What Is Sacral Colpopexy?

Medically Reviewed by Nivin Todd, MD on May 20, 2023
4 min read

Sacral colpopexy is a surgery used to repair pelvic organ prolapse. This is a condition where your pelvic organs, such as your vagina and uterus, sag, or protrude through the vaginal opening. Sacral colpopexy treats pelvic organ prolapse by putting your organs back where they should be. 

Pelvic organ prolapse is when your pelvic organs, such as your vagina, uterus, and cervix, sag or protrude. This happens when the ligaments and muscles that support your pelvic organs weaken, causing them to drop lower in your pelvis. Eventually, this creates a bulge in your vagina known as prolapse.‌

Pelvic organ prolapse can occur years after childbirth, after menopause, or after a hysterectomy. It can also be the result of:

  • Aging
  • Being overweight
  • Genetic factors
  • Physical strain from lifting heavy objects

If you experience the following symptoms of pelvic organ prolapse, contact your doctor immediately for a proper diagnosis:

Sacral colpopexy is a surgery to repair pelvic organ prolapse. It’s done with an open abdominal technique or a minimally invasive technique.

One of the safest and most effective treatments for pelvic organ prolapse, sacral colpopexy has a high long-term success rate. The surgery works by connecting the top of the prolapsed organ to ligaments in your pelvis to alleviate symptoms such as sexual and bathroom difficulties.

In this procedure, the surgeon attaches the vagina or uterus to the tailbone using a surgical mesh. A graft can also be used to lend support to the wall of your vagina or uterus and attach it back to your pelvis. Grafts can be:

  • Made from your own tissue (autologous)
  • Made from a human donor’s tissue (allograft)
  • Made from a non-human donor’s tissue (xenograft)
  • Made from synthetic material

‌The procedure usually takes around two to three hours to complete and is performed under general anesthesia. This means you will be asleep during the procedure.

If your vagina or uterus isn’t sagging that much, sacral colpopexy may not be your best choice. Non-surgical management of your condition should be tried before any type of surgery is attempted.‌

Furthermore, if you want to preserve your uterus, you’ll need to get an ultrasound before you get a sacral colpopexy. Talk to your doctor about your symptoms and what you can expect out of the surgery. You’ll be provided with options to preserve or remove your uterus.

Risks of sacral colpopexy include bleeding if a vein or artery is damaged, perforation of the bladder or rectum, hip pain, difficulty peeing, or it may not stop vaginal prolapse. 

After a sacral colpopexy, you’ll stay at the hospital until the anesthesia wears off. After that, you will have to do the following to make sure you’re recovering properly:

  • Keep your surgical wound clean, open to the air, and dry.
  • Wash your hands often, particularly before touching your wound or changing your dressings.
  • Get plenty of rest, particularly since you will be sleepy and confused for up to a day after the surgery due to anesthesia
  • You may experience abdominal swelling, shoulder pain, or gas pain for the next one to three days. Warm showers and walks can help alleviate discomfort.
  • Drink lots of water and eat low-fat foods such as chicken broth and crackers. Fatty foods can make you sick during this recovery period.

If your pelvic organ prolapse isn’t severe enough to require a sacral colpopexy, you may get the following treatments.

Pelvic floor exercises. These include exercises such as Kegel exercises, which can strengthen the muscles in the lower part of your pelvis and prevent your pelvic organs from sagging.‌

Kegels will help you to recognize and actively squeeze these muscles. You can do them around three times a day since they don’t have any negative side effects. Generally, these exercises work better if the sagging organs are in the front of your pelvis, where your bladder is.

Vaginal pessary. A vaginal pessary is a device inserted in your vagina to prevent it from descending further. Typically shaped like saucers, rings, or cubes, pessaries are made of silicone or rubber and are inserted into your vagina to support your pelvic organs.

You should try out different shapes and sizes to see which pessary works best for you. Doctors usually suggest using cube pessaries, since you can clean, insert, and remove these by yourself. Other types of pessaries have to be inserted or removed by a doctor every six to eight weeks.

While pessaries don’t fix prolapse, they can alleviate symptoms such as bladder problems. They can also come in handy if you want to delay or avoid surgery, and can also help if you are using pelvic floor exercises to correct your prolapse.

Some potential risks of using pessaries include:

  • Irritation, since pessaries can put pressure on the mucous membranes of the vagina, which can lead to sores, bleeding, and pain.
  • Discomfort or inability to have sex with some pessaries. This is why it’s a good idea to get a cube pessary if possible, since you can remove it before sex.
  • Issues with bowel movements.

You should use lubricant when inserting a pessary. If you are post-menopausal, you should also try using hormone cream to protect the inside of your vagina before inserting a pessary, unless you have experienced breast cancer or cancer of the reproductive organs.

In any case, make sure to talk to your doctor about your symptoms and medical history. Your doctor will guide you through the process of treatment and provide proper medical advice.