Incontinence & Prolapse - Part 1: The "Genital Hiatus" - What Is It? And Why Should You Care?

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?