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What is a Ganglion Impar Injection?

A ganglion impar injection or block is a procedure employed for the treatment of persistent pain in the coccyx (tailbone) as well as the pelvis and anorectal area. Ganglion impar refers to a group of nerve cells located close to the coccyx. Nerves that convey pain impulses from the groin and lower pelvis travel through the ganglion impar on their way to the brain.

A ganglion impar block can be used for diagnostic as well as therapeutic purposes. In a diagnostic block, a contrast agent along with a local anesthetic is used to determine the source of pain while in a therapeutic block, a contrast agent, local anesthetic, and steroid are collectively used to reduce the pain and inflammation. 

Indications for Ganglion Impar Injection

A ganglion impar injection may be recommended for the treatment of pain from the groin or lower pelvic area caused by cancer, dysfunction, or damage to organs in the region when other treatment modalities have failed to provide relief. A ganglion impar injection may help you if you have conditions such as:

  • Perineal pain
  • Pelvic pain
  • Coccygodynia (tailbone pain)
  • Rectal/anal cancer pain
  • Cervical cancer pain
  • Pain of the female/male genital system
  • Scrotal cancer pain
  • Vaginal/vulvar cancer pain

Preparation for Ganglion Impar Injection

In general, pre-procedure preparation for ganglion impar injection will involve the following steps:

  • You will be asked if you have allergies to medications, anesthesia, contrast dye, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You may need to refrain from vitamins and supplements or medications such as blood thinners for at least a week prior to the procedure.
  • It is also important to inform your doctor if you are pregnant or might be pregnant, diabetic, asthmatic, or have any other medical conditions.
  • You should refrain from alcohol or tobacco at least a few days prior to the procedure.
  • You should not consume any solids at least 6 hours prior to the procedure. A small quantity of clear liquids is okay up to 2 hours before the procedure.
  • You should arrange for someone to drive you home after the procedure.
  • A written consent will be obtained from you after the pros and cons of the procedure have been explained in detail.

Procedure for Ganglion Impar Injection

The procedure usually takes about 10 to 15 minutes and is performed in an office setting in a procedure room enabled with fluoroscopy. You will lie on your stomach on the procedure table. You may receive sedation to help you relax. Your physician will clean the intended site with iodine and cover it with a sterile drape. A local anesthetic is then used to numb the skin. Under real-time x-ray (fluoroscopy) guidance, a small amount of contrast dye is injected to confirm the positioning of the needle. This is followed by the administration of a local anesthetic and steroid mix through the needle into the ganglion impar area under x-ray guidance.  The needle is then removed, and a dressing is used to cover the injection site.

Post-procedure Care and Recovery

In general, post-procedure care instructions and recovery after ganglion impar injection will involve the following steps:

  • You will be transferred to the recovery area where your nurse will observe you for 30 to 60 minutes.
  • You may experience pain and soreness in the treatment area for a few days. Pain and anti-inflammatory medications are prescribed as needed. Ice packs are also advised to mitigate soreness.
  • Refrain from operating heavy machinery or driving for at least 24 hours.
  • Refrain from consuming alcohol for at least 24 hours.
  • You will be able to shower the very next day of the procedure.
  • You will be able to resume your normal activities the following day but may have certain activity restrictions.
  • A follow-up visit will be scheduled to monitor your progress.

Risks and Complications

Ganglion impar injection is a relatively safe procedure; however, as with any procedure, some risks and complications may occur, such as:

  • Infection
  • Bleeding
  • Pain
  • Numbness
  • Damage to adjacent tissue
  • Soreness/bruising
  • Allergic/anesthetic reactions