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On level 18, there will be the message in chat
"You hear cries of Anguish in the distance..."
You will need a good amount of luck, and a reliable way of teleportation, or levitation, to make things easier, any digging item will help.
You will find a platform that's completely enclosed in with two levers, and two gates.
Using the levers opens said gates, but to get to them, you need a teleport with good luck, or levitation.
Going through, one side has Spikes, another side has a Boulder.
if you have no digging, you have to make a choice, Either rush past the boulder, or accept the damage of either the spikes or boulder.
If you fail the boulder path, you will be forced into the spikes.
If you however have any digging, you can break the wall between the two levers, to reach the portal immediately, once you get into the portal area, the entire floor will be lava, thus you must quickly get through if you have temporary levitation.
You will now be in "The Underworld" do not take the portal right outside of spawn, that will send you to level 20, and thus Herx. Instead, use your levitation or teleportation method once again (If you have none left, you will have to choose Herx) and find the exit. Get to it, and you can now safely take the next portal.
Be wary, there are Imps, and Shadows in the underworld, however.
Once you get through the first hatch in The Underworld, you can just simply take the portal at spawn in the second level, and you will be into hell, The second level will have no hatch, just the portal.
OFF TOPIC:
There is also an earlier Underworld after the mines, in the intermission between the Swamp and Mines, It is in the second chest room, behind the skull block, The first level is a much, much easier version of the "Anguish" underworld, this one also has a hatch, going through this one's hatch, in this second underworld, given you some how have levitation or teleportation reliably this early (Surely possible) You have a high chance of finding the Legendary Bow, (Artifact bow, if you go by game files), Khryselakatos, it generally will spawn in this underworld.