I think the holy grail in incontinence treatment is a procedure that you can do with your pants on. The emsella chair checks that box (check out their website here). This chair uses electromagnetic energy to contract the pelvic floor. You sit on it (with your pants on) for about 30 minutes. The standard treatment is 2 sessions per week for three weeks. You can play on your phone while your pelvic floor contracts in a “supramaximal fashion” (more strongly than you have ever felt it contract). This is a unique feeling that I know I had never felt before- it is more weird than uncomfortable. But can the emsella chair treat urinary incontinence?
The claims about the emsella chair
We know that strengthening the pelvic floor improves bladder leaking. Theoretically, this chair should work since it really works the muscles. But over the years, I’ve treated lots of women who have improved their strength but not their leakage. The emsella website states that 95% of women have an improvement in quality of life and 75% are able to decrease their pad use. But what does this mean? How well does the emsella chair treat urinary incontinence?
The data: how well does the emsella chair treat urinary incontinence?
There are some studies that look at how well the emsella chair treats incontinence. One study showed that it worked as well as electric stimulation of the muscles, an older, vaginal technique to contract the muscles used by pelvic floor physical therapists. Another study followed 75 women with stress urinary incontinence, urgency urinary incontinence, or mixed incontinence for 3 months after emsella treatment. These women sat on the chair twice a week for 3 weeks. Around 80% of women were significantly better at 3 months. The number of pads they used decreased by about 50%. There were no complications or side effects.
A third study followed incontinent women who sat on the chair twice a week for 6 weeks. Six months after the treatment, 70% of the women used fewer pads and about 30% were completely dry. The treatment worked best in women who did not leak more than 3 times a day and had not had an incontinence surgery. So I think it fair to summarize how well the emsella chair treats incontinence by saying that you can expect to use at least 50% fewer pads for at least 6 months. This data should improve soon. The company is in the middle of a randomized controlled trial which compares the chair to a sham chair. Having a trial with a comparison group always gives us better data.
FDA approved but not covered by insurance
The emsella chair is FDA approved but is not currently covered by insurances. This is pretty common for new procedures; insurance won’t start paying until a large number of people have been successfully treated by the emsella chair. The FDA approval really hinges on safety data and not efficacy data. It tells us that the “benefits of the product outweigh the known risks for the intended use”- meaning that no one will get hurt but they aren’t really looking at how well it works. In the FDA application, the chair was declared to be “substantially equivalent” to another chair. This is regulatory speak and means that there wasn’t a need for clinical data since the device is so much like an existing device on the market. The only clinical study provided showed that the mean temperature of scrotal skin doesn’t increase when sitting on the chair (the chair is indicated for men and women). While this is important safety data, it doesn’t tell me how well this chair treats incontinence.
If you track the FDA applications back to the first submission, (the neotonus model 1000 muscle stimulator system, I love this name) there was one study submitted. 10 women used the chair and used an electrical stimulator to stimulate the muscles. They found that while muscle contractions were visible and palpable with both techniques, more muscle activity was produced by the chair. More patients preferred the chair and found it more comfortable. There was no mention in the study of how well the chair treated incontinence.
Cost of the emsella chair treatment
The cost for the whole treatment varies depending on where you have it done. The range is between 1,500 and 3,000 dollars. This is spendy but might be worth it if the impact lasts. The only problem is we don’t know how long the effect lasts. The trials have only looked at improvement at 6 months and not longer. And I don’t know about you, but my muscles don’t stay toned if I am not working them. There is no logical reason to think this is a permanent fix.
Take-home points
The emsella chair is an expensive treatment for incontinence with no long-term data. It will help some women but because we don’t have more data, we can’t be specific in recommending who should get this treatment. You can expect to use half as many pads for 6 months. It will appeal to some women though, because there are few complications, the initial treatment only takes 6 sessions and you keep your pants on. If you pick to get this done, PLEASE make sure the provider is collecting data so we can all learn more about this procedure.
Bakar Y et al. The use of extracorporeal magnetic innervation for the treatment of stress urinary incontinence in older women: a pilot study Arch Gynecol Obstet (2011) 284:1163–1168
