionic sympathetic fibers
  • visceral afferent fibers
  • preganglionic and postganglionic parasympathetic fibers

The inferior hypogastric plexus supplies the portion of the rectum and the distal portion of the ureter together with the urinary bladder. In males, the inferior hypogastric plexus supplies the vas deferens, seminal vesicles, prostate, accessory glands and penis in males. In females, it supplies the ovary, fallopian tubes, uterus, uterine cervix and vagina. That said, the proper functioning of the inferior hypogastric plexus is key for basic functions such as micturition and sexual function (e.g. erection and ejaculation).

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