Sacrospinous fixation (hysteropexy)

Sacrospinous fixation

Please be aware that the following prices are a guide price. Your final price will be confirmed in writing following your consultation and any necessary diagnostic tests.

Any diagnostic tests that are carried out will incur a fee and if you see a consultant to go through your results they may also charge an extra consultation fee.

Patient pathway	Initial consultation	Diagnostic Investigations	Main treatment	Post discharge care	Guide price
Hospital fees	N/A	Not included	£7,855	Included	£7,855
Consultants fees from	£200	N/A	Included	Included	£200
Guide price	£8,055

Your consultant may recommend sacrospinous fixation when you have a uterus prolapse, which occurs when your pelvic floor muscles and ligaments become stretched and weakened to the point when they can no longer provide support for your uterus. This means that your uterus slips down into your vagina or protrudes out of your vagina. You are more likely to experience this issue after menopause or after giving birth (typically after one or more vaginal deliveries).

Sacrospinous fixation might also be needed if the top of your vagina (your vaginal vault) sags and falls into your vaginal canal, which can occur as a result of a hysterectomy, which is a procedure that involves the removal of your uterus.

Symptoms that indicate the need for sacrospinous fixation

It could be that you don't experience any symptoms as a result of either a uterus or vaginal vault prolapse, with no medical treatment being required.

However, other people will have significant symptoms that affect their quality of life, meaning they will want or need to seek treatment. These include:

• A heavy feeling around your lower belly and genitals
• A dragging discomfort inside your vagina
• Feeling or seeing a bulge or lump in or coming out of your vagina
• Difficulty with peeing - a common one being feeling like your bladder is not emptying fully, needing to go to the toilet more often, or leaking a small amount of pee when you cough, exercise, or sneeze
• Trouble with bowel movements (needing to press your vagina with your fingers to support your bowel movement)
• Pressure or discomfort in your pelvis and/or lower back
• Sexual issues - discomfort and/or numbness during sex and/or concerns around the vaginal tissue being loose

To determine whether you need sacrospinous fixation, your consultant will do an internal pelvic examination. This involves them feeling for any lumps in your pelvic area and inside your vagina. To do this, your consultant may use a speculum - an instrument that holds your vaginal walls open so that they can see more easily if you have a prolapse. You may be asked to lie on your side, as this may give your consultant a better view of your prolapse.

No imaging tests are needed for determining whether you require sacrospinous fixation. If your consultant suspects you have problems with your bladder, they may take a urine test to check for any infections, or insert a small tube into your bladder to see if there are any other problems.

Please note that you can always ask for a female consultant and/or have a member of your support network with you during the consultation.

If your uterus and/or vaginal vault prolapse is mild and not causing you any discomfort, your consultant may only recommend some lifestyle changes that can help to manage your uterus or vault prolapse, such as losing weight and/or avoiding heavy lifting. In cases where you are experiencing symptoms that are leading to discomfort, they may suggest some non-surgical treatments, such as:

Pelvic floor exercises

By strengthening the muscles around your bladder, buttocks, and vagina, pelvic floor exercises can prevent your prolapse symptoms from getting any worse. These exercises usually involve being sat down comfortably and squeezing your muscles 10 or 15 times. To start with, don't hold your breath or tighten your stomach. Over time, you'll be able to hold each squeeze for longer.

Vaginal pessaries

A vaginal pessary is a device that your consultant will insert into your vagina to hold your prolapsed womb and/or vaginal walls in place. You may receive a ring pessary, which is round and comes in different sizes, or a shelf pessary, which gives you extra support in cases where your ring pessary does not stay in place. Your consultant will take care to ensure you're given a vaginal pessary that is most suitable for you.

If these more conservative treatments do not make a difference to your situation, your consultant may recommend sacrospinous fixation. Ahead of the treatment, they will give you some information on how you can prepare.

Prepare for a hospital stay

After your sacrospinous fixation, you'll need to stay in hospital for a couple of days so that we can monitor how you're doing. So, ahead of coming to hospital, think about bringing along anything that might make your time with us more comfortable, such as loose-fitting clothing or a laptop/tablet to keep you entertained.

Stop smoking

Smoking increases your chances of breathing and heart troubles both during and after surgery, along with potentially affecting the quality of your recovery. If you smoke, your consultant may then recommend that you stop two weeks prior to your sacrospinous fixation.

Stock up on supplies

For the first week after your sacrospinous fixation, you will need to take it easy and get plenty of rest, which means you won't be able to make trips to the shop on a daily basis. To make your recovery as smooth as possible, then, be sure to gather any supplies you might need before coming in for surgery. If you need anything else while you recover, ask a family member and/or friend to grab it for you.

Check medications with your consultant

Medications like aspirin, warfarin, or any anti-inflammatories (NSAIDs) can increase your chances of unwanted bleeding during and/or after surgery, so your consultant may speak to you about any medications before your procedure. It could be that you have to stop taking them for two weeks before your treatment.

Food and drink

Don't eat or drink anything after midnight on the day of your sacrospinous fixation, and avoid alcohol for 48 hours prior to your visit to hospital.

Sacrospinous fixation is usually done under general anaesthetic, which means you'll be asleep for the procedure and won't feel anything. If you prefer, your anaesthetist can administer spinal anaesthesia instead; you'll have no sensation below the waist and be awake for the procedure. They will speak to you beforehand about which anaesthesia option you would prefer.

Your sacrospinous fixation procedure will follow a series of steps, which include:

• Your surgeon makes an incision in the back wall of your vagina
• The prolapsed top of your vagina is then stitched to one of your sacrospinous ligaments (a thin ligament that attaches to your lower pelvis and bottom of your spine)
• Two strong dissolvable stitches are placed between your sacrospinous ligament and the top of your vagina, restoring it to its normal position (these stitches dissolve in four to six months, by which point your tissue would have healed and the top of your vagina can stay in place)²

Generally, you will make a full recovery in around two months after sacrospinous fixation, but your exact timeline may differ depending on a range of factors, such as:

• Your fitness levels
• Your everyday activities
• The nature of your job
• General health
• Your age

Recovering in hospital

You will likely feel a bit groggy if you had your sacrospinous fixation under general anaesthetic, but this is completely normal. You'll be transferred to a private room and given some time to rest, receiving pain relief medication whenever necessary.

A catheter (a flexible tube used to collect urine) to your bladder will be attached, as this allows us to monitor your condition. Your nurse may also place a pack into your vagina to help with any bleeding and/or bruising, which is usually taken out 48 hours following your sacrospinous fixation.

Three days to three weeks after sacrospinous fixation

To ensure your vaginal tissues heal properly and you make a full recovery, you'll need to take it easy and avoid any strenuous activities for the first few weeks. You may experience vaginal bleeding for up to two weeks, along with vaginal discharge for up to six weeks.

Take care to eat a healthy diet to avoid constipation, which could make your symptoms return, and avoid any heavy lifting.

Three to six weeks after sacrospinous fixation

After around three or four weeks, you should be able to return to work. When exactly you go back depends on how you've recovered, so please speak to your consultant about this. Your time away from work will be longer if you do any kind of manual labour. You can also start driving again at the four-week stage following your sacrospinous fixation.

Your consultant will recommend that you wait six weeks before having sex or doing anything physically strenuous, like heavy lifting.

As is the case with any surgery, some complications are possible, but these are very rare. Your consultant will talk to you about any risks involved before your sacrospinous fixation and answer any questions you might have about the procedure.

General complications of any operation

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of sacrospinous fixation

• Buttock pain
• Heavy bleeding
• Damage to your surrounding organs (bladder or rectum)
• Clots forming in your legs or lungs
• Urinary tract infection (UTI)
• Pain during sex
• Inability to pee or involuntary peeing

What should you not do with a prolapse?

We advise patients with a uterine or vaginal vault prolapse to refrain from:

• Heavy lifting (anything over 5kg)
• High-impact exercises like jumping or running
• Straining during bowel movements
• Prolonged standing or sitting
• Smoking, which can weaken tissues

We do recommend:

• Maintaining a healthy weight
• Exercising your pelvic floor regularly
• Eating a high-fibre diet to prevent constipation

Your consultant will provide you with personalised advice and a plan based on your specific condition and lifestyle.

How long do you stay in hospital after prolapse surgery?

Your comfort and safe recovery are our priorities at Circle Health Group. After sacrospinous fixation:

• Most patients stay in hospital for one to two days
• Enabling us to monitor your recovery and manage any immediate needs after surgery
• Some patients may be able to return home on the same day, depending on an individual case-by-case basis

Your consultant will advise you on the expected length of your in-patient hospital stay during your pre-operative consultation, accounting for your specific procedure and overall general health.

What is sacrospinous ligament fixation?

At Circle Health Group, we offer sacrospinous ligament fixation as an effective treatment for uterine or vaginal vault prolapse. This procedure involves:

• Making an incision in the back wall of your vagina
• Attaching the top of your vagina to one of your sacrospinous ligaments
• Using strong dissolvable stitches to hold everything in place

This surgery helps to restore your vagina to its normal position and improves your bladder and bowel function. Our experienced surgeons perform this procedure with great care and precision to ensure the best possible outcomes for our patients.

What is the success rate of sacrospinous fixation?

As with all operations for prolapse, it is not guaranteed to be completely successful as the reason for the prolapse in the first place is that the tissues in that area are weak. However, at Circle Health Group, we're proud of the high initial success rates achieved overall in curing the vault prolapse with sacrospinous fixation:

• Studies report success rates of 80-90% for treating vaginal vault prolapse
• Most patients experience significant improvement in their symptoms
• Long-term success rates are generally good, with many patients having relief for years

However, it's important to know that every patient is different. Prolapse of the vaginal walls may still be present after surgery and may require a vaginal repair, and recurrence of the prolapse due to weakness of the repaired tissue can occur after some time. During your consultation, your specialist will discuss the expected outcomes based on your individual case and medical history.

How strong is a sacrospinous fixation?

Sacrospinous fixation is a robust procedure designed to provide long-lasting support. At Circle Health Group, we ensure:

• The stitches used are strong and durable
• They're placed precisely to maximise support
• The sacrospinous ligament itself is very strong, providing great anchorage

While the stitches dissolve after a period of 4-6 months, by this time your body has grown new tissue connections, maintaining the support. Our surgeons use precise techniques that aim to provide strong, lasting results for our patients.

What are the side effects of sacrospinous ligament fixation?

We believe in fully informing our patients of any possible side effects at Circle Health Group. Potential side effects of sacrospinous fixation can include:

• Temporary buttock pain
• Vaginal bleeding or discharge for a few weeks
• Urinary tract infections
• Temporary difficulty urinating
• Possible pain during sexual intercourse

Most side effects are temporary and resolve over time. Our team provides comprehensive aftercare to help you manage any side effects while ensuring you’re as comfortable as possible during recovery.

How painful is sacrospinous fixation?

We always prioritise your comfort. While everyone's experience of pain is different:

• The procedure itself is performed under anaesthesia, so you won't feel pain during surgery
• Post-operative pain is usually manageable with prescribed pain medication
• Most patients describe the pain as moderate and improving over time
• Buttock pain can occur, but usually resolves within a few weeks

Our team will provide you with a personalised pain management plan to ensure your comfort throughout your recovery process.

Can you get back pain from sacrospinous fixation?

While back pain isn't a common complaint after sacrospinous fixation, some patients may experience:

• Temporary buttock pain that can sometimes extend further to the lower back
• Discomfort because of changes in posture as your body adjusts to the new positioning

Should you experience back pain that persists after the procedure, we encourage you to contact your consultant. They can evaluate whether it's associated with the surgery or if there's another cause that needs addressing.

Is mesh used in sacrospinous fixation?

We want to reassure our patients that:

• Sacrospinous fixation does not typically involve the use of mesh
• The procedure uses strong, dissolvable stitches to attach your vaginal vault to the sacrospinous ligament
• This technique provides support without the need for synthetic mesh

If are concerned about mesh use in pelvic floor surgeries, please feel free to talk this through your consultant. They can explain to you in detail why sacrospinous fixation is an option for treating prolapse without the use of mesh.

What is bilateral sacrospinous fixation?

At Circle Health Group, we offer a range of surgical techniques tailored to individual patient needs:

• Standard sacrospinous fixation involves attaching to one sacrospinous ligament
• Bilateral sacrospinous fixation attaches to both sacrospinous ligaments
• This bilateral approach may provide additional support in some cases

Your consultant will discuss whether a unilateral or bilateral approach is best for your specific situation or needs, taking into careful consideration factors like the extent of your prolapse and your overall general health.

What is sacrospinous colpopexy or sacrospinous fixation?

We use these terms to describe the same procedure:

• Sacrospinous fixation and sacrospinous colpopexy refer to the same surgical technique
• Both describe attaching the top of the vagina to the sacrospinous ligament
• The procedure is used to treat vaginal vault prolapse or uterine prolapse

We understand medical terminology can be confusing and complex – with different terms for the same or sometimes similar things. Our medical professionals are always happy to explain these terms and what the procedure involves in plain, clear language.

What nerve is injured in sacrospinous fixation?

Patient safety is our top priority at Circle Health Group. While nerve injury is a rare complication:

• The pudendal nerve runs close to the sacrospinous ligament
• In very rare cases, this nerve may potentially be affected during the procedure
• Our highly skilled and experienced surgeons use precise techniques to minimise the possibility of this risk

If nerve-related symptoms present after surgery, such as numbness or pain in the genital area, we strongly encourage patients to inform their consultant as soon as possible for a full assessment and management.

When you choose to go private with Circle Health Group, you can expect:   

• Flexible appointment times and locations to fit your routine  
• The freedom to choose which hospital and Consultant suit your needs  
• Personalised, Consultant-led treatment plans tailored to your individual needs  
• Comfortable and safe private facilities maintained by expert multidisciplinary teams  
• Support by the same compassionate clinical team from beginning to end  
• Affordable, fixed-price packages with aftercare included  
• Flexible payment options to spread the cost of your care

If you would like to learn more about this procedure, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Sacrospinous fixation, Benenden Hospital
2. Sacrospinous fixation, Mayo Clinic
3. Vaginal pessary for prolapse, NHS Oxford University Hospitals
4. Sacrospinous fixation for vaginal vault prolapse, NHS Oxford University Hospitals
5. Sacrospinous fixation patient information leaflet, British Society of Urogynaecology
6. Sacrospinous fixation and pelvic floor repair, NHS Gloucestershire
7. Sacrospinous fixation, Your Pelvic Floor
8. Uterine prolapse, Mayo clinic
9. Vaginal prolapse, Hopkins Medicine
10. Vaginal prolapse, Cleveland Clinic
11. Pelvic organ prolapse, NHS