What is Sacrocolpopexy

Sacrocolpopexy is a surgical procedure that is done to return the top part of the vagina (vaginal vault) to its normal position inside the pelvis.

This procedure is done when the vaginal vault falls down into the lower vagina (vaginal prolapse). It repairs the condition and relieves its symptoms, which may include bowel or bladder problems, backache, or dragging, aching feeling.

You may need this procedure if your pelvic muscles have become weak after childbirth, or if you have had surgery to remove your uterus (hysterectomy). During the procedure, a surgeon may use a surgical mesh to lift and support your vagina.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• The prolapse happening again after surgery. This is the most common problem.
• Bleeding.
• Pain.
• Pain or reduced sensation during sexual intercourse.
• Infection.
• Loss of urinary or bowel control.
• Movement or loss of the surgical mesh.
• Formation of a blood clot in the leg.
• Having a blood clot travel to the lungs.

Be sure to talk with your health care provider about the risks of this procedure and the options available to you for the management of your problem.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may need to use a certain diet and medicines to clean out your digestive system (bowel prep):
  • Follow your health care provider’s instructions. Bowel prep is done to make sure your bowel is empty for the procedure. It can also prevent constipation.
  • You may need to start your bowel prep a few days before the procedure.
• You may be required to use a vaginal cream to strengthen your vaginal tissues. Use it as told by your health care provider.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • An antibiotic medicine to prevent infection.
• A tube (catheter) will be inserted to drain your bladder.
• Your surgeon will perform the surgery using one of the following methods:
  • Open surgery. The surgery will be done through a small incision made in the skin on your lower abdomen.
  • Laparoscopic surgery. The surgery will be done through several tiny incisions, using long instruments and a telescopic camera. In some cases, laparoscopic surgery will be done by remote control (robotic surgery).
• Your surgeon will make one or more incisions and then separate your vagina from your bowel and your bladder.
• Your surgeon will push up the vaginal prolapse from below and attach a surgical mesh to your vagina.
• The mesh will be used to lift your vaginal vault. It will be attached to a part of your tailbone with stitches (sutures) or staples.
• Your surgeon will close the incisions with stitches or staples.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have a bandage in your vagina for a few days.
• You will be encouraged to walk when you can get out of bed. Walking helps prevent blood clots.
• You will get fluids and nutrition through an IV until you can start eating on your own.
• You will be given pain medicine as needed. You may also be given antibiotics to prevent infection and a medicine to prevent blood clots.
• You may have your catheter removed soon after your surgery.

Summary

• Sacrocolpopexy is a surgical procedure that is done to repair vaginal prolapse, a condition in which the top part of the vagina (vaginal vault) has fallen down into the lower vagina.
• The surgery will relieve symptoms such as bowel or bladder problems, backache, or dragging, aching feeling.
• During the procedure, a surgeon may use a surgical mesh to lift and support your vagina.
• Follow instructions from your health care provider about eating and drinking before the procedure.

Sacrocolpopexy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Some vaginal bleeding.
• Tiredness (fatigue).

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider says it is okay to do so. Do not shower for 24 hours or until after your bandages have been removed.

Activity

• Take frequent, short walks throughout the day. Rest when you get tired.
• Limit your activities as told by your health care provider. For at least 6 weeks:
  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe.
  • Do not sit on a bike seat.
  • Do not use a tampon or put anything inside your vagina.
  • Do not have sexual intercourse.
  • Do not participate in activities that take a lot of effort (strenuous), such as running or aerobics.
• Ask your health care provider when you can return to work and do all your usual activities. It may take 3 months to recover completely.

General instructions

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have chills or a fever.
• Your pain medicine is not helping.
• You have vaginal bleeding or discharge that will not go away.
• You have any signs of infection, such as:
  • Redness, swelling, or pain around your incision.
  • Fluid or blood coming from your incision.
  • Your incision feeling warm to the touch.
  • Pus or a bad smell coming from your incision.

Get help right away if:

• You have a fever for more than 2–3 days.
• You have very bad pain.
• You have heavy vaginal bleeding or discharge.
• You have a foul smell coming from your vagina area.
• You develop a warm, tender area in your leg.
• You have chest pain or trouble breathing.

Summary

• After the procedure, it is common to have some vaginal bleeding.
• Limit your activities as told by your health care provider. For at least 6 weeks, do not lift anything heavy, have sexual intercourse, use tampons, sit on a bike seat, or participate in strenuous activities.
• Follow instructions from your health care provider about how to take care of your incisions. Check your incision areas every day for signs of infection.
• To prevent blood clots, take frequent, short walks throughout the day. Rest when you get tired.