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Incontinence & Prolapse – Part 1:
The “Genital Hiatus” – What Is It? And Why Should You Care?

Incontinent woman, embarrassed by urine leakage
What is a “genital hiatus”? No, it’s not a doctor’s note intended for your partner, excusing you from “marital duties”! The genital hiatus is actually the space between your legs from the front (where urine comes out) to the back wall of your vagina. More than a space, the genital hiatus refers to the muscles of the pelvic floor, along with the nearby organs including the urethra, vagina, and rectum. It is something you really should care about because it impacts much more than hubby!

What is the pelvic floor? Imaging you’re standing: you can feel your bony pelvis by putting your hands on your hips, your “butt bones”, your pubic bone. But your pelvic floor is an essential part of the pelvis that you can only feel internally: Your pelvic floor is a bowl-shaped group of muscles located at the base of your bony pelvis.

This bowl-shaped group of muscles interlaces between and around your urethra, vagina, and rectum. Your pelvic floor is what keeps all you internal abdominal organs, your bladder and bowels, from falling through in-between your legs.

Your genital hiatus and pelvic floor are where it all comes together (or falls apart) in the middle. If these are good shape you’re less likely to leak urine, gas, or feces (incontinence) and you’ll enjoy better sexual function. Prolapse is when the organs such as the bladder, rectum, and intestines fall downward into and sometimes out of the vagina.

Let’s do the numbers.

Did you know:

25% of women leak urine, stool, or gas for at least a few months after having their first baby. Being pregnant and giving birth stretches the muscles and nerves of the pelvic floor. Without reconditioning these after pregnancy we can sustain permanent damage to our pelvic floor.

Having an episiotomy or laceration during childbirth can sometimes cause long-term dysfunction of the pelvic floor, depending on the extent of the episiotomy / laceration, and whether or not they cut the muscles.

Incontinence and prolapse affect over half the female population.

Your chances of undergoing surgery for incontinence during your lifetime is 1 in 9 (11%).

30% (nearly one third!) of women who have surgery for “incontinence” or “prolapse” experience failure of the procedure and undergo repeat surgery.

Incontinence and prolapse surgeries cost > $1Billion annually.

You can prevent or correct incontinence without surgery by learning about your genital hiatus and doing your Kegel exercises.

What happens to the Pelvic Floor and Genital Hiatus to cause Incontinence and Prolapse?

When we are young, before aging, babies, and genetics have taken hold, the floor of our “bowl” is taut like a trampoline, able to withstand all kinds of downward forces with nary a dent.

However, after babies, and depending on genetics, weight, and smoking status, our nice taut trampoline evolves into something more like a hammock. What does a hammock do? It sags in the middle; and when you put weight on it or exert pressure (such as jumping) it will sag more.

Over time, we can experience a gradual weakening of the muscles due to pregnancy, delivery, nerve damage, weight gain, and aging tissue, which can result in leaking urine, stool, and gas. Before having babies the average length of your genital hiatus is around 3 cm (1.5 inches). After all that living, your genital hiatus can increase in size to 3-5 cm.

What can you do to keep your pelvis healthy and strong?

The lengthening and gaping of your genital hiatus can result in leakage of urine, gas, or stool. It can cause decreased sensation during sex. Don’t despair! There is hope for this “saggy dog” story. The genital hiatus is one area you can impact to significantly improve your quality of life. Think back again to the “bowl” of muscles at the bottom of your pelvis. Imagine it’s like a camera-shutter (the old-fashioned “iris” style).

The muscles converge in the midline and “wrap around” the openings of the urethra, vagina, and rectum. By doing Kegel exercises, [link to Incontinence III, explains this in detail], or doing “pelvic muscle biofeedback”, you can restore your genital hiatus well enough to correct leaking within three months time.

Kegel Exercises

Imagine stopping your urine stream. In this action you use the muscles that form the pelvic floor. You can tell if you’re doing Kegel exercises correctly by placing a finer in the vagina and contracting your muscles around your finger. If you can feel the vagina constricting around your fingers, you know you’re doing your Kegel exercises correctly.

If you do Kegel exercises, 10 sets of 10 per day, (that’s 100 per day) for six weeks, I promise you will experience improvement in your prolapse symptoms.

Break the Kegels up into one set at a time and create for yourself a reminder cue: try to do one set each time you’re phone rings, your text tone goes off, or you’re at a stop sign. Pick a reminder cue that works for you and occurs several times throughout the day.

Kegel exercises are at least as effective, if not more so, than surgery; and if you’re considering surgery, you’ll get a better result if you do Kegel exercises before and after.

To summarize, we’ve seen that incontinence is caused by gradual weakening of the genital hiatus, we’ve learned the anatomy of our pelvic floor, and we’ve discovered the power of Kegel exercises in reversing the anatomic changes and symptoms associated with prolapse.

To learn more about prolapse and incontinence check out and

Have you had problems with leaking urine, gas or stool?
What did you “do” about it?
What worked for you and what didn’t?

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{ 8 comments… add one }

  • Marianne May 15, 2011, 11:01 am

    How much hope is there for reducing the Gential Hiatus when there is a large un-repaired laceration of the perineum requiring reconstruction of the pelvic floor? (Uterine prolapse, rectocele and cystocele are present.)

    • Shelley Binkley May 30, 2011, 5:23 pm

      Hi M, If the laceration is repaired and the neuromuscular function is normal you can do quite a bit reduce the size of the genital hiatus with a pelvic floor exercise program. I’d start with either Kegels alone, with a pessary, weighted vaginal cones, or with using a vaginal insert with a pressure sensor such as the Athena (I have no financial interest in the Athena; it just happens to be the only device of it’s kind I know of). I’d try a frequency of tens sets of ten (i.e. 100 muscle contractions daily). The use of a pessary, cones, or pressure sensor device might hasten the response by providing increased resistance and immediate feedback for your pelvic floor muscle efforts. Let me know how it goes and if you have any follow-up questions. Thank you for reading the blog. -SB

  • Kathy Meyer December 9, 2011, 7:12 am

    I wore a pessary for about 5 years until it started interferring with bowel movements and started bleeding from irration – my dr performed a bladder suspension and hysterectomy – 3 months later it fell and I have had trouble finding a pessary to work now? My dr said there is another type of surgery(mesh) but only has a 50/50 chance of working? DRAT! I went for physical thereapy to help increase my kegel strength – it helps a little – would physical thereapy fix the problem or should I try surgery again?

    • Shelley Binkley December 16, 2013, 7:19 am

      Hi Kathy,

      Did you wind up doing the physical therapy? How did it work for you?
      Thank you for reading the blog and commenting.

      -Dr. B

  • Sharleen March 12, 2012, 1:38 am

    I have been told I have rectocle and have been advised that by using pessary and vaginal weights, that this condition can be repaired. I am 70 yrs young. Will it work for me and how hard is it to insert and remove them for cleaning.

    • Shelley Binkley December 15, 2013, 7:01 am

      Hi Sharleen,

      Pessary and vaginal weights are very effective for treating any type of pelvic prolapse such as rectocele, cystecele, etc. Your doctor should discuss with you use and cleaning when you go for the fitting.

      Thank you for reading the blog and commenting.
      -Dr. B

  • Connie October 24, 2012, 8:37 pm

    I hope that there is hope for a 64 year old mother of 11! I am finally taking time for me as my nest is empty at last! I have a rectal prolapse as well as a rectocele and cystocele. Dr. wants to do surgery for all of the above AND a hysterectomy. Says uterus and all looks fine but will need to come out sometime with age. I am very holistically inclined not at all interested in surgery BUT struggle with possible accidents. Will a pessary and the Athena be something that will help someone like me?

    • Shelley Binkley October 31, 2013, 5:51 pm

      Hi Connie,

      It’s great to try a pessary and / or Athena first. It won’t hurt and regular use may reduce your symptoms enough that you don’t need surgery. If you do decide to have the surgery, you’ll get a better result if you’ve exercised your pelvic floor for at least 3 months beforehand and continue to do so after. Kegels (10 sets of 10 a day), combined with a pessary, can be an enormous help.

      Thank you for reading the blog and commenting.

      -Dr. B

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