Sacrospinous Fixation

Sacrospinous Fixation - What it is

It is an operation that is performed through the vaginal route to support the vagina (after previous surgery to remove the womb) by attaching the top of it to the right sacrospinous ligament.

It is often not the only procedure that is done. It may be done concurrently with surgery to correct urinary incontinence, to remove the womb or to correct bladder or rectal prolapse in the vagina.

Why Is It Performed?

It is performed for severe protrusion of the vagina (after the womb was removed surgically).

The protrusion can bother you because of:

A heavy dragging, sometimes painful sensation in the vagina
An uncomfortable lump that can be felt or seen
Urinary difficulties (e.g. incomplete emptying of the bladder)
Bowel difficulties (e.g. constipation, incomplete emptying of the bowels)
Pain
Infection
Bleeding

The objective of the operation is to relieve the symptoms, restore vaginal anatomy and sexual function.

How Is It Done?

It may be done under regional anaesthesia (which involves the injection of a local anaesthetic medicine into the spine to numb the lower half of the body) or general anaesthesia (where you will be asleep throughout the procedure). The anaesthetist will discuss the advantages and disadvantages of both methods with you.

At the end of the operation, the vagina will usually be packed with an antiseptic gauze.

A catheter will be inserted into the bladder as there may be temporary difficulty in urination immediately after the procedure.

Painkillers and antibiotics will generally be prescribed after the procedure.

What Are The Risks Associated With Sacrospinous Fixation?

Sacrospinous fixation is a safe operation. However, like all surgical operations, complications may occasionally occur. These include:

Bleeding
Infection
Injury to surrounding tissues (e.g. rectum and nerves)
Conversion into an abdominal operation to correct complications
Blood clot formation in the legs or lungs
Recurrence of prolapse

Are There Alternatives?

Another operation that could be done to correct this problem would be abdominal sacrocolpopexy. Whilst abdominal operation may give better long term results of cure compared to sacrospinous fixation, it involves an abdominal incision and longer hospital stay.

The advantages of sacrospinous fixation are that it avoids an abdominal incision and it requires a shorter hospital stay. It is also less painful and patients can recover faster.

Conservative management includes using vaginal pessaries but complications such as infection and ulceration of vaginal tissues are common.

Sacrospinous Fixation - Preparing for surgery

How Do I Prepare Myself For The Operation?

Find out more about the procedure (e.g. by reading this pamphlet, you could be mentally and emotionally prepared for this operation).
Blood tests, an electrocardiography (ECG) and a chest X-ray may be done to ensure that you are in optimal health for the surgery.
A hormonal preparation containing estrogen (i.e. cream or pessaries) may be given to you before the operation if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for healing after surgery.
You will generally be admitted one day before your surgery.
You will generally be given medical leave of 4 weeks to rest after operation.

Sacrospinous Fixation - Post-surgery care

What Happens After Surgery?

After operation, you may experience:
- Tiredness - you should rest and gradually increase your activity until you feel fit to return to your normal activities.
- Some discomfort in the lower part of the abdomen - this is to be expected and painkillers should help to relieve the discomfort.
- Vaginal bleeding - mild to moderate amount of reddish watery discharge up to 3 weeks after the operation is quite normal. You may want to wear a protective sanitary pad (not a tampon) during this period.
You should refrain from:
- Strenuous exercise - until you are feeling fully fit. You may return to normal activity after 4 weeks.
- Using tampons, douching or sexual intercourse over the next 4 weeks
You should return immediately to the Urogynaecology Centre (during office hours) or come to the O&G 24-hour Clinic if there is:
- Heavy bright red vaginal bleeding
- Foul smelling vaginal discharge
- Severe abdominal distension and/or pain not relieved by painkillers
- High fever
- Pain on passing urine
- Difficulty passing urine

When Do I Return For Follow-up

After the surgery, you will be seen at 1 week, 1 month, 6 months, 12 months and yearly thereafter. It is important to keep your follow-up appointments to ensure the best possible results.