The Pelvic Floor Problem Most Doctors Don't Discuss
Most Doctors Don't Discuss
Stress Urinary Incontinence: More Common — and More Treatable — Than You Think
Stress urinary incontinence (SUI) — the involuntary leakage of urine during physical activity such as coughing, laughing, sneezing, or exercise — is one of the most prevalent and most under-addressed conditions in women's health. Yet despite its frequency, the majority of patients never seek medical care, believing it to be a normal and unavoidable consequence of childbirth or aging.
The evidence is clear: SUI is a medical condition with effective, noninvasive treatments — not an inevitable fact of life. A comprehensive body of clinical guidelines, including those from the American College of Obstetricians and Gynecologists (ACOG) and the American College of Physicians (ACP), outlines a spectrum of management options with meaningful outcomes for most women.
Pelvic floor muscle training produced cure or improvement in 74% of women at 3–6 months, compared to just 11% receiving no treatment — a more than 6-fold difference.
What Causes Stress Incontinence?
SUI occurs when the pelvic floor muscles and urethral support structures are weakened — commonly by childbirth, hormonal changes at menopause, aging, or excess body weight. Obese women have a 4.2-fold greater risk of developing SUI compared to women of healthy weight. Even modest weight loss — approximately 8% of baseline body weight — reduces incontinence episodes by nearly half.
The pelvic floor is a group of muscles that supports the bladder, bowel, and uterus. When these muscles weaken, the structural support for the urethra diminishes — and leakage occurs under any pressure that exceeds what the weakened floor can contain.
with supervised pelvic floor training
vs. healthy weight — ACOG data
with structured weight loss (PRIDE trial)
What Does the Evidence Recommend?
Major clinical guidelines — from ACOG, ACP, and the Women's Preventive Services Initiative — align on a clear hierarchy of noninvasive management strategies. The good news is that first-line options are effective, accessible, and do not require surgery.
| Intervention | Efficacy | Key Notes |
|---|---|---|
| Pelvic Floor Muscle Training (PFMT) | ★★★ High 74% cure/improvement; ~59% cure at 12 months |
First-line (ACP strong recommendation). Supervised programs outperform self-directed. Requires consistent adherence. |
| Weight Loss | ★★★ High 58% SUI reduction with ~8% weight loss |
ACOG: obesity is an independent risk factor (4.2× risk). Even modest loss produces significant improvement. |
| Incontinence Pessary | ★★ Moderate 33% symptom-free at 3 months |
Useful for situational SUI. Equivalent satisfaction to PFMT at 12 months. Requires fitting. |
| Vaginal Estrogen (postmenopausal) | ★★ Moderate OR 0.12 for SUI improvement |
Adjunctive in postmenopausal women. Vaginal formulations effective; transdermal patches worsen SUI — avoid. |
| Electrical Stimulation / HIFEM | ★★★ High Superior to sham; comparable to supervised PFMT |
Delivers supramaximal pelvic floor contractions non-invasively. No adherence burden. FDA-cleared. |
| Vaginal Laser | ★ Emerging Modest benefit vs. sham (2026 meta-analysis) |
Inconsistent data. FDA advisory warning against marketing for vaginal rejuvenation. Not recommended as first-line. |
What Effective Management Actually Looks Like
The research is consistent: the best outcomes come from combining approaches — addressing the underlying muscle weakness, the structural support of the pelvic floor, and for many women, excess body weight. Here is how I think about this clinically:
-
Address weight if relevant — For overweight patients, even a 5–10% reduction in body weight produces meaningful, sustained improvements in SUI frequency. This is the most impactful first step for many women.
-
Pelvic floor muscle training — At minimum 8 supervised contractions three times daily. Supervised programs produce significantly better outcomes than unsupervised home exercises. This is the ACP's #1 strong recommendation.
-
Fluid and caffeine management — Reducing fluid intake to no more than 2 liters daily, limiting caffeine, and establishing regular bladder emptying are simple, evidence-based lifestyle adjustments.
-
Vaginal estrogen for postmenopausal women — Highly effective as an adjunct. Vaginal formulations (cream, ring, tablet) improve continence; transdermal patches do not — and may worsen symptoms.
-
FDA-cleared pelvic floor technology (Emsella) — For patients who want faster results, who struggle with PFMT adherence, or who want to amplify their pelvic floor training outcomes, Emsella delivers thousands of supramaximal pelvic floor contractions per session — now available at MyOne PCP.
Emsella Is Now Available at MyOne PCP
I am pleased to announce that Emsella — the only FDA-cleared non-invasive device specifically designed for pelvic floor restoration — is now available at MyOne PCP in Tigard. This is a technology I evaluated carefully before bringing it into the practice, and I am confident it represents the best available non-surgical option for patients dealing with stress urinary incontinence, urgency incontinence, or pelvic floor weakness.
Emsella uses High-Intensity Focused Electromagnetic energy (HIFEM) to stimulate deep pelvic floor muscles with supramaximal contractions — the kind and intensity that are physically impossible to achieve through voluntary Kegel exercises alone. Each 28-minute session is equivalent to performing approximately 11,000 Kegel exercises, while you sit fully clothed in the Emsella chair.
In plain terms: Emsella does what months of self-directed pelvic floor exercises attempt to do — in a fraction of the time, with no discomfort, no undressing, and no downtime. You can return to your normal activities immediately after each session.
What the clinical data shows:
improvement in quality of life
satisfaction with results
contractions per session
over 3 weeks for full results
Who Is Emsella For?
Emsella is clinically appropriate for women (and men) experiencing:
- Stress urinary incontinence (leaking with coughing, laughing, sneezing, or exercise)
- Urgency incontinence (sudden, strong urge to urinate)
- Mixed incontinence
- Postpartum pelvic floor weakness
- Pelvic floor weakness associated with menopause or aging
- Reduced intimate sensation or sexual wellness concerns
- Core instability related to pelvic floor dysfunction
Most patients notice improvement beginning around session three, with peak results appearing 4–6 weeks after completing the series — consistent with the physiologic timeline for pelvic floor muscle remodeling.
Note: Emsella is not appropriate for patients with implanted metal devices, pacemakers, or cardiac defibrillators. A brief medical screening will be conducted before your first session.
You Don't Have to Accept This as Normal
Pelvic floor dysfunction is one of the most treatable conditions in women's health — and one of the most undertreated. I brought Emsella into this practice because I want my patients to have access to the best available noninvasive options, not just the most common ones.
If you experience leakage, urgency, reduced sensation, or simply feel that your core and pelvic strength have declined, I encourage you to schedule a visit. We will review your symptoms, discuss what the evidence recommends for your specific situation, and determine whether Emsella belongs in your care plan.
As always, every decision at MyOne PCP is made together — with your full health picture in view and your goals leading the way.
