Pain Management for Interstitial Cystitis and its Response to Superior Hypogastric Nerve Block, Pudendal Nerve Block

Authors: Aparna Bagle, anushka sharma, yashwant nankar

Keywords: Interstitial Cystitis, Pudendal Nerve Block, Superior Hypogastric Plexus Block, Chronic Pelvic Pain, Ultrasound-Guided Nerve Block, Pain Management

Abstract: Background: Interstitial cystitis (IC) presents significant therapeutic challenges due to its complex pathophysiology and variable response to conventional treatments. This case report describes the successful management of refractory IC using a combination of superior hypogastric nerve block and ultrasound-guided pudendal nerve block. Case Presentation: A 70-year-old woman presented with a one-year history of severe right sided perineal pain (NRS 8/10), frequent urination, and nocturia. Initial conservative management with oral medications showed limited efficacy. The patient underwent a fluoroscopy-guided superior hypogastric nerve block, resulting in 20-30% pain reduction and modest improvement in urinary symptoms. Subsequently, an ultrasound-guided pudendal nerve block was performed, leading to 80% pain reduction, significant improvement in urinary symptoms, and enhanced quality of life, as evidenced by improvement in the King's Health Questionnaire score from 76 to 39. Discussion: The marked improvement following the combined nerve block approach suggests that targeted intervention of both the superior hypogastric plexus and pudendal nerve may provide effective pain relief in refractory IC. The use of ultrasound guidance enabled precise anatomical targeting and real-time visualization of local anaesthetic spread. Conclusion: Combined superior hypogastric and pudendal nerve blocks may offer an effective, minimally invasive option for managing refractory IC, particularly before considering more invasive surgical interventions.