What is EMsella therapy, including its indications, contraindications, treatment protocol, and recommended next steps if it fails?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: May 19, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

EMSella Therapy for Urinary Incontinence

EMSella therapy is a non-invasive electromagnetic chair-based treatment that delivers high-intensity focused electromagnetic (HIFEM) energy to strengthen pelvic floor muscles, primarily indicated for mild-to-moderate stress and urgency urinary incontinence in women who prefer to avoid surgery or have surgical contraindications.

What EMSella Is

EMSella uses electromagnetic technology to induce supramaximal pelvic floor muscle contractions while the patient sits fully clothed on a specialized chair. The device generates approximately 11,000 contractions per 28-minute session, targeting the entire pelvic floor musculature without requiring active patient participation.

Indications

  • Stress urinary incontinence (mild to moderate severity)
  • Urgency urinary incontinence
  • Mixed incontinence
  • Patients with grade 2 cystocele and associated UI 1
  • Women who decline or cannot tolerate pelvic floor muscle training (PFMT)
  • Patients with surgical contraindications
  • Those seeking non-invasive alternatives before considering surgery

Treatment Protocol

Standard regimen:

  • 6 sessions total over 3 weeks
  • 2 sessions per week
  • 28 minutes per session
  • Patient remains fully clothed
  • No anesthesia or recovery time required
  • 91% of patients resume daily activities within one week 1

Expected Outcomes

Based on comparative data, EMSella achieves:

  • 55% bladder function normalization (compared to 72% with surgical anterior colporrhaphy) 1
  • 64% achieving stage 0 prolapse in patients with grade 2 cystocele (versus 88% with surgery) 1
  • Significant improvement in quality of life scores (PFDI-20 and PFIQ-7), though less than surgical intervention 1
  • 31% one-year recurrence rate (versus 14% with surgery) 1

Contraindications

  • Pregnancy
  • Cardiac pacemakers or implanted defibrillators
  • Metal implants in the treatment area
  • Active malignancy in the pelvic region
  • Severe pelvic organ prolapse (grade 3-4)
  • Menstruation (relative contraindication during treatment session)

Advantages Over Other Treatments

Compared to PFMT: No active patient effort required, no need for proper technique mastery, and higher compliance rates since the device does the work.

Compared to surgery: Minimal complications, no infections, no dyspareunia, immediate return to activities, and no anesthesia risks 1.

Safety profile: Superior to surgical approaches with fewer adverse effects and no reported cases of dyspareunia 1.

When EMSella Fails: Next Steps Algorithm

Step 1: Reassess at 3 Months Post-Treatment

If inadequate response (<50% symptom improvement):

Step 2: Consider Repeat Course

  • Additional 6-session course may benefit partial responders
  • Maintenance sessions (monthly) for those with initial improvement but symptom return

Step 3: Escalate to Established First-Line Therapies

The 2014 American College of Physicians guideline establishes the evidence-based hierarchy 2:

For Stress UI:

  • Supervised PFMT (RR 1.92 for cure vs self-administered, though not statistically significant) 2
  • PFMT with biofeedback using vaginal EMG probe (RR 1.27, high-quality evidence) 2
  • Weight loss if BMI >25 (RR 2.17, NNT=4, moderate-quality evidence) 2
  • Intravaginal estriol plus PFMT (RR 8.1 for continence, NNT=1-2) 2

For Urgency UI:

  • Antimuscarinics as pharmacologic option:
    • Fesoterodine (RR 1.5 for continence, NNT=8, moderate evidence) 2
    • Solifenacin (RR 1.5, NNT=9, high evidence) 2
    • Oxybutynin (RR 1.7 for continence, NNT=9, high evidence) 2

Step 4: Surgical Consultation

Anterior colporrhaphy for patients with:

  • Grade 2 or higher cystocele
  • Failed conservative management
  • Desire for definitive anatomical correction
  • Acceptable surgical risk profile

Surgery provides 88% stage 0 prolapse achievement and 72% bladder function normalization with only 14% one-year recurrence 1.

Critical Clinical Pearls

Patient selection is paramount: EMSella works best for mild-to-moderate UI without severe anatomical defects. Patients with grade 3-4 prolapse should proceed directly to surgical evaluation rather than attempting EMSella.

Set realistic expectations: While EMSella offers convenience and safety, it provides inferior anatomical correction and higher recurrence rates compared to surgery 1. Frame it as a reasonable first attempt for appropriate candidates, not a replacement for definitive surgical management.

The recurrence rate matters: With 31% recurrence at one year 1, patients need counseling about potential need for maintenance treatments or eventual surgical intervention.

Don't abandon proven therapies: The guideline evidence strongly supports PFMT, weight loss, and antimuscarinics 2. EMSella should complement, not replace, these established interventions when they fail or are not tolerated.

References

Related Questions

In a patient on an Impella device and veno‑arterial extracorporeal membrane oxygenation (VA‑ECMO), why are both the Impella green motor screen and the aortic pressure waveform flat?
What are the risks, negative side effects, and potential long‑term damage associated with the EMSella chair?
A 10‑day postpartum woman presents with dysuria and a urine culture growing mixed microbiota >100,000 CFU/mL; how should this be managed?
In a 10‑month‑old infant with a slightly indented coronal suture, normal fontanelles, and appropriate head growth, what is the appropriate next step in management?
What is the appropriate 10‑day antibiotic regimen for a patient undergoing ENT follow‑up after image‑guided fine‑needle aspiration/biopsy, assuming no documented β‑lactam allergy?
Can I take pregabalin (Lyrica) for neuropathic pain while continuing levetiracetam (Keppra)?
My ferritin levels are increasing but my hemoglobin is decreasing while I am taking oral iron supplements; what should be the next step in evaluation and management?
In an adult with pericardial effusion, what is the appropriate colchicine dosing, monitoring, and alternative therapy if colchicine is contraindicated?
What is the appropriate urgent evaluation and management for a patient with a 4‑day history of intermittent throbbing pain behind the right ear (mastoid region) with an indention, awakened from sleep, no tinnitus, visual changes, fever, chills, or systemic symptoms, and no relief from acetaminophen?
Why is serum fructosamine ordered as a preoperative test?
Can a patient safely take atorvastatin, metoprolol, sacubitril‑valsartan (Entresto), sertraline (Zoloft) and cariprazine (Vraylar) together, and what monitoring is required, especially if clozapine is also prescribed?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.