Emsella vs. Kegels.
EMSELLA vs. Kegels: What Actually Works for Pelvic Floor Strengthening?
You've been told to "just do your Kegels." Here's why that advice falls short for most people — and what the research says about high-intensity electromagnetic therapy.
If you've ever mentioned bladder leakage, pelvic pressure, or urgency to a doctor, you've almost certainly received the same advice: "Do your Kegels." It's the default recommendation for pelvic floor weakness, handed out so routinely that most people assume it's the best — or only — solution.
But here's what most people don't realize: research consistently shows that up to 50% of people perform Kegels incorrectly, even after instruction. And even when performed perfectly, manual Kegels have significant limitations in how much force they can generate and how deeply they can engage the full pelvic floor musculature.
EMSELLA — a non-invasive, FDA-cleared device that uses High-Intensity Focused Electromagnetic (HIFEM) technology — offers a fundamentally different approach. This guide compares both options with clinical honesty so you can decide what makes sense for your body.
Understanding Your Pelvic Floor
Your pelvic floor is a group of muscles that form a hammock-like structure at the base of your pelvis. These muscles support your bladder, uterus (in women), prostate (in men), and rectum. They control urination, bowel movements, and sexual function. They also play a critical role in core stability and spinal support.
When pelvic floor muscles weaken — due to pregnancy and childbirth, aging, hormonal changes (especially menopause), chronic constipation, heavy lifting, obesity, or surgery — the consequences affect daily life in ways that range from inconvenient to devastating. Stress urinary incontinence (leaking when you cough, sneeze, laugh, or exercise) is the most common symptom, but pelvic floor dysfunction also includes urge incontinence, pelvic organ prolapse, reduced sexual sensation, and chronic pelvic pain.
An estimated 1 in 3 women and 1 in 10 men experience pelvic floor dysfunction at some point in their lives. Despite how common it is, most people suffer in silence for years — wearing pads, avoiding exercise, declining social invitations — because they think it's just a normal part of aging or motherhood.
It's not. And it's treatable.
Kegels: The Standard Advice
How They Work
A Kegel exercise involves voluntarily contracting and relaxing the pelvic floor muscles — the same muscles you'd use to stop the flow of urine midstream. A standard recommendation is 10–15 contractions, held for 5–10 seconds each, performed 3 times daily. Over weeks to months, this repetitive contraction is intended to strengthen the pelvic floor muscles the same way bicep curls strengthen your arms.
What the Research Says
Kegels do work — when performed correctly and consistently. Studies show that supervised pelvic floor muscle training can improve stress urinary incontinence symptoms in 56–70% of women. That's a meaningful success rate, and pelvic floor physical therapy (which includes guided Kegels plus other techniques) is a legitimate first-line treatment.
But "supervised" and "consistently" are doing a lot of heavy lifting in that sentence.
The Problems with Kegels
Most people do them wrong. A landmark study published in the American Journal of Obstetrics and Gynecology found that over 50% of women could not perform a correct Kegel contraction even after verbal instruction. Many bear down instead of lifting up, engage their glutes or abdominals instead of their pelvic floor, or contract too weakly to produce meaningful strengthening. Without biofeedback or hands-on assessment from a pelvic floor physical therapist, you may be doing Kegels for months with zero benefit — or potentially making things worse by creating muscle imbalance.
Compliance is terrible. Even patients who learn to do Kegels correctly rarely stick with the program long enough to see results. Research shows that adherence drops dramatically after the first few weeks. Let's be realistic — remembering to do 30–45 invisible muscle contractions every single day, indefinitely, is difficult. Life gets in the way. And unlike visible exercises (where you can see your arms getting bigger), pelvic floor progress is invisible, which makes it hard to stay motivated.
There's a ceiling to how much force you can generate voluntarily. Even a perfectly executed Kegel engages only a portion of the pelvic floor muscle fibers. Voluntary contractions cannot match the supramaximal contractions that electromagnetic stimulation produces — and it's the intensity of contraction that drives real structural change in weakened muscles.
They don't work for everyone. Patients with severely weakened pelvic floors — particularly after multiple childbirths, during/after menopause, or after pelvic surgery — often cannot generate enough voluntary contraction to produce a training stimulus. When the muscle is too weak to contract meaningfully, telling it to contract harder doesn't work. It's like asking someone who can't do a single push-up to build chest strength by doing push-ups.
EMSELLA: A Different Approach Entirely
How It Works
EMSELLA uses High-Intensity Focused Electromagnetic (HIFEM) technology to stimulate the entire pelvic floor musculature — not just the fibers you can voluntarily contract. You sit fully clothed on the EMSELLA chair, and electromagnetic energy passes through your body to trigger supramaximal pelvic floor contractions — contractions far more intense than anything achievable through voluntary effort.
A single 28-minute session delivers approximately 11,200 supramaximal contractions. To put that in perspective: even if you performed Kegels perfectly, 3 sets of 15 contractions per day, it would take you over 8 months to match the contraction count of a single EMSELLA session. And the intensity of each EMSELLA contraction exceeds what's possible voluntarily.
What the Research Says
Clinical studies on EMSELLA show a 95% improvement rate in patients treated for urinary incontinence. Pad usage decreased by 75% on average. Quality of life scores improved significantly across validated questionnaires. And importantly, the results held at 6-month and 12-month follow-ups, indicating that the muscle strengthening is durable — not just a temporary effect.
A study published in the International Urogynecology Journal found that HIFEM treatment produced significant increases in pelvic floor muscle thickness and strength as measured by perineometry, confirming that the improvement isn't just symptomatic — the muscles are genuinely getting stronger and thicker.
Head-to-Head Comparison
| Factor | Kegels | EMSELLA |
|---|---|---|
| Contractions Per Session | 30–45 (if done correctly) | 11,200 supramaximal contractions |
| Contraction Intensity | Submaximal voluntary effort | Supramaximal — beyond voluntary capacity |
| Muscle Fibers Engaged | Partial — only fibers under voluntary control | Entire pelvic floor musculature |
| Correct Technique Required | Yes — and 50%+ do them incorrectly | No — the device does the work |
| Time Per Session | 5–10 minutes, 3x daily | 28 minutes, 2x per week |
| Sessions to Results | 8–12 weeks of daily practice | 6 sessions over 3 weeks |
| Success Rate | 56–70% (supervised) | 95% improvement rate |
| Works for Severe Weakness | Limited — muscle must be strong enough to contract | Yes — bypasses voluntary effort entirely |
| Cost | Free | $200–$500 per session; ~$1,500–$2,500 per series |
| Clothing Removal Required | No | No — fully clothed |
| Pain Level | None | Tingling/vibrating sensation; not painful |
| Downtime | None | None |
Who Should Start with Kegels?
Kegels — especially supervised pelvic floor physical therapy — are a reasonable starting point for patients with mild pelvic floor weakness, good body awareness, and the discipline to do them consistently. If you're a younger patient with mild stress incontinence (occasional leaking only with heavy exercise or a big sneeze), and you have access to a pelvic floor physical therapist who can confirm you're engaging the right muscles, a 3-month trial of supervised Kegels is a legitimate first step.
Kegels are also complementary to EMSELLA — not necessarily an either/or decision. Learning to engage your pelvic floor voluntarily is a useful skill that supports the results EMSELLA produces. Many providers recommend continued Kegel practice between and after EMSELLA sessions for optimal long-term results.
Who Should Consider EMSELLA?
EMSELLA is the better choice in most clinical scenarios. If you've tried Kegels and haven't seen improvement, EMSELLA bypasses the technique and compliance issues that limit Kegel effectiveness. If you have moderate to severe incontinence, the supramaximal contractions provide a training stimulus that voluntary effort simply can't match. If you're postpartum and dealing with pelvic floor weakness, EMSELLA can accelerate recovery that might otherwise take months of physical therapy. If you're perimenopausal or postmenopausal, hormone-related muscle weakening makes voluntary Kegels less effective — EMSELLA works regardless of hormonal status.
EMSELLA is also the clear choice for anyone who values efficiency. Six 28-minute sessions over three weeks versus daily exercises for months — the time comparison alone makes it worth considering.
What About Men?
Pelvic floor dysfunction isn't just a women's issue. Men experience urinary incontinence — particularly after prostate surgery — and pelvic floor weakness contributes to erectile dysfunction, post-void dribbling, and urgency. EMSELLA is FDA-cleared for both men and women, and the same principles apply: supramaximal contractions strengthen the pelvic floor muscles that control urinary function and sexual health.
For men post-prostatectomy, EMSELLA can significantly accelerate the return of continence that might otherwise take 6–12 months of Kegel-based rehabilitation.
What a Typical EMSELLA Treatment Plan Looks Like
At Defiance Health, a standard EMSELLA protocol consists of 6 sessions over approximately 3 weeks (2 sessions per week). Each session is 28 minutes. You remain fully clothed — just sit on the EMSELLA chair and let the technology work. Most patients describe the sensation as an intense tingling or vibration in the pelvic area. It's unusual but not painful.
Improvement typically begins after the 2nd or 3rd session, with maximum results at 2–4 weeks after completing the full series. Results continue improving as the strengthened muscles remodel over the following weeks. Maintenance sessions (1 session every 3–6 months) help sustain results long-term.
Frequently Asked Questions
Is EMSELLA embarrassing?
Not at all. You sit fully clothed on what looks like a regular chair. There's no undressing, no internal devices, no physical contact. You can read, scroll your phone, or just relax during treatment.
Does EMSELLA hurt?
No. Patients feel a tingling and vibrating sensation along with involuntary pelvic floor contractions. The intensity is gradually increased during your first session. Most patients describe it as unusual but comfortable.
How soon will I notice results?
Many patients notice improvement after 2–3 sessions. Full results develop 2–4 weeks after completing the 6-session series as muscles continue to remodel and strengthen.
Can I do EMSELLA and pelvic floor PT together?
Absolutely. They complement each other well. EMSELLA provides the intense strengthening stimulus, while pelvic floor PT teaches you body awareness and voluntary control. Combined, they often produce the best outcomes.
Who should NOT get EMSELLA?
EMSELLA is not appropriate for patients with metal implants in the pelvic area (hip replacements are typically fine — consult your provider), cardiac pacemakers or defibrillators, or those who are pregnant. A consultation determines whether you're a good candidate.
Defiance Health — Denver/Centennial & Alamosa, CO — (719) 480-2400