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When four separate friends recently asked for my opinion about Urospot, a new company in town that uses “high intensity electromagnetic technology” to contract the pelvic floor “11 000 times in 28 minutes”, I knew that I had some major research to do.
Now, before I get into my thoughts, let me acknowledge that yes, I am a certified pelvic health physiotherapist and, like all of us, I have biases. And yes, I do also run a pelvic health practice in the same city as Urospot. So while you may be tempted to think that this article is a low-handed attempt to prevent the competition from thriving, let me assure you that it is not. I am all for organizations that speak out about pelvic health concerns like incontinence and let men and women and children know that they can live leak free lives.
I actually went back and forth for a long time before deciding to write this article. I didn’t want to come across as one of those old-school health professionals stuck in the stone ages poo-pooing all new technologies that seem too good to be true.
I also didn’t want to give the impression that pelvic health physiotherapy somehow equates to just doing kegels. The truth is that incontinence is only a small part of all that we treat. And kegels are but one of many treatment strategies we can explore with clients.
Basically, I hoped that I could just send my inquiring friends to read all the pros and cons on someone else’s evidence-based blog post.
But such a blog post doesn’t exist.
So you see, after my fourth friend contacted me asking if Urospot is legit, I knew that although I may get some flack for it or be misunderstood, that as an evidence-based health professional and as a voice in the pelvic health community here in London, I have a mandate to advocate for accuracy and veracity in the world of women’s health.
Now that we’ve cleared all that out of the way, I invite you to put on your thinking cap. We’re going to think critically and challenge underlying assumptions as there are many myths that continue to circulate when it comes to the pelvic floor.
The Coles Notes.
This article is pretty in depth. If you don’t want to dive into the nitty gritty of it all, here are the coles notes.
- Urospot uses the Emsella Chair to treat stress urinary incontinence. The underlying premise is that leaking is due to a weak pelvic floor.
- The chair uses high-intensity focused electromagnetic technology that causes the pelvic floor to contract 11 000 times in a 28 minute session.
- Treatment consists of 6 sessions over a period of 3 weeks and costs a total of $1800 at Urospot in London, Ontario. You are encouraged to return for maintenance sessions every 4 months.
- The Emsella chair itself is new to the market. But there are other similar chairs that pre-existed the Emsella. They did not seem to have enjoyed widespread success.
- Opinions on the internet are largely positive. However, most voices appear to come from those who stand to profit. There are also “news pieces” that come across like advertising, and several posts from women who have tried it out.
- The only voice I could find out there that questioned the use of such devices is Dr. Jen Gunter, a well known OB-Gyn who literally wrote “The Vagina Bible”.
- There is little in the body of research evidence to support the Emsella chair. Several studies conclude that the chair shows promise but they are all low quality studies.
- There is no explanation given regarding the 11 000 generalized pelvic floor contractions in 28 minutes parameter. It seems to be completely arbitrary.
- Only two studies testing kegel chairs (not the Emsella but two other brands) are considered high quality and rigorous. One showed little to no benefit that electromagnetic stimulation improves incontinence. The other concluded that although there may be some benefit to electromagnetic stimulation of the pelvic floor, further studies need to demonstrate how it compares to pelvic floor muscle training.
- Pelvic floor muscle training (usually taught by a pelvic physiotherapist) has the highest level of evidence. Many studies over decades have proven that it is extremely effective curing women of stress urinary incontinence.
- Concerns about Urospot and the Emsella Chair from a pelvic physiotherapy perspective include:
- Lack of a comprehensive evaluation by a registered health professional
- False assumption that leaking is due to pelvic floor muscle weakness
- Incorrectly assuming that pelvic floor strengthening will improve stress, urge, or mixed urinary incontinence
- Overly simplistic and inaccurate understanding of pelvic floor physiology
- Overtraining only one component of the continence system rather than the body as a whole unit
- Possibility of too many kegels causing harm, particularly on already hypertonic pelvic floors
- No specificity or functional approach to re-training the pelvic floor
- Discouraging brain-body connection through a passive treatment approach
- Charging $1800 for a condition that should and does cost far less to cure
- Disempowering women by failing to teach them to re-connect to their own bodies and heal themselves
Intrigued? Read on to dive in deeper.
The Kegel Throne – Old Concept, New Packaging.
I learned that the secret sauce at Urospot is the Emsella Chair (also known as the “Kegel Throne”, or “Orgasm Throne” in some circles). This chair is designed by BTL which is a privately held global company that develops and manufactures medical and aesthetic equipment.
Side note – at our office, we actually have a therapeutic ultrasound machine by BTL that we use to treat blocked milk ducts. It is quite a sleek machine. We like it and it gets the job done.
BTL markets itself as being on the cutting edge of health care technologies and it has an entire branch dedicated to aesthetics. Products from the aesthetics side of the company (which are designed to shape and sculpt a “Body by BTL”) are ultimately sold to medical equipment distributors, health care offices, medical specialists, medi-spas, cosmetic surgeons, private businesses such as Urospot, and the like. Interestingly, the Emsella Chair is one of the products from their aesthetics line rather than their medical or rehabilitation line.
The Emsella Chair is said to use High-Intensity Focused Electromagnetic (or HIFEM) technology to elicit involuntary supramaximal contractions of the pelvic floor muscles. This document goes more in depth to explain the chair’s mechanism of action. If you are curious like I was, then have a read.
Well, it all sounds very fancy (and don’t we humans love shiny new gadgets) but the concept of external devices doing the work of activating muscles for you isn’t at all new. Have you heard of Muscle E-Stim units? Dr. Ho? The now hilarious seeming Ab-belt hype straight out of the 90s?
Even the idea of a kegel chair isn’t new.
There is a similar chair called the Pelvic Wave that is currently used in some offices. And back in the late 90s and early 2000s, the Neocontrol chair-like device was touted to be the next big thing for pelvic health. Yet this double-blinded randomized controlled trial using the Neocontrol found that electromagnetic stimulation to the pelvic floor muscles for stress urinary incontinence was “no more effective than sham treatment”.
Basically, the Emsella Chair, like the Neocontrol, is a rather large external electrotherapeutic modality that can cause contraction of the pelvic floor muscles.
Now for us physiotherapists, this isn’t as exciting as it may be those outside of the rehab world. After all, we are trained to use many types of energy modalities – from ultrasound, to laser, to shock wave, to TENS units, neuromuscular stimulation units, and more – to assist with rehabilitation. When indicated, pelvic floor physiotherapists may even use smaller hand held units to elicit involuntary contractions of the pelvic floor; or we may suggest clients do a trial run with a device like this one on their own at home while being followed by a pelvic floor therapist.
My whole point here is that concepts like the Emsella Chair, well, it’s been done. And though this version of the kegel throne at Urospot may be bigger and badder, is it necessarily better?
We’ll have to see what the research evidence says – but more on that later.
More About The Process At Urospot.
I wanted to know more about Urospot and their Emsella Chair so naturally, I ventured onto their website. There were some surprising claims based on an inaccurate understanding of pelvic floor physiology that I will address later in this article. However the website did list some benefits of treatment as being: non-invasive, easy, no need to remove clothing, quick to get results, safe, and greater sexual pleasure as an unintended but who-would-really-complain “side effect” of treatment.
All pros in my books – if true.
So I could see how Urospot’s claims would be appealing to many women looking for a quick fix to a bladder problem.
After checking out their website, I decided to call up the company and ask some questions about the process and costs. Here’s what I was told:
- I was invited to come in for a free 30 minute consultation with a nurse. She would go over my story and symptoms to ensure that the technology is appropriate for me. Then I would have about a 10 minute test-run sitting on the chair to see how it feels since “feeling is believing”.
- If I decided to move forward with treatment, I would need to book out all my sessions up front. I was told this is to work around my body’s time to ensure I wasn’t on my period during any of the sessions. Visits would take place twice a week over a period of three weeks. I would sit on the chair for 28 minutes each session.
- I was told that I would be invited back to Urospot 4 months after completing treatment for a maintenance session to maintain the gains I would get from the treatment. The maintenance sessions could be offered every 4 months indefinitely.
- No prescription from a physician or midwife or pelvic physiotherapist was required unless I perhaps wanted to file the treatment as an expense on my income tax return.
- When I asked how much it all cost, I was told that $1800 would need to be paid up front. When I expressed surprise at the cost I was told that the rate at Urospot is a good deal compared to Toronto rates where the treatment costs $3000-$5000.
- When I asked “what happens if it doesn’t work?”, it was emphasized that the key to seeing results is to complete the whole treatment which must consist of 6 sessions.
I will let you draw your own conclusions.
How Does The Internet Feel About The Chair?
The majority of information I could find online was posted by businesses that stood to profit by promoting the same technology used at Urospot. There were also a bunch of articles by women who shared their personal experiences with the “vagina gym“. Lastly, there were quite a few news pieces, many of which of which came across like advertising more than anything else.
It was all overwhelmingly positive and seemed the be-all and end-all cure for incontinence. Not a contrary voice in sight!
Sounded too good to be true. And because life has taught me to be somewhat skeptical of seemingly perfect solutions, I did more digging. One article from Health.com quoted Dr. Jen Gunter (of course) on the matter. Here is a direct quote from the article:
Turns out Dr. Gunter is less convinced that the buzzy chair is the answer to less trickle and more Os. “There are very few studies of quality on these tools,” she wrote in an email to Health. “Intravaginal electrical stimulation with specialized equipment can help some women with pelvic floor issues, but this is not that device.”
Gunter added that she doesn’t think patients should head to medispas if they’re struggling with incontinence. “I would see a board certified gynecologist, urologist, or urogynecologist, and a pelvic floor physical therapist instead,” she said.
If you don’t know about Dr. Jen Gunter, she is a no nonsense, speak her mind, self proclaimed authority on vaginas and vulvas. She’s a Canadian OB-Gyn who wrote the Vagina bible – quite literally. It’s the #1 National Bestseller right now.
Hers was the only voice I found that questioned the whole idea of using technologies like the one at Urospot. And while she remains a controversial figure and I don’t agree with all of her views, I quite appreciate her perspective in this video on knowing one’s own body and making health decisions that are based on the evidence and not on pop culture or what’s trending in the celebrity world.
So speaking of the evidence, let’s delve in.
10 Things You Must Consider Before Trying the Kegel Throne.
1. What Does The Research Say?
Unfortunately, not much.
In surveying the literature, I asked two questions:
a) Is the Emsella Chair/HIFEM technology effective in treating stress urinary incontinence (SUI)? If so, how effective is it?
b) How does this technology compare to other types of treatment for SUI (specifically various strategies that pelvic physiotherapy has to offer such as: education, pelvic floor muscle training, nervous system re-training, use of vaginal weights, neuromuscular electric stimulation, manual therapy, posture and breathwork, pressure management and regulation, inner unit training, functional re-training, strength and conditioning, etc, etc, etc)?
Here is what I found.
The BTL Emsella is relatively new to the market. From what I can gather, the company manufactured units in 2017 and officially launched the chair in 2018. Because it is a new product, there are only a handful of research articles I could find about it – at least that’s my reasoning as to the dearth of studies. See here, here, here, here, here, and here to read the articles I was able to find. Dr. Berenholz, a vaginal cosmetic surgeon, authored the key study (ie. white paper) for the Emsella. There is another study in the works and I’m interested to read the results once published.
I encourage you to search the scientific literature and if you find another article specifically testing the Emsella and its use of HIFEM technology, let me know.
Now while the above studies generally conclude that the technology is promising compared to doing nothing, they are unfortunately not the highest quality research studies. Limitations include: small sample sizes, absence of sham testing, lack of clarity regarding outcome measures and measurement tools, short follow up periods, general lack of robustness, and questionable affiliations between researchers, funders, and manufacturers.
What would be great is if there was an Randomized Controlled Trial (RCT) or a Meta-Analysis of HIFEM Technology for Stress Urinary Incontinence.
Oh wait – there is one! (Kinda.)
This systematic review and meta-analysis was conducted by He et al. Here’s what they concluded:
“Our meta-analysis preliminarily indicates that Magnetic Stimulation treatment is an effective therapeutic modality for patients with urinary incontinence. Nevertheless, additional large, high quality RCTs with a longer follow-up period that use consistent stimulation methods and analyse comparable outcomes are required to validate the efficacy.” (Emphasis mine.)
Well back in 2015 Lim et al. did in fact propose a study protocol for an RCT with the aim of determining “conclusively whether magnetic stimulation is effective for stress urinary incontinence”. I’m very impressed with the thoroughness of their study design. Plus the futuristic looking “PelviCenter” chair that they used in the study reminds me of an uber comfy Lazy-boy recliner, which is pretty awesome if you’re a study participant (see page 5 of the study protocol to see a photo of the chair).
So what were the results of the study?
In their article “Pulsed Magnetic Stimulation for Stress Urinary Incontinence: 1-Year Followup Results”, Lim et al. concluded this:
“Pulsed Magnetic Stimulation (PMS) is an attractive and promising nonsurgical alternative for patients who do not want to undergo surgery. Studies are indicated to compare PMS with Pelvic Floor Muscle Training in a long-term, randomized, controlled trial.” (Emphasis mine.)
Now hold your horses before you run off to Urospot to jump on that kegel throne! There are some super important things to note about the study by Lim.
First off, subjects received pulsed magnetic stimulation as opposed to High Intensity Focused Electric Magnetic Stimulation used by the Emsella chair at Urospot. To be honest, I’m not sure what the difference is since both chairs describe a similar coil device just underneath the seat that is responsible for causing contraction of the pelvic floor muscles. In my research, terms I encountered that seem to be synonymous to HIFEM including “electric stimulation”, “static or continuous magnetic stimulation”, and “extracorpreal magnetic innervation”. Are they all one and the same? A little clarity on this would be great.
Secondly, I must agree with the statement that studies are needed to compare PMS with pelvic floor muscle training (PFMT). We already know that PFMT works for urinary incontinence; many level 1, grade A studies have consistently demonstrated this to be true over several decades such as this, this, this, this, this, and this, one. So is PMS as effective as PFMT? Ultimately this Cochrane Review concludes that “it is not possible to say whether electric stimulation is similar to PFMT or other active treatments in effectiveness or not” because of too many low quality studies on electric stimulation.
Lastly, in the Lim study, subjects experienced a grand total of 100 kegels during each 20 minute session compared to the 11 000 kegels during 28 minutes that the Emsella chair boasts. That’s a HUGE difference. So huge that I question if results from the Lim study can even be really applied to similar chairs like Emsella at Urospot.
2. Where Do They Get That 11 000 Number Exactly?
While we’re on this topic, let’s talk about the 11 000 “perfect” kegels thing for a second.
Lim and his team studied 100 kegels and saw positive results. So ok, I can get the justification for doing 100 kegels. But 11 000 kegels in 28 minutes?!
That’s 393 kegels per minute – and supramaximal ones at that (that means higher than a maximal contraction of the pelvic floor muscles).
Where did the developers of the Emsella protocol come up with that parameter? Your guess is as good as mine.
The only thing I could find that remotely justified the number of contractions was from the discussion section of this article (and keep in mind that this article was written after the technology was already developed):
“To regain continence, regular pelvic floor muscles exercising is required. Normally, 300-500 contractions of the pelvic floor muscles should be performed to begin to develop a new motor pattern, whereas 3,000-5,000 contractions are required to erase and correct poor motor pattern. During 1 session using HIFEM technology, thousands PFM contractions are performed. This method is extremely important to PFM re-education as the patients are not able to perform this high-repetition rate pattern due to PFM weakness and an inability to consistently contract this muscle group.”
Now, motor learning and motor patterning is a whole other can of worms that I’m not going to go into here. Let’s just say that theories of motor learning are a LOT more complex than what’s presented in the quote above. Plus, there is way more to regaining continence than just exercising the pelvic floor muscles (which I will later explain).
In clinical practice, we see many women make rapid and sustained gains with their pelvic floor motor patterning and motor control with significantly fewer repetitions, and with other strategies that have little to do with actively contracting the pelvic floor.
In the research article entitled “Determining the Optimal Pelvic Floor Muscle Training Regimen for Women with Stress Urinary Incontinence“, Dumoulin and her co-authors wrote this:
“Pelvic floor muscle (PFM) training has received Level-A evidence rating in the treatment of stress urinary incontinence (SUI) in women, based on meta-analysis of numerous randomized control trials (RCTs) and is recommended in many published guidelines. However, the actual regimen of PFM training used varies widely in these RCTs. Hence, to date, the optimal PFM training regimen for achieving continence remains unknown and the following questions persist: how often should women attend PFM training sessions and how many contractions should they perform for maximal effect? Is a regimen of strengthening exercises better than a motor control strategy or functional retraining?….The questions are endless.”
It sounds like the scientific community is still trying to figure out exactly what training parameters should be taught when treating stress urinary incontinence.
Call me a cynic but they’ll never figure it out.
In truth, the parameters are different for everyone.
Because each body is different, the ideal training regimen for the pelvic floor ought to be personalized. That’s why a thorough evaluation of each individual is key.
And that’s why 11 000 kegels in 28 minutes for every. single. person. who sits on the Emsella chair at Urospot seems a little arbitrary to me. One size treatment does not fit all.
3. Is There A Comprehensive Evaluation And Reassessment By A Regulated Health Professional?
You cannot under-estimate the importance of a thorough, individualized pelvic health evaluation. This is just so basic.
In fact, in one of the articles I listed above examining the safety and efficacy of HIFEM technology, the author writes this about pelvic and perineal evaluation:
“It is one of the most important parts to define diagnosis and behavior. The advanced examination of pelvic floor should serve to rule out associations to prolapses of pelvic organs. The evaluation of the pelvic floor musculature is essential as well as the evaluation of vulvovaginal disorders due to urigenital atrophy. In complex cases and with recurrent UTI, interdisciplinary evaluation will be useful and necessary.“
I agree for all those reasons and more.
Did you know that pelvic health symptoms, such as incontinence, may have many underlying causes other than muscle weakness? For example, pelvic or bladder cancers feature urinary incontinence as an early symptom. I have had one client whose incontinence was actually advanced cancer related and it was terrifying when we both discovered this was the case. It is important to rule out pathology.
Now symptom checklists and a verbal health history or written questionnaire are handy for forming a theory of what is happening with an individual. But that theory still needs to be confirmed or denied by an actual physical evaluation of the individual’s body. There have been plenty of times where I have been surprised by evaluation findings because they didn’t line up with how my client presented on paper. We therefore can’t treat based on assumptions.
We advocate for an evaluation process because it’s the first step in knowing how to best treat you. (Read our FAQ on our evaluation process and the importance of internal evaluations). In fact, as physiotherapists, we can’t start treatment unless we’ve first assessed a patient. Our regulatory body, The College of Physiotherapists of Ontario, mandates this. And as regulated health professionals, we are held accountable for everything we do during the assessment and treatment of a person.
Beware of places where there is no comprehensive health evaluation of your body before starting treatment.
Beware of consultants whose job it is to close deals and get you to pay for a treatment package before actually starting treatment.
Beware of places that only offer one option for treatment – ie. their solution.
Beware of healthcare services that are offered by anyone other than regulated health professionals.
4. Myths, False Assumptions, and Inaccuracies Cause Confusion.
Why do people always assume that pelvic floors need strengthening?
And what does it mean to have a strong pelvic floor anyway? Is it possible that leaking can occur in a pelvic floor that is already strong? Is it possible that the continence system is impacted by more than just the pelvic floor? Are we missing the bigger picture by focusing on pelvic floor strength rather than pelvic floor training, or pelvic floor resilience, or something else?
Hopefully these questions give you pause for thought.
Unfortunately, Urospot seems to have reduced pelvic health to doing thousands of kegels to produce a strong pelvic floor. Urospot seems to assume that stress, urge, and mixed urinary incontinence are the result of a weak pelvic floor. If so, this inaccurate understanding of pelvic physiology can perpetuate myths about pelvic health and can lead to major confusion for people trying to get better.
It is so much more nuanced than that.
The pelvic floor doesn’t always need to be strengthened in order to regain continence. Sometimes it needs to relax and release. Sometimes it needs to lengthen. Sometimes it needs to be positioned differently. Sometimes it just needs a gentle reminder to wake up. Sometimes it needs training on coordination or timing. The pelvic floor, like any other muscle group, should be able to move through a full range of motion; should be compliant and supple, not stiff or tight; and should be dynamic and adaptable so it can function well in a variety of situations.
Forcing tens of thousands of suprmaximal kegels isn’t going to accomplish all those things. (Now somebody throw your hands up in the air and shout “truth”!)
For a refresher on urinary incontinence, check out this post written by one of our amazing physiotherapists, Sophia. (It’s important to note that different types of incontinence require different treatment approaches).
I also really appreciate this article co-authored by my former prof – shoutout to Dr. Linda McLean – which describes three modifiable factors that influence urinary continence. They are:
- Motor control factors – pelvic floor muscle dysfunction, postural and movement dysfunction, low back and pelvic pain, and breathing disorders;
- Musculoskeletal factors – decreased range of motion, decreased muscle strength, and decreased muscle endurance;
- Behavioural factors – chronically elevated intra-abdominal pressure, physical inactivity, abnormal fluid intake and voiding patterns, and poor psychosocial health.
To improve or cure incontinence, we really need to be thinking outside of the box, or in this case, pelvis.
When we do so, we train interconnected, synergistic body systems. We help the body to work the way it’s designed to.
Imagine the body as an orchestra. When each section plays its part, it produces life changing and inspiring music. Now imagine if one section of the body orchestra (let’s say the small but mighty piccolo – aka pelvic floor), decides to go all shrill and play F# really loudly a total of 11 0000 times in 28 minutes. I’m thinking the audience would leave, no?
It completely ignores the other equally important players in the body orchestra, such as the diaphragm, the abdominal muscles, the brain.
It’s not nice to listen to and can be a pain in the ear – or in the case of the pelvic floor, a literal pain in the butt.
5. Can Kegels Do More Harm Than Good?
Which brings me to the important point that all those kegels can end up doing more harm than good.
Have you ever overtrained before? Got all zealous at the gym and then set yourself back due to injury? How did it feel? Not great, right?
First of all, kegels are completely inappropriate if you already have a pelvic floor that tends to be stiff, carry tension, lack full range of motion, have tender points, or is overactive and non-relaxing.
And in case you didn’t realize this, an inflexible, tight, or chronically clenched pelvic floor can leak too. This is why it’s so important to get evaluated!
For people who do not start with an overactive pelvic floor, it’s possible that too many kegels can inadvertently create one. It can literally manifest as pain in the lumbar-pelvic-hip-groin area. One pelvic physio I spoke with who tried the chair at a trade show ended up with muscle strains in her groin hip rotator muscles.
Pain is not what we’re after here!
Now on the Urospot FAQ, the question is asked about recovery time between sessions. Here’s the answer Urospot gives:
“The 11,000 kegels performed during your session is equivalent to doing 70 hours of kegels. Like any workout you do, muscle recovery time is important. We recommend 2-3 days between sessions.”
For the record, if someone did 70 hours (that’s nearly 3 days) of continuous supramaximal bicep curls or hamstring curls, or crunches, I venture a guess that she would need more than 2-3 days of recovery time.
To be candid, solutions like the one offered at Urospot could potentially cause other pelvic problems for people who seem so to be the right candidate. The tricky thing is that many of the women who experience leaks, and especially with urgency or frequency, actually have hypertonic pelvic floors that really need to first lengthen before attempting any strengthening. To go straight to lifting and contracting the pelvic floor would be an exercise in futility.
Please come and see us first if you’re not sure about the current resting state of your pelvic floor.
6. Let’s Talk About Sex.
Yep you read that right. Sex.
It’s a known fact that sex sells.
If my earlier mention of the “orgasm throne” caught your attention, then you might be keen to know if the Emsella can help in the intimacy department.
Well, Urospot certainly thinks so. The website lists “more pleasure during sex” as an unintended but kind-of-awesome side effect of sitting on the vibrating chair.
(Speaking of vibration, I can’t help but wonder if some of the effects of the Emsella chair are due to whole body vibration rather than anything else. But that’s just a random thought.)
When it comes to sex, it is widely thought that strong pelvic floor muscles play a role during arousal and climax (although this is debated by some experts). While it’s certainly very helpful for pelvic floor muscles to be working at their best, don’t make the mistake of thinking that a super strong pelvic floor is the ultimate solution to your orgasm woes.
Female sexual response is as result of many things – such as overall physiology, emotions, hormones, mindset, social factors, stress, safety, and more – and not just strong pelvic floor muscles. So it’s overly simplistic to suggest that sitting on a vibrating chair will transform your sex life.
In the one study about the Emsella improving “female sexual dysfunction“, I think it’s important to highlight the rationale given for using HIFEM to treat women in this instance:
“The main cause for the development of Pelvic Floor Disorder (PFD) occurs when the pelvic floor muscles (PFM) and connective tissue weaken. Weak or deconditioned muscles may provide insufficient activity necessary for vaginal friction or blood flow, and thus inhibit orgasmic potential. Therefore the initial approach for the treatment of PFD and Female Sexual Dysfunction is to start with the strengthening of PFM.”
It is a cause, not the main cause.
It is true that women can experience pelvic floor issues due to tissue laxity, BUT many women also experience pelvic floor problems due to the opposite – hypertonicity. This means their pelvic floor muscles tend to be too tight, or too stiff, or non-relaxing, or hold tension. Both low tone and high tone pelvic floor muscles can impact sexual functioning in ways that are not great. Orgasms can be elusive, short lived, feeble, or on the other hand they can be extremely painful.
Once again, it’s really important to get checked so you know the starting state of your pelvic floor muscles. And truly, the last thing you want to do for a hypertonic pelvic floor is an additional 11 000 supramaximal kegels.
7. Specificity And Functional Training Matter.
When it comes to rehabbing the pelvic floor, specificity matters.
Some pelvic floors need more training in a particular area – say in the posterior area which houses anal sphincters. Other pelvic floors can handle normal daily stressors, but need specific training to manage the higher demands and pressures placed on it – say during AMRAP box jumps or that last 5km of a marathon. Many pelvic floors need to be trained to engage to the right degree – not too much, not too little – so the nervous system learns to choose the appropriate level of work required for a particular task.
It’s important be specific. At our office, we test the limits of the inner core system (which includes the pelvic floor and other muscles). Understanding the current limits gives us an idea of where to start training and ultimately gives our clients the biggest bang for their buck.
When it comes to rehabbing the pelvic floor, function matters.
You may be familiar with the concept of functional training. It’s the idea that when you train, you choose movements and exercises which parallel your job or life demands, and that allow you to perform your activities of daily living with greater ease.
The starting point in most traditional kegel programs is lying or sitting. Many of these programs don’t move beyond these positions. I suppose it’s functional if your life consists of lying down or sitting all.day.long. But in real life, teaching your system kegels in sitting alone is not all that helpful.
Practicing something in only one position will take you only so far because our bodies are designed to move. Many women we work with are active, play sports, or train at a gym. Others run around chasing toddlers all day. Still others have jobs that are physically demanding. They can’t slow down due to pelvic floor issues.
The pelvic floor and inner unit, therefore, must be able to adapt to all the realities of a dynamic, sometimes unpredictable life. When we train for both function and specificity, the result is a well-rounded, more resilient system. This truly is the key to long term success at home, the gym, the workplace, or on the field.
The Emsella chair at Urospot, on the other hand, is neither functional nor specific. It does not train all the elements required for human movement and performance.
Imagine attempting to train an Olympian for peak performance by keeping her in a chair that does all the training for her.
Seems an absurd proposition, doesn’t it?
8. Your Brain Wants To Be Involved.
Urospot and other centres using the Emsella chair mention how all you have to do is just sit there while the chair does its thing. You can watch TV or read a magazine…but you don’t have to engage in the treatment in any other way.
It is the ultimate passive treatment.
I can see how that would be appealing for tired women everywhere. But in truth when it comes to initially learning a new or different way to function, our bodies do much better when our brains are involved.
When you actively participate in something, your entire system benefits tremendously. You retrain more robust neural pathways. You tap into your system’s creativity. You expand your body’s library of options. You gain greater appreciation for the beautiful complexity and interconnected nature of your body. By slowing down and paying attention, you begin to change your system from within.
In our fast paced, hyperactive and distracted society, this is a good thing.
Being mindfully present and making connections about what is happening in our bodies might take a little more work a first. But the value is immeasurable – you unleash the intelligence of your body. You can literally change your body by changing your brain.
9. Money, Money, Money.
I believe that health is not uni-dimensional.
To pursue health in its fullest sense is to pursue wholeness of heart-mind-body-spirit.
A product that encourages you to leave your brain at the door, that cultivates dependency, that does not require a comprehensive evaluation, that is one-size-fits-all, that requires a large sum of your hard earned money upfront, that could make your pelvic health symptoms worse, that has limited evidence in the scientific literature, that is touted as the ultimate solution to your symptoms…it doesn’t sound like holistic health to me.
If it’s not about your health, then what is it about? Let me be blunt:
The aesthetics industry is about making money off of the insecurities of people. (Remember, the Emsella chair is from the aesthetics line by BTL, not their medical or rehabilitation line.) It’s my opinion that the whole industry is profit driven, not health-outcomes driven.
The recent wave of cosmetic devices designed to tighten the vagina, sculpt the vulva, reconstruct perfectly normal labias…they all send a dangerous message to women: that there is something wrong with their femaleness, something broken about their bodies, something undesirable about their sexuality, that their natural anatomy isn’t up to par, they are somehow not enough.
And that a machine can fix it all.
Now these machines are very expensive to purchase. Here in Ontario, the Emsella chair runs for around $150 000. If a business buys such a device, that device has to first pay for itself before it becomes a profitable investment. (All that marketing and advertising costs money too. And so does rent. And paying staff. And all the overhead that comes with running a business.) In my reasoning, that explains the why the costs for treatment are obscenely high – $600 per hour in the case of Urospot!
Now Urospot was founded and is run by a woman who is quite savvy in business, marketing and finance. And while she may have experienced the Emsella treatment herself, her LinkedIn profile shows no background in pelvic health rehabilitation whatsoever. As of the time I’m writing this, she’s not registered with The College of Physiotherapists of Ontario or rostered to assess and treat pelvic health musculature. She is a businesswoman who saw an opportunity to open “London’s first urology focused medical spa“.
Now, don’t get me wrong, there’s nothing wrong with running a business and making money. Heck, I am a business owner myself. But unlike owners of medispas (who can be pretty much anybody), I am accountable to my regulatory body for all things financial – from how we determine our rates, to billing practices, to when clients pay for their treatment (which is after each visit). Every single thing I do is subject to audit by my College. This is important because it’s ultimately for the good of the public and for the reputation of physiotherapy as a profession.
But before I ever went into business I was, and still am, a healthcare professional – first and foremost. I went into healthcare help empower people and inspire confidence in their abilities. Nothing thrills me more than seeing my clients crush their goals and walk out of my office with a newfound knowledge of their body, and with a greater appreciation for their capacity as a human being. I think most physios everywhere would say amen to that!
It shouldn’t cost $1800 to treat a straightforward case of stress urinary incontinence. For us pelvic physios, incontinence is easy to treat. Most women with this condition who receive 1:1 individualized treatment from a pelvic health physiotherapist won’t spend more than $400-$600 dollars in total. And physiotherapy is usually covered by benefits.
It may take a little longer than three weeks to become leak free, but in the end, women gain a wealth of knowledge about their bodies. They often don’t need to return for physiotherapy because they know what to do to help themselves. That is true freedom.
10. Quick Fixes Or Empowerment Mindset?
That brings me to my last point. And I might get quite impassioned for a moment here.
Our society loves quick fixes.
Our society will slap a band-aid on a mortal wound and pretend everything is OK.
Our society will look for shortcuts and miss the bigger picture, the deeper meaning.
Our society will sing the praises of technology even as it leads us to become less connected and more lonely.
Our society’s values have affected the way we deliver healthcare. Think of the opioid crisis we’re currently facing here in North America. The crisis is the result of many things, but at its root is the idea that all you need to do is pop a pill to solve your problems.
And our society has suffered due to this kind of thinking.
At The Mama’s Physio, we don’t slap on band-aids or promise quick fixes. No, we are interested in road less travelled. Rather than disempowering women and making them dependent on anything, or person, or any technology, we help women discover their own agency. Women have so much more in them than they can imagine.
We help women reconnect to themselves and harness their inner power for change.
My work over the years has led me to conclude that disconnection is a feature in many pelvic health issues that women face:
In childhood, shame and embarrassment about our vaginas and vulvas was passed down. We couldn’t talk about our anatomy without using disconnected phrases like “down there” or “nether regions”. As children, some of us had to disconnect just to survive the abuse.
As youth, many of us were led to believe that our menstrual cycle was an inconvenience or a curse. We popped prescribed pills to silence everything “down there” and disconnect from thinking about it at all.
As relationships began to form, we were somehow convinced that our bodies were for the pleasure of others. We accepted their standards of beauty or ideas about what was sexy. We did what they wanted, what made them feel good, and our minds went elsewhere as it all unfolded.
When childbirth became imminent, we feared it like nothing else. We preferred to disconnect from feeling that raw untamed power in our pelvis and chose the needle or the knife instead.
We got older and couldn’t ignore our pelvic area anymore as it began to leak, sag, and feel like sandpaper. We were given the final solution to all our feminine troubles – cut it out. Problem solved.
This is the script that we are handed by virtue of being born female in this culture.
But it is not my story. It will not be the story of my daughters.
I’m convinced that we simply don’t know what to do with our pelvic anatomy because we, and society at large, have never been taught to understand, respect, honour, and appreciate it. We simply disconnect because it’s the easiest thing to do. And sadly, it’s encouraged by the very institutions and industries who should be advocating for true health.
But there is a better way my dear friends.
Much of our work is inviting women to reconnect to their bodies and discover that they have it within themselves to heal. Yes, it can be slow work, but it is good work. It is a gift that can unlock other areas of healing in a woman’s life.
I love the thoughts of Juliana Mitchell, a yoga teacher in New York. She wrote this in a blog about kegels:
“…simplistic instructions do not take the time to aid women in building sensitive and deep awareness of their own pelvic floor, of their breath and of their emotional life. Pelvic floor awareness and health deserves and takes time. It cannot be (and should not be) like fast food.
It takes compassionate awareness, as well as time, to get to know our own pelvic floor, and to begin to work thoughtfully and specifically with its structures. I am describing the delicate process of awakening and befriending our own feeling-body. For someone to embark on rebalancing and reawakening their pelvic floor, they will need the support of someone who can create a safe space for the process.”
I couldn’t have said it better.
I will get off my soapbox now.
Final Recommendations From A Certified Pelvic Health Physiotherapist.
Let me make it clear – I’m not suggesting that you avoid the Emsella Chair at Urospot. You’re an adult and get to make your own decisions. I completely respect that.
If you do choose to go for the kegel throne at Urospot, I would like to suggest the following things:
- Re-read this article in its entirety. It’s important to be informed of the procedure, evidence, risks, benefits, and alternatives to a technology like the one at Urospot.
- Get introspective and ask yourself why you really want to do this. There are no right or wrong answers. But just be honest with yourself.
- See your doctor to rule out any pathology which may be responsible for your incontinence.
- Get assessed by a pelvic health physiotherapist beforehand so you understand what’s causing the incontinence in the first place. It might not be weak pelvic floor muscles. Your pelvic floor might need the very opposite of kegels.
- Get re-assessed by a pelvic health physiotherapist afterwards to see if it made a change to the tissues or to how you actually integrate your pelvic floor and inner unit during your daily movements
Well, that concludes what has turned out to be a very long article! Thank you for reading.
If you have any questions about what I’ve written, or if you want to challenge anything, please don’t hesitate to contact me. I’m open to healthy debate and I’m willing to learn different perspectives.
Our physiotherapists are knowledgeable, compassionate, and have successfully treated tons of women with incontinence. Please book a consultation here. We’d truly love to help.