Good Vibrations

By George Gillson MD PhD CCFP

I hope no one metaphorically or literally scratched their head as they started to read this post. Alert readers will recall that the last post was about men’s hormonal health and toward the end of it I talked about prostate cancer and BPH or Benign Prostatic Hypertrophy. Any man who is old enough to be facing urinary, prostate-related symptoms gets the Good Vibrations-Beach Boy connection. I probably didn’t need to point that out but this paragraph, including this sentence, upped my word count by 85.

Disclaimer: I don’t get paid by the word to write this blog.

Anyway, moving right along here, I closed the last post with the following statement: “Stay tuned for the next post later this month when I’ll discuss a fascinating non-invasive, non-drug treatment that can reduce the symptoms of BPH!”

Well. It’s now later this month.

For several years, the EvolveWell Clinic has been offering treatments with an intriguing device called the Emsella®, to treat urinary incontinence in females. I’m going to talk about the Emsella in just a little bit: I promise. But first I want to quickly review incontinence and the pelvic floor. Note: Pelvic flooring is not something sold at Home Depot.

There are various types of urinary incontinence:

• Stress incontinence: pressure exerted on the bladder causes leakage of urine (coughing, laughing, sneezing, or exercising)
• Urge: sudden, intense urge to urinate frequently, especially if the bladder is full
• Mixed incontinence: a combination of both stress and urge incontinence.

Regardless of type or cause, urinary incontinence can have a significant effect on quality of life.

Basically, a large part of urinary incontinence in women involves weakening of the pelvic floor, which is a bowl-shaped sling of muscles that support and cradle the bladder, rectum, uterus, prostate. This may be due to age, childbirth, surgery, as well as certain neurologic disorders, obesity and chronic coughing from lung disease.

The relevant anatomy for both sexes is shown below.

In females, incontinence is often addressed with Kegel exercises which consist of the intentional repetitive tightening of the muscles used to interrupt the flow of urine and/or to delay defecation. Other treatments include prescription medications, and if all else fails, use of incontinence pads and undergarments-which can be a considerable expense (>$1000/yr) and also a nuisance/inconvenience/source of embarrassment.

In males, as is the case for females, causes of incontinence include neurologic disorders, obesity, and chronic coughing but can also arise due to uncomplicated (nonsurgical) BPH, after surgical treatment for severe BPH (Transurethral Resection of Prostate aka TURP) or after removal of the prostate due to cancer. In males, incontinence may be accompanied by erectile dysfunction, reduced control over ejaculation and impairment of orgasm. Again, conventional nonsurgical treatments of incontinence include various medications and absorbent undergarments.

I think we’re all up to speed now on the basics of incontinence so I want to introduce you to the Emsella device:

Your mind might be literally brimming with speculation and puzzlement right now. I’ll put you at ease.  This is not a robot companion or some kind of futuristic, self-contained, regenerative, zero-waste toilet.  It’s a chair containing an MRI-grade electromagnet that emits trains of electromagnetic energy pulses that stimulate thousands of pelvic floor muscle contractions over the course of a treatment session. These contractions retrain and strengthen the muscles of patients struggling with urinary incontinence but also seems to retrain the nerves as well.  The energy pulses are a neuromuscular treatment as opposed to a simple muscular treatment.

The EvolveWell Clinic has been offering this FDA- and Health Canada- cleared device to treat female incontinence for several years now, to great effect. A course of therapy typically consists of six sessions over the course of three weeks. Each session involves sitting on the seat, fully-clothed I might add, for 28 minutes. If you know what Kegel exercises are, I’ll say that each Emsella session stimulates about 11,000 Kegel exercise-like contractions. Two points here:

• That is a lot of contractions. You could never do that many Kegels on your own even if you were born on the planet Krypton aka the home planet of Superman, his relatives and their super pets.
• The contractions are more sustained and intense than any Kegels you could do on your own. Note: do NOT be alarmed! I tried out the chair for a full session and it’s OK. You have full control over the intensity of the effect. It is NOT painful.

This figure depicts the difference between Kegel exercises and the contractions elicited by the Emsella:

And here are ultrasound images showing the effect on the pelvic floor during an Emsella pulse train. In the words of Mr. Spock: “Fascinating.” Note how the bladder is elevated up to the dotted line during the pulse sequence.

Difference in mean score of KHQ domains (mean ± standard error). Maximum score of each domain is 100 points and lower scores indicate patient wellbeing. The statistical significance is highlighted by the asterisk (*P<0.05; ***P<0.001), reduction in score by 5 points indicates clinical significance.

References

https://bermansexualhealth.com/emsella-for-men/

Azparren J, Brandeis J. HIFEM procedure enhances quality of life of elderly men with post-prostatectomy incontinence.  Not peer-reviewed.  Publication available on request.

Emsella Clinical Summary.  Available on request