Uterosacral Ligament

What is the uterosacral ligament?

Your uterosacral ligament is a thick, supportive band of tissue that connects the lower part of your uterus (cervix) to the base of your spine (sacrum). It is part of the network of ligaments and muscles that support your pelvic organs. After hysterectomy, surgeons use the uterosacral ligament to support the top of your vagina.

What is the purpose of the uterosacral ligament?

The main function of your uterosacral ligament is to support your uterus, which is part of the female reproductive system. Your uterosacral ligament works with the other ligaments and muscles in your pelvic area to keep everything in place

Where is the uterosacral ligament?

Your uterosacral ligament runs front to back, from your uterus to your spine. You have two uterosacral ligaments — left and right. Your rectum travels downward through the two ligaments, ending at the anus.

How big is the uterosacral ligament?

Your uterosacral ligament is approximately 5 inches (12 to 14 cm) long, about the length of a soda can. It is about one-quarter inch wide (0.5 cm), increasing slightly where it attaches to your cervix.

What is the uterosacral ligament made of?

Ligaments are made of connective tissue that usually consists of tough interwoven bundles of fibers. However, your uterosacral ligaments are less fibrous and more like a strong membrane. They also contain some blood vessels and nerves, especially in the cervical section.

What conditions and disorders affect the uterosacral ligament?

The most common problems associated with the uterosacral ligament are:

• Endometriosis, where the cells that usually line your uterus (endometrium) are found in other locations.
• Vaginal prolapse, when your pelvic organs aren’t supported properly and drop from their typical location.

What is endometriosis of the uterosacral ligament?

In endometriosis, cells that line your uterus grow in places where they usually don’t grow. These cells follow your menstrual cycle and thicken, break down and bleed each month. But these cells can’t escape your body. So the blood can cause inflammation, scar tissue and cysts. Many people with endometriosis experience pain and infertility.

The uterosacral ligament is the most common location for deep infiltrating endometriosis (a specific type of endometriosis). The endometrial cells are found well below the tissue that lines the pelvic cavity (peritoneum).

How is uterosacral ligament endometriosis treated?

Healthcare providers do not have a cure for endometriosis. But they can relieve symptoms and reduce the growth of endometrial tissues. Treatment options include:

• Pain relievers to relieve mild symptoms.
• Hormone therapy to regulate the menstrual cycle or stop menstruation.
• Surgery to remove endometrial growths or scar tissue.
• Hysterectomy to remove your uterus and possibly your ovaries.

What is vaginal prolapse?

Vaginal prolapse occurs when your vagina, uterus, bladder or rectum drop from their typical location. It usually happens due to poor support from weakened or stretched pelvic muscles and ligaments, including the uterosacral ligament. In severe cases, prolapsed tissue can stick out from the vagina.

Causes of prolapse include:

• Childbirth.
• Hysterectomy.
• Age.
• Heavy lifting.
• Increased pressure in your abdomen due to excess weight, straining during bowel movements or a chronic cough.
• Genetic connective tissue diseases.

Symptoms of vaginal prolapse can include:

• Feeling pressure or seeing a bulge in your vagina.
• Pain during sex.
• Problems with urinating or having a bowel movement.

Can the uterosacral ligaments cause chronic pain during vaginal prolapse?

The uterosacral ligaments can cause chronic pelvic pain or back pain, but this isn’t common. This is due to overstretching of the uterosacral ligaments that can occur even with minor uterine prolapse. Chronic pain can cause fatigue, irritability and depression, so many providers once thought uterosacral ligament pain was a psychological condition.

How is vaginal prolapse treated?

Vaginal prolapse has surgical and nonsurgical treatment options. When you experience prolapse after a hysterectomy, a surgeon may perform uterosacral ligament suspension. Working through a small incision in your vagina (transvaginally), your surgeon attaches your uterosacral ligaments (or other ligaments) to the top of your vagina.

How can I prevent uterosacral ligament problems?

Your uterosacral ligaments are a common location for endometriosis. Currently, we don’t know how to prevent endometriosis. Your best strategy is early detection. By scheduling routine gynecological exams, including pelvic exams, you can catch problems early.

Your uterosacral ligaments also play an important role in supporting your pelvic organs. Keeping your pelvic floor strong is essential as you age, especially if you’ve given birth vaginally. Try Kegel exercises and activities that strengthen your core, like yoga and Pilates. These exercises can help you maintain urinary continence and prevent prolapse.

You can also improve your pelvic health by following these tips:

• Avoid straining during bowel movements.
• Drink six to eight glasses of noncaffeinated fluid per day.
• Limit caffeine and alcohol.
• Maintain a weight that’s healthy for you.
• Manage chronic constipation.
• Work with your provider to quit smoking.
• Use proper lifting techniques.

A note from Cleveland Clinic

Conditions involving the uterosacral ligament are relatively common and treatable. If you’re experiencing pelvic pain, pressure or other symptoms, talk to your healthcare provider. They can help you understand all your treatment options to manage your symptoms and provide long-term relief.