Atrium Health Navicent Women's Care Urogynecology & Pelvic Surgery

Iliococcygeus suspension

What is a iliococcygeus suspension?

Older woman standing and smiling.Iliococcygeus suspension is a vaginal procedure that is typically performed to correct prolapse that occurs after a woman has had a hysterectomy. However, occasionally it is performed with the uterus still in place (uterine sparing procedure).

The iliococcygeus is one of the muscles that make up the levator ani, a complex of muscles that form the pelvic floor. It lies close to the the sacrospinous ligament and therefore provides many of the same benefits of the sacrospinous fixation. While not typically used as a primary procedure to correct prolapse, it can often be added to help with resuspending the vaginal apex.

How is the procedure performed?

Iliococcygeus suspension is a vaginal procedure that is performed through an extraperitoneal approach, meaning the surgeon does not enter the pelvic cavity making it a safer procedure than some of the other prolapse procedures.

During surgery, the ligament is identified and cleared off of overlying tissue. Unlike the sacrospinous ligament suspension, it does not require an extensive dissection in order to gain access to it. Next, sutures are attached from the vaginal cuff or top of the vagina to the belly of the iliococcygeus muscle, therefore resuspending the vagina. Often times, additional prolapse procedures such as an anterior colporrhaphy and posterior colporrhaphy are performed to correct any additional prolapse of the vaginal walls.

What to Expect?

Older woman standing and smiling.After initial consultation with Dr. Kow, you may be asked to undergo some bladder testing (urodynamics) prior to surgery. Prior to surgery, you will need to attend a preoperative visit with Dr. Kow and draw some basic lab work. Should you need surgical clearance, you will be asked to obtain this prior to surgery.

The surgical procedure takes approximately 1 to 1.5 hour to perform when performed with additional procedures to correct a cystocele or rectocele. You will be under general anesthesia during the procedure.

What is my recovery time?

Typical recovery time is one overnight stay at the hospital. While pain tolerance is variable among patients, most patients report minimal pain with iliococcygeus suspension. Overall recovery time includes six weeks with some activity restrictions, however patients are often able to return to a normal routine shortly after surgery. Restrictions including the following:

  • No heavy lifting of more than 10 lbs for 6 weeks
  • No tub baths for 6 weeks
  • No sexual intercourse for 6 weeks
  • No driving while on narcotic pain medications

What are the risks of the procedure?

Complications from the iliococcygeus suspension are typically very low. However with every procedure there always some risks including anesthesia problems, postoperative pain, intraoperative bleeding, infection, blood clots and damage to adjacent organs. With regards to the iliococcygeus suspension, some specific risks include the following:

  • 5-10% risk of postoperative urinary tract infection

Will my insurance company cover the procedure?

Most insurance policies will cover iliococcygeus suspension. Our office will help you with obtaining prior authorization if your insurance policy requires it. If you have further questions, contact your insurance carrier to determine the details regarding your coverage.