Emsella is a chair. You sit on it fully clothed for about half an hour while an electromagnetic field beneath the seat makes the muscles of your pelvic floor contract, roughly 10,000 times in a session, far more than anyone could do voluntarily. The technology is high-intensity focused electromagnetic stimulation, the same principle used for muscle building elsewhere in the body, aimed at the sling of muscle that supports the bladder, urethra and pelvic organs.
At NYMD Center, Emsella is part of our stress incontinence and pelvic floor program, offered at both our Manhattan and Forest Hills offices, and used by women and men. It is a support for that program, not a substitute for evaluation. A weak pelvic floor is one cause of leakage among several, and the chair helps only when weakness is actually the problem. We find that out first.
Who it affects and the symptoms that bring people in
Stress urinary incontinence is leakage with effort: a cough, a sneeze, a laugh, a jump, lifting a child or a suitcase. It happens when the pelvic floor and the sphincter can no longer hold the urethra closed against a sudden rise in abdominal pressure. In women it typically follows childbirth, menopause, or both, and it is common enough that many accept it as normal. It is not. In men it most often follows prostate surgery, especially removal of the prostate for cancer.
Pelvic floor weakness has other consequences. Women may notice a sense of heaviness or bulging from mild pelvic organ prolapse, reduced sensation during sex, or difficulty holding gas. Men and women both may have a pelvic floor that is weak in some parts and overly tight in others, which produces pain and incomplete emptying rather than leakage. That pattern needs a different approach, which is one reason we do not put patients on the chair without examining them.
How we evaluate it at NYMD Center
The evaluation is the same one we use for every form of urinary incontinence, because the first job is to establish what kind of leakage you have. Urge incontinence, leakage after a sudden need to go, is a bladder problem and is treated through the overactive bladder ladder. Stress incontinence is a support problem. Mixed incontinence has both, and in that case we treat the urge component first.
You will be asked to keep a bladder diary before the visit. In the office we do a uroflow study, a bladder scan for post-void residual, a urine dip with culture if needed, and a pelvic examination that includes asking you to cough with a full bladder and assessing pelvic floor strength and coordination directly. In women we look for prolapse. In men after prostate surgery we assess the sphincter. Where the picture is unclear, urodynamic testing tells us how much of the leakage is stress and how much is urge, and whether the bladder is emptying properly. Emsella is recommended when the exam shows a pelvic floor that is weak and would benefit from strengthening, and when there is no problem that needs to be fixed first.
Treatment options
Supervised pelvic floor rehabilitation
The foundation of stress incontinence treatment is learning to use the pelvic floor correctly, and this is where most people go wrong. Kegel exercises done from a pamphlet, without feedback, do not work well; most people contract the wrong muscles, bear down instead of lifting, or hold their breath. Pelvic floor rehabilitation with biofeedback shows you what a correct contraction feels like on a screen and builds strength and timing over a course of sessions. This is the part of the program that lasts, because you keep the skill.
Emsella
The chair adds volume of contraction that no exercise program can match. A typical course is six sessions over about three weeks, each roughly 28 minutes, sitting fully clothed. You feel tingling and strong muscle contractions but no pain, and there is no recovery; you walk out and continue your day. Many patients notice improvement partway through the course, and results build for a few weeks after. Maintenance sessions are sometimes used to hold the gain. Emsella works best alongside rehabilitation, not instead of it: the chair strengthens, the rehab teaches you to use what you have strengthened. It is not used in pregnancy or in people with metal implants, pacemakers or other electronic devices in or near the pelvis.
Office bulking injection
For stress incontinence that persists despite a stronger pelvic floor, a bulking agent injected around the urethra in the office thickens the wall and improves closure. It takes a few minutes with local anesthetic, has a quick recovery, and can be repeated. It is less effective than a sling but far less invasive.
Sling surgery
For significant stress incontinence, a sling placed under the urethra provides durable support. It is an outpatient operation with a short recovery, and it is the most effective option for the right patient. We reserve it for people who have not gotten enough benefit from the less invasive steps or whose leakage is severe from the outset.
What to expect at your visit
Your first visit is an evaluation, not a treatment session: history, bladder diary review, office testing and examination, ending with a plan that may include the chair, rehabilitation, or both. Emsella sessions are then scheduled in a series, and you can book them around work; there is nothing to prepare, and wearing thin, non-metallic clothing without a phone or keys in your pockets is the only requirement. Each session is about half an hour. We reassess at the end of the course with a repeat history and, where useful, a cough test or pad count to measure what has changed. If leakage is still limiting you, the next rung of the ladder is discussed then.
Questions patients ask
What does an Emsella session feel like?
You sit on the chair fully clothed for about 28 minutes. You feel tingling and strong, rhythmic contractions of the pelvic floor, similar to an intense set of exercises you are not doing yourself. It is not painful and there is no recovery time. Roughly 10,000 contractions occur in a session, which no voluntary exercise program can match.
Is Emsella only for women?
No. Men use it as well, most often for leakage after prostate surgery, where the pelvic floor has to compensate for a weakened sphincter. The evaluation is the same: we confirm that pelvic floor weakness is the cause of the leakage and that nothing else needs to be treated first.
Why do I need an evaluation first?
Because the chair strengthens the pelvic floor and does nothing else. If your leakage comes from an overactive bladder, an obstruction, an infection, or a pelvic floor that is tight rather than weak, Emsella will not help and may delay the right treatment. A short office workup tells us which kind of problem you have.
How many sessions are needed and how long do results last?
A course is usually six sessions over about three weeks. Many patients notice a difference partway through, and improvement continues for a few weeks afterward. Like any muscle strengthening, the gain fades if it is not maintained, which is why we pair the chair with pelvic floor rehabilitation you can continue on your own, and sometimes schedule periodic maintenance sessions.
Who should not use Emsella?
Anyone who is pregnant, and anyone with a pacemaker, metal implant or other electronic device in or near the pelvis, since the chair uses a strong electromagnetic field. We review your history before the first session. Copper IUDs and some other implants need individual discussion.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, most major insurance accepted.