EMSELLA for menopause urinary incontinence (UK guide)
Bladder leaks can become more noticeable during perimenopause and menopause. For many people, it is a mix of hormonal changes, ageing tissues, and day to day pressures such as coughing, exercise, or rushing to the toilet.
EMSELLA (sometimes written as Emsella) is a non-surgical treatment designed to strengthen the pelvic floor muscles using high intensity focused electromagnetic energy. You remain fully clothed and sit on a specialised chair for the session. This post explains Emsella for menopause urinary incontinence UK, who it is for, what to expect, and realistic timelines for improvement.
Understanding the 3 types of urinary incontinence
Urinary incontinence is a symptom, not a diagnosis. The most common patterns in menopause are:
Stress urinary incontinence
Leaks happen with increased pressure on the bladder, for example:
- Coughing, sneezing, laughing
- Running, jumping, lifting
- Changing position
This is often linked to pelvic floor weakness and reduced support around the urethra.
Urge urinary incontinence (overactive bladder)
A sudden, difficult to defer need to pass urine, sometimes with leakage on the way to the toilet. Symptoms can include:
- Urgency and frequency
- Waking at night to pass urine
- Triggered urgency, for example when arriving home or hearing running water
This can involve bladder muscle overactivity and can be influenced by irritation, infection, and lifestyle factors.
Mixed urinary incontinence
A combination of stress and urge symptoms. Mixed incontinence is common in midlife and can require a combined approach.
Why menopause can contribute to bladder leaks
During perimenopause and menopause, falling oestrogen levels may affect the urogenital tissues. Common contributing factors include:
- Thinning and dryness of the vaginal and urethral tissues, which may reduce the seal around the urethra
- Reduced collagen and tissue support in the pelvic floor
- Changes in muscle strength and coordination with time, pregnancy history, or reduced activity
- Weight changes, constipation, chronic cough, and high impact exercise increasing pressure on the pelvic floor
Some people also experience symptoms of genitourinary syndrome of menopause (GSM), such as vaginal dryness, irritation, pain with sex, and recurrent urinary tract infections (UTIs), which can worsen urgency and frequency.
What is EMSELLA and how does it work?
EMSELLA uses electromagnetic stimulation to induce repeated pelvic floor muscle contractions while you sit on the chair. The goal is to improve pelvic floor strength and neuromuscular control, which can support the bladder and urethra.
It is not surgery, and there are no incisions or internal devices used during treatment. It is also not the same as electrical stimulation via a vaginal probe.
Important: Results vary. EMSELLA is best viewed as one part of a broader continence plan rather than a guaranteed cure.
Who EMSELLA is most likely to suit
EMSELLA may be a good fit if you:
- Have stress or mixed urinary incontinence related to pelvic floor weakness
- Want a discreet, non-surgical option with no undressing
- Struggle to do pelvic floor exercises effectively or consistently
- Are early in your symptom journey and want to strengthen the pelvic floor alongside lifestyle changes
It can also be considered for some people with urgency symptoms, particularly if pelvic floor weakness coexists, but urge incontinence often needs additional assessment and targeted management.
Who should have GP or specialist review first (red flags)
Seek medical assessment before proceeding if you have any of the following:
- Blood in urine, new pelvic pain, or unexplained weight loss
- Recurrent UTIs, fever, or symptoms of infection
- New, significant change in bladder habits, especially if sudden
- Difficulty passing urine, weak stream, or feeling unable to empty the bladder
- New bowel symptoms, faecal incontinence, or numbness in the saddle area
- A known or suspected pelvic mass
- A noticeable vaginal bulge or heaviness suggestive of pelvic organ prolapse, especially if worsening
- History of pelvic cancer, pelvic radiotherapy, or recent pelvic surgery, unless cleared by your specialist
When EMSELLA may not be appropriate
A clinic should screen carefully. EMSELLA is usually not suitable for people with:
- Certain implanted electronic devices, for example some pacemakers or neurostimulators
- Metal implants in the pelvis or hips in some cases, depending on type and location
- Pregnancy
- Uncontrolled epilepsy
Suitability depends on your individual medical history, so a proper consultation is essential.
What an EMSELLA session feels like
You sit upright on the chair while the device delivers pulses that stimulate the pelvic floor.
Common sensations include:
- A rhythmic tightening and lifting feeling in the pelvic floor
- Tingling or tapping sensations
- Strong contractions that feel unusual at first, but should be tolerable
You should not feel pain. Intensity is usually adjusted gradually to your comfort level.
Practical prep, clothing, and comfort
- Wear comfortable clothing, for example leggings or thin trousers. Avoid very thick seams or heavy shaping garments.
- Remove items from pockets and remove metallic objects as advised by the clinic.
- Arrive with your bladder comfortably empty, unless instructed otherwise.
- If you are prone to urgency, avoid large amounts of caffeine just before the session.
Aftercare and downtime
Most people return to normal activities immediately. Some people report:
- Mild pelvic floor muscle fatigue
- Temporary increase in awareness of the pelvic floor
If you develop pain, unusual bleeding, or urinary symptoms suggestive of infection, seek medical advice.
How many sessions do you need?
Protocols can vary by clinic and by symptoms. A common approach is a short course over a few weeks, followed by review.
Typical course length
Many patients are advised:
- 6 sessions as an initial course
- Sessions spaced across 2 to 3 weeks
Some people may need more, particularly with more severe symptoms or long-standing pelvic floor weakness. Others may be better served by pelvic health physiotherapy, medical treatment for overactive bladder, or management of GSM.
Maintenance sessions
If you respond well, some clinics suggest maintenance sessions. A common pattern is a top up every few months, but timing should be individual and based on symptom return rather than a fixed schedule.
Results can diminish over time if underlying drivers continue, for example chronic cough, constipation, high impact exercise without pelvic floor support, or ongoing weight gain.
When do results start?
Response varies. Some people notice improvements early, while others only notice change after completing the course.
After 1 to 3 sessions
Possible early changes include:
- Reduced small leaks with cough or sneeze
- Better ability to “hold on” during urgency
- Improved confidence during exercise
However, early changes can be subtle and not everyone notices a difference this soon.
After the full course
More meaningful improvements are more often assessed after completing the course and allowing time for the muscles to adapt. Many clinics review outcomes at around 4 to 8 weeks from starting, using symptom diaries and practical measures, for example pad use and frequency of leakage.
How long do results last?
There is no single answer. How long improvements last depends on:
- Your baseline pelvic floor strength
- Whether you continue pelvic floor exercises and healthy bladder habits
- Hormonal and tissue factors, including GSM
- Body weight, cough, constipation, and activity type
Some people need periodic top ups. Others maintain improvement by combining treatment with pelvic floor physiotherapy and lifestyle measures.
EMSELLA vs pelvic floor physio, Kegels, and HRT
Bladder leak treatment is often most effective when approaches are combined.
Pelvic floor physiotherapy and Kegels
Pelvic health physiotherapy is often first line for stress and mixed incontinence. It can help with:
- Confirming you are contracting the right muscles
- Building a tailored strength and endurance programme
- Managing prolapse symptoms and safe exercise advice
- Addressing overactive pelvic floor, which can sometimes worsen urgency
EMSELLA may suit people who cannot effectively engage the pelvic floor, or who want an additional strengthening stimulus. It does not replace learning correct technique, and many patients do best with both.
HRT and menopause related urinary symptoms
Systemic HRT may help some menopausal symptoms, but it is not a stand alone treatment for incontinence. For GSM symptoms, local vaginal oestrogen is commonly used in the UK and can improve tissue health and urinary comfort for many people, subject to medical suitability.
If urgency and recurrent UTIs are prominent, discussing GSM assessment and treatment with your GP or menopause clinician can be helpful.
Overactive bladder treatments
If urge incontinence is the main issue, additional options may include:
- Bladder training
- Reducing bladder irritants, for example caffeine and fizzy drinks
- Managing constipation and fluid timing
- Medicines for overactive bladder, prescribed by a clinician
A careful diagnosis matters because the best treatment differs between stress and urge symptoms.
If EMSELLA does not work or results plateau
If you have little or no improvement after a full course, it does not mean nothing can help. Consider:
- Reassessing the diagnosis, stress vs urge vs mixed
- Pelvic health physiotherapy assessment to check technique, coordination, and possible prolapse
- Screening for UTIs and assessing GSM
- Reviewing contributing factors, cough, constipation, weight, high impact exercise
- GP or uro-gynaecology referral for further investigation if symptoms are significant
Keeping a simple bladder diary for 3 days can help clarify patterns, including triggers, frequency, and leakage episodes.
Quick UK guide: suitability, sessions, and timeline
| Question | Typical answer | Notes |
|---|---|---|
| Who is it for? | Often stress or mixed incontinence | Urge symptoms may need additional assessment |
| How many sessions? | Commonly 6 | Individual plans vary |
| When might I notice changes? | Sometimes after 1 to 3 sessions | More reliable assessment after the full course |
| Is there downtime? | Usually none | Temporary muscle fatigue can occur |
| How long do results last? | Variable | Maintenance and lifestyle factors matter |
A calm next step
If bladder leaks are affecting your confidence, it is worth getting a proper assessment so your treatment matches the type of incontinence and any menopause related tissue changes. Patients can be assessed by experienced medical professionals at Renovatio Clinic, and if needed you can be guided towards GP or specialist care alongside conservative options.
