Is Emsella effective for treating urinary incontinence?

Emsella for Urinary Incontinence: Limited Evidence Does Not Support Its Use as a Primary Treatment

Based on current clinical practice guidelines from the American College of Physicians, Emsella is not included among recommended treatments for urinary incontinence, and you should prioritize evidence-based first-line therapies instead. 1

What the Guidelines Actually Recommend

The most authoritative clinical guidelines for urinary incontinence management do not mention Emsella therapy at all. Instead, they provide clear, evidence-based treatment algorithms:

For Stress Urinary Incontinence:

• Pelvic floor muscle training (PFMT) is the recommended first-line treatment, with high-quality evidence showing it increases continence rates and improves quality of life 1
• PFMT has a large magnitude of benefit with essentially no adverse effects 1
• Weight loss and exercise are strongly recommended for obese women with UI 1

For Urgency Urinary Incontinence:

• Bladder training is first-line treatment (strong recommendation, moderate-quality evidence) 1
• If bladder training fails, pharmacologic therapy with antimuscarinics (solifenacin, tolterodine, darifenacin, fesoterodine, oxybutynin, trospium) or β-3 agonists should be added 1, 2
• Solifenacin has the lowest discontinuation rate due to adverse effects among antimuscarinics 3

For Mixed Urinary Incontinence:

• PFMT combined with bladder training is the recommended approach 1

The Limited Evidence on Emsella

Only one recent comparative study (2025) examined Emsella therapy directly 4:

• In women with grade 2 cystocele and UI, Emsella showed inferior outcomes compared to surgical correction: only 64% achieved stage 0 prolapse versus 88% with surgery, and only 55% achieved bladder function normalization versus 72% with surgery 4
• Higher one-year recurrence rates with Emsella (31% vs. 14% with surgery, p = 0.03) 4
• The main advantage was faster recovery time, with 91% resuming daily activities within a week 4
• Emsella had fewer infections and no dyspareunia compared to surgery 4

Critical Limitations of Emsella

This single study has major limitations that prevent recommending Emsella as a primary treatment:

• No comparison to guideline-recommended first-line therapies (PFMT, bladder training, weight loss)
• Only studied in the specific context of grade 2 cystocele with UI, not general urinary incontinence
• No long-term data beyond one year
• Not included in any major clinical practice guidelines 1
• Classified as a "third-line therapy" in recent reviews, lacking high-grade evidence 2

What You Should Do Instead

Follow this evidence-based algorithm:

1. Start with behavioral and physical interventions (no adverse effects, high efficacy):

   • PFMT for stress UI 1
   • Bladder training for urgency UI 1
   • Weight loss and exercise for obese patients 1

2. Add pharmacologic therapy if behavioral interventions fail (for urgency UI only):

   • Choose based on tolerability, adverse effect profile, and cost 1
   • Solifenacin has the best tolerability profile 3
   • Evaluate efficacy after 4-8 weeks 3

3. Consider surgical options only after conservative measures fail 1

Common Pitfalls to Avoid

• Do not use systemic pharmacologic therapy for stress UI - it has not been shown to be effective (strong recommendation, low-quality evidence) 1
• Do not skip behavioral interventions - they have large magnitude of benefit with no adverse effects 1
• Do not assume UI is inevitable with aging - most women improve with appropriate treatment 5
• Do not prescribe off-label agents like tricyclic antidepressants or alpha-agonists without trying guideline-recommended therapies first 6

The bottom line: Emsella may offer a faster recovery option for select patients with anatomical prolapse who cannot undergo surgery, but it shows inferior long-term outcomes and is not supported by clinical practice guidelines as a primary treatment for urinary incontinence. 4 Stick with proven first-line therapies that have strong evidence for improving morbidity and quality of life. 1