What Is Uterosacral Ligament Suspension?

Medically Reviewed by Dany Paul Baby, MD on November 02, 2022
Written by Alyssa Anderson
5 min read

A uterosacral ligament suspension surgery is a type of surgical procedure, generally, that’s done after a hysterectomy — a surgical procedure to remove the uterus. The goal of this surgical procedure is to provide support for your vagina once your uterus is gone and fix any prolapse in the area. Prolapsed organs have fallen from their original position. They interfere with other tissues and can cause uncomfortable symptoms.

Specifically, this type of surgery is a form of native tissue repair because it uses your own body parts for the repairs.

Ligaments are strong, stretchy tissues that connect bones to other bones. Your uterosacral ligaments stretch from the edges of your pelvis to your sacrum. Your sacrum is a triangular bone at the base of your spine that forms the center of your pelvis. 

These ligaments provide support to a number of organs and tissues in your pelvic region. This includes your uterus and cervix. Throughout your lifetime, the ligaments can become weak and distended — or stretched out. This can cause organs — like your uterus — to fall from their original location.

The most frequent reason for a uterosacral ligament suspension surgery is correcting a prolapsed vagina. Your vagina is a stretchy, tube-shaped organ that connects the bottom of your uterus, called your cervix, to an opening in your vulva. There are a few different types of vaginal prolapse: 

  • Cystocele. This is when your bladder has fallen, and it causes your vagina to cave in. 
  • Rectocele. With this version, your rectum has become displaced and affects your vagina. 
  • Uterine or vaginal vault. If you still have a uterus, this version is caused by the organ falling on the top of your vagina and causing the collapse. If your uterus has been removed, then it’s when the top of your vagina collapses in on itself. 
  • Enterocele. This is when a certain part of your colon has sagged into your vagina.  

Uterosacral ligament suspension surgery is most commonly used for prolapses in the vaginal vault. But it’s also a viable alternative for people who have experienced other types of pelvic organ prolapse. It’s less effective than an alternate surgery called a laparoscopic sacral colpopexy but poses fewer risks. 

Ultimately, your doctor will need to determine the type of surgery that’s best for you.

Some people are more at risk for pelvic organ prolapse than others. Those who are more likely to need a corrective surgery — like a uterosacral ligament surgery — are those who: 

  • Have had multiple births — the likelihood increases with each birth
  • Have a high body mass index and are overweight
  • Are advancing in age
  • Have a connective tissue disorder — including Marfan syndrome

Pelvic organ prolapses are fairly common events. They affect about 10% of all females between the ages of 20 and 39. They became much more frequent with age — approximately half of all females over the age of 80 will have experienced some form of pelvic organ prolapse throughout their lifetime.  

Keep in mind that many organ prolapses — such as a prolapsed uterus — aren't particularly life-threatening. But they can be uncomfortable and create a variety of problematic symptoms. This is when surgical treatments are necessary.

Uterosacral ligament suspensions are commonly done alongside other operative procedures. They’re most commonly done with hysterectomies — procedures that remove your uterus. The surgery is sometimes done by itself when you've already had a hysterectomy. It may also be done at the same time as surgery to correct urinary incontinence. 

To perform the surgery, your surgeon will first choose the best minimally invasive way to enter your body. This may be through your vagina or laparoscopically from the outside of your pelvic area, using small robots. 

Then, they use stitches to attach your prolapsed organ to the uterosacral ligaments. Usually, a part of the ligament that’s further up in your pelvis is used. 

Sometimes the stitches are temporary and are reabsorbed into your body, others are permanent. Research into the best types of stitches is still ongoing, but results are usually positive when only temporary stitches are used.

For the most part, there are very few complications associated with this surgery. There’s a 1% to 10% risk that you’ll experience ureteral kinking or an obstruction. There’s also a 5% to 10% chance that you’ll develop a urinary tract infection (UTI) or vaginal infection after the surgery. 

You should let your doctor know if you experience any signs of a UTI. Common symptoms include: 

  • Bad-smelling vaginal discharge
  • A frequent, urgent need to pee
  • Pain while peeing

Like any surgery, this one also comes with common risks including:

  • Problems with anesthesia
  • Bleeding during the operation — though blood transfusions are rarely needed during this surgery
  • The formation of blood clots during the operation

There’s also the risk that this surgery will damage nearby.

  • Organs,
  • Nerves,
  • Muscles, and
  • Ligaments

It's also important to keep in mind that about 30% of women who undergo this procedure will experience another prolapse.

The amount of pain that you’ll experience after this surgery varies from person to person. Most report mild, manageable levels of discomfort. Your doctor may prescribe some form of pain medication — including some narcotics — to help you during the first few days of your recovery process. 

In rare cases, you may experience pain in your buttocks or while having sex. This is typically treated with physical therapy or a procedure to release scar tissue. 

You should contact your doctor if you experience severe pain or if your pain doesn’t go away at the end of your recovery period.

Your doctor should provide you with recovery information specific to your situation. When the surgery is done at the same time as a hysterectomy, you should allow six weeks for a full recovery. But you should be able to return to most of your normal activities sooner than this.  

For these first six weeks, you should avoid: 

  • Lifting anything heavier than 10 pounds 
  • Taking any baths in a tub or similar soaking habits
  • Having sex
  • Driving while on any prescribed narcotics

You know best how your body feels. Take it easy when you need to and slowly resume your normal activities when it feels like you’re ready. Just be careful.