Emsella Review By A Pelvic Floor PT
The Emsella is a tool that’s been gaining in popularity in recent years, often recommended by physicians to treat symptoms like urinary incontinence, difficulty achieving orgasm and pelvic pain. It’s also a tool that’s faced a lot of criticism from the pelvic floor physical therapy community. In this blog post, we’re going to break down what the Emsella is, what it’s used to treat, what kind of research there is to support the use of this tool, the benefits and drawbacks of the Emsella and why the pelvic health community talks so much crap about it.
TL;DR
The Emsella is a tool - tools are never all good or all bad. For certain conditions it seems that this tool is helpful. For others we have no data to indicate that it is or isn’t. The problem, as with all tools, is in how it’s used by people. Keep reading for more.
What is the Emsella?
The Emsella is a non-invasive treatment that uses high-intensity focused electromagnetic stimulation (HIFEM) to treat pelvic floor dysfunction.
Here’s a very basic explanation of how this works.
This device uses a coil that’s built into a chair. The patient sits on the chair with their perineum in contact with the device. This allows the stimulation to be focused directly on the pelvic floor. The Emsella boasts that in the course of one treatment, an individual achieves the equivalent of 10,000 submaximal contractions. A treatment session is typically around 30 minutes long.
How is this tool used and marketed?
Most often this tool is used and marketed by physicians offices as a passive treatment for pelvic floor dysfunction. In my clinical practice, I’ve had patients recommend the Emsella for symptoms like stress urinary incontinence, urge urinary incontinence, inability to orgasm and even pelvic pain.
Research on the Emsella and treatment of pelvic floor dysfunction
This controversial tool touted as a miracle solution by some and a sham by others has research supporting its use in certain ways and lacks evidence in others. Let’s break the research down.
The majority of Emsella research has been done on using the device to treat stress urinary incontinence. This is the type of leakage that occurs with a big cough, sneeze, laugh or jump. Some studies have also looked at using the Emsella to treat urge urinary incontinence and mixed urinary incontinence. Urge urinary incontinence is the type of leakage that occurs with a strong, sudden urge to urinate. Mixed urinary incontinence is a combination of stress and urge. I found no research assessing the use of the Emsella on pelvic pain and pain with sex.
Here are some basic breakdowns of the research I was able to find that assessed more than just stress urinary incontinence:
A systematic review noted studies that found improvement in stress and urge urinary incontinence. They included a study that noted both types of incontinence improved until the first year but benefits gradually decreased close to baseline by year 3 following treatment. This is the only study I was able to find with a longer term follow up.
Another study looked at 75 women who showed symptoms of stress, urge and mixed incontinence. The treated participants for 6 sessions, each 28 minutes long and evaluated improvements at the 6th visit and a 3 month follow up. They found an average improvement of 50% with the highest level of improvement of 69% with 70% less pad usage. This is pretty promising!
And yet another study looked at symptoms associated with weakness, including vaginal laxity, inability to achieve orgasm and incontinence. The treatment protocol included 10 treatment sessions lasting 28 minutes at the doctors office, 2-3 times per week for 4 weeks. There were 95 participants. This study was assessing both the impact the treatment had on the ability of the pelvic floor muscles to contract as well as a questionnaire about symptoms. They found improved contractile abilities, however they only test muscle contraction with participants on their backs. They did find some improvements in the functional questionnaire as well but didn’t report specifics.
What are the issues with the Emsella?
There is clearly some evidence to suggest this is a useful tool. So what are the issues with the evidence and with the Emsella as a practical tool?
We have limited long term studies and the longer term study that we do have indicates that patients may return to baseline within a few years. This is true even in the case of urinary incontinence which is amongst the best studied symptom associated with Emsella treatment.
The Emsella is being recommended for conditions that haven’t been studied or have been very minimally studied, like pain with sex, prolapse symptoms, inability to orgasm. These symptoms are often multifactorial and require more holistic treatment than pelvic floor muscle strengthening.
The cost of Emsella treatments range anywhere from $1500 for 3-4 visits to ~$300-$500 for 6-10 visits. Besides the fact that this is cost prohibitive for most people, this is a high cost for a treatment that has limited evidence for many conditions and limited long term efficacy.
Why should pelvic floor PT still be a first line of defense for pelvic floor symptoms
Health is multifactorial and pelvic floor symptoms are a result of so much more than just pelvic floor weakness. While a tool like the Emsella may help treat the underlying pelvic floor weakness (although I haven’t seen evidence to suggest that it can do that effectively) it’s unable to address all the other factors that often contribute to pelvic floor dysfunction, like hip and core weakness, bowel and bladder habits, underlying medical conditions, lifestyle… the list goes on.
Pelvic floor physical therapy is effective because it’s a personalized treatment provided by a healthcare professional and is designed for each individual patient. Long term pelvic health is about so much more than kegels.
How I would love to see the Emsella used in the future
There is clearly evidence that the Emsella has positive and fast impact on incontinence symptoms in the short term. The impact that can have on the physical and mental health of folks experiencing urinary incontinence is profound. As with all tools, I imagine the Emsella will become more affordable with time. I’d love to see a future where we can pair the short term improvements achieved with the Emsella alongside the longer term benefits that can be achieved with pelvic floor physical therapy. This would allow us to achieve the perfect combination of treatment outcomes - short term relief and long term health gains, translating to long term health.
Want to learn more about how pelvic floor PT can help you address your symptoms? Send us a message today!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.