Leaking when you cough, laugh, lift, or run has a physical cause. The pelvic floor has lost strength, and the tissue around the urethra has thinned. Both respond to treatment. Severity varies widely, and most women improve without an operation.
Reviewed by Allison Mollet, PA-C, MSCP
Updated August 2026
Stress incontinence is urine escaping when pressure rises inside the abdomen. Coughing, sneezing, laughing, running, and lifting all raise it.
The mechanism is the same in every woman who has it. Pressure exceeds what the pelvic floor and urethra can hold back.
Severity varies widely. It runs from a few drops during a hard sneeze to leakage that needs pads through the day, and that range determines what treats it.
It is common, and it is not a consequence of aging that has to be accepted.
Urge incontinence is different. The bladder contracts without warning and gives little notice, so the leak arrives with a sudden need to go.
Many women have some of each. Which one predominates changes what helps most, and that is established at the visit.
The pelvic floor. It is the sling of muscle that supports the bladder and closes the urethra. Pregnancy and vaginal delivery stretch it. Age and inactivity weaken it further.
Estrogen. The urethra and the tissue around it depend on estrogen. After menopause that tissue thins and loses its seal, which is why leakage often starts or worsens in the years after the final period.
Pressure from above. Chronic cough, constipation, heavy lifting, and additional body weight all raise the load the pelvic floor carries. Reducing that load reduces the leakage.
Emsella is a chair that delivers focused electromagnetic energy to the pelvic floor. Over a session it produces thousands of contractions, far more than a woman can perform on her own.
You sit on it fully clothed. There are no needles, no anesthetic, and no downtime. Most women read through the session.
A course is typically about six sessions over a few weeks, with simple maintenance afterward to keep the result.
The strongest evidence for Emsella in women is on incontinence, and it comes from independent studies rather than the manufacturer.
In a study of 35 women with urinary incontinence, six sessions halved daily pad use, and by the one-month follow-up it was down about two-thirds.
About 83% reported significant relief. About a quarter reached a symptom score of zero, meaning completely dry, after the sessions, rising to about a third at one month (Tosun 2024).
A 2025 systematic review pointed the same way: less leakage and better quality of life. Its authors note that the studies are small and varied in quality.
These are study results rather than guarantees, and they match what we see.
The muscle is one half of continence. The tissue is the other.
Vaginal estrogen restores the thickness and blood supply of the urethral and vaginal tissue, with minimal absorption into the rest of the body. It reduces leakage and urgency, and it lowers the rate of urinary infections.
It also works before symptoms appear, used to prevent the thinning rather than to treat it. Many women use it alongside Emsella, and many do well on it alone.
Systemic hormone therapy addresses the wider changes of menopause. Whether it suits you depends on your history, and our forms of hormone therapy page covers the options.
Most women with stress incontinence are told to do Kegels and little else. In our experience both halves need treating: the muscle with Emsella, and the tissue with vaginal estrogen. That is enough for the majority. Where it is not, a surgical repair works well, and the visit is how we tell the difference.
— Allison Mollet, PA-C, MSCP
Not every case is treated the same way, and a few situations call for something beyond the muscle and the tissue.
A severe or persistent leak. Where leakage is heavy, or continues through a full course of treatment, a surgical repair is usually the more effective option. We assess for that and refer.
Prolapse. A sense of pressure, heaviness, or bulging means the support has given way rather than weakened. That is a surgical question from the start.
Urgency. Leakage that arrives with a sudden need to go is urge incontinence, and it is treated differently.
Anything unexplained. Blood in the urine, pain, or repeated infections need investigation of their own.
Where a surgical repair is the right answer, we refer to urology or urogynecology and stay involved in your care.
Your consultation covers your symptoms and history, and includes a free demonstration of the chair, so you know what a session feels like before deciding.
For most women the plan from there is a short Emsella course, vaginal estrogen where the tissue is involved, and hormone therapy where the wider picture calls for it.
Emsella is not used with metal or electronic implants, such as a pacemaker, or during pregnancy. We review your history first.
Let's begin
A consultation covers your symptoms and history, and includes a free Emsella demonstration so you can feel it before you decide. To speak with us first, call 714-671-2005.
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Urine escaping when pressure rises inside the abdomen: coughing, sneezing, laughing, exercise, lifting. The pelvic floor and urethra cannot hold against the pressure. It is one of the two common types of leakage, and it ranges from a few drops to a heavy leak.
Because those actions raise pressure inside the abdomen, and the pelvic floor is no longer strong enough to close the urethra against it. Childbirth, age, and the drop in estrogen after menopause all contribute.
For most women, yes, and that is where treatment starts. Emsella rebuilds pelvic-floor strength non-invasively, and vaginal estrogen restores the tissue.
Where the leak is severe, or where it continues after a full course, a surgical repair is usually the more effective option. Both paths work; which one fits you depends on how severe the leakage is and on your anatomy.
Severity and the state of the pelvic support are what decide it. A heavy or constant leak, or a sense of pressure or bulging, points toward a repair. A leak that comes with pressure — a cough, a sneeze, a lift — usually responds to strengthening the muscle and restoring the tissue.
Your visit establishes which, and if a repair is the answer we refer to urology or urogynecology.
The independent evidence is the strongest in this field. In a study of 35 women, six sessions halved daily pad use, down about two-thirds by one month, and about 83% reported significant relief. About a quarter were completely dry after the sessions, rising to about a third at one month (Tosun 2024).
A 2025 systematic review found less leakage and better quality of life, and noted that the studies are small. Results vary by person.
Kegels depend on doing the exercises correctly and keeping them up, which is hard to sustain. Emsella produces thousands of strong contractions per session automatically, and it reaches muscle that voluntary exercise often misses.
Typically about six sessions over a few weeks. Improvement usually continues in the weeks afterward, and simple maintenance sessions help hold it. Your provider sets the plan at your consultation.
No. You sit fully clothed and feel a strong tingling with the muscles contracting. Most women read or relax through the session, and there is no downtime afterward.
Often, yes. Low estrogen thins the tissue around the urethra, and restoring it improves leakage and urgency and lowers the rate of urinary infections. Absorption into the rest of the body is minimal, and it can be used alongside Emsella.
No. Pelvic-floor strength can be rebuilt years later, and women who have leaked for a long time often respond well. The length of time is not what determines whether treatment helps.
That is urge incontinence, and it is treated differently. Many women have some of each. Your visit establishes which one predominates, which is what determines the plan.
It does. Additional body weight raises the pressure the pelvic floor has to hold against, so reducing it reduces leakage. It works alongside treatment rather than in place of it.
It is not used with metal or electronic implants, such as a pacemaker, or during pregnancy. We review your history at the consultation to confirm it is safe for you.
