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No woman wants to deal with the involuntary leakage of urine, also known as stress urinary incontinence (SUI) caused by weakened pelvic floor muscles. A common culprit of damages to the vaginal walls and surrounding muscles in childbirth and/or hormonal changes triggered by menopause. In some cases, these tissues do not return to their pre-childbirth state, resulting in the involuntary leakage of urine, whereas hormonal changes associated with menopause can cause increased difficulties with bladder control. Stress urinary incontinence can occur in young females just as it can in older patients. Regardless of your particular case, at SpaMedica Toronto plastic surgery clinic, we offer only the best roster of modern, cutting edge, noninvasive treatments for patients seeking to increase their quality of life and do away with the shame and social anxiety that often accompanies stress urinary incontinence. We have various stress urinary incontinence treatment options available for our patients including the incomparable BTL Emsella procedure. Although common traditional methods were often far more invasive, modern patients rarely need to resort to stress urinary incontinence surgery.

Anatomy of the Bladder, Urethera and Pelvic Floor

Figure 1.  The Muscle of the Pelvic Floor help maintain the bladder and the channel to the outside world, called the urethra, and keep the bladder competent and continent.

What does Stress Urinary Incontinence mean?

Involuntary loss of urine, or leaking from the urethra during activities that increases the intrabdominal pressure, such as coughing, sneezing, laughing, physical activity, even sexual intimacy. Symptoms are wetting and staining of undergarment and the malodor of urine.

Figure 2. Approximately 60% of patients with SUI describe a significant loss of confidence in social circumstances and in 50% of patients there has been a loss of intimacy.

What are the common causes of SUI?

With childbirth, age, menopause, tamoxifen, the pelvic floor muscle can weaken and get lax, allowing the bladder neck and urethra to descend at or below the pubis, which can keep the opening of the bladder into the urethra open when straining, causing leaking of Urine or incontinence.

Figure 3.  With loss of tone of the muscles of the pelvic floor, the bladder and the urethral opening descend below the pubic bone and the bladder neck and urethra open up easily with increases in Intraabdominal pressure resulting in urine leaking out.


What are the treatment options for SUI?

Traditional treatments have included invasive procedures which resuspend the bladder or insert supportive meshes in the muscle of the pelvic floor, which can be successful have significant pain, morbidity and substantial risk of failure or complication. Non-invasive treatments have focused on pelvic floor exercises, which are difficult to optimally strengthen and elevate the muscle of the pelvic floor and often fail to minimize of eliminate the incontinence.

Regardless of your particular case, at SpaMedica Toronto plastic surgery clinic, we offer only the best roster of modern, cutting edge, noninvasive treatments for patients seeking to increase their quality of life and do away with the shame and social anxiety that often accompanies stress urinary incontinence. We have various stress urinary incontinence treatment options available for our patients including the incomparable BTL Emsella procedure. Although common traditional methods were often far more invasive, modern patients rarely need to resort to stress urinary incontinence surgery.


How does EMsella work?

Where traditional pelvic floor exercises have patients learning to exercise the muscles of the pelvic floor through maximal voluntary contraction of the pelvic floor muscles. These exercises, called Kegel exercises, at best can only result in a maximal contraction for a split second. The EMsella uses non-invasive FDA and Health Canada approved, SAFE, electromagnetic energy, (called High-Intensity Focused Electromagnetic, HIFEM, pulsed field) to induce supramaximal contractions of the pelvic floor muscles, literally thousands of supramaximal contraction during the treatment session.

Figure 4. The EMsella uses gentle, painless, safe, non-invasive Health Canada and FDA approved electromagnetic energy to induce thousands of supramaximal contractions of the pelvic floor muscles. These supramaximal contractions quickly enlarge and strengthen the muscles of

the pelvic floor so they can once again support the bladder and urethra that can lead to improvement or elimination of the incontinence.

Over a series of EMsella treatments, the supramaximal contraction increases the fiber size and strength of the pelvic floor muscles, which elevates the bladder and urethra, restoring the physiologic control of the bladder neck and cuts off the incontinent stream of urine and the symptoms of SUI.

What does the EMsella device look like and how is the Electromagnetic Energy delivered?

The EMsella is a therapeutic chair. EM is an acronym for Electromagnetic and “Sella”, is Latin for “Chair”. In essence, EMsella, is a painless, non-invasive SUI therapeutic chair uses to induce localized energy delivered “body building” of the muscles of the pelvic floor without the patient

Actually having to do anything!

Figure 5. The EMsella is a simple chair that delivers the electromagnetic energy to the pelvic floor of the patient while they are sitting comfortably during the treatment. The electromagnetic energy and chair deliver thousands of supra-maximal contractions of the pelvic floor resulting in strengthening of the muscles supporting the bladder and urethra, restoring competency and reduction or eliminating the leaking urine.

EMsella Procedure Details

BTL Emsella is a non-invasive, nonsurgical, gentle highly advanced procedure with virtually no downtime, and is increasingly considered the vanguard and leading treatment of stress urinary incontinence management. BTL Emsella effectively stimulates the pelvic floor using High-Intensity Focused Electromagnetic technology (HIFEM) to achieve incredible rehabilitation of neuromuscular control. One single treatment in a BTL Emsella chair at SpaMedica in Toronto triggers 11,200 supramaximal pelvic floor muscle contractions, which is key to effective muscle reeducation, hypertrophy, strengthening and enlargement.

Figure 6. EMsella emits High Frequency, focused, pulsed, electromagnetic energy to stimulate tens of thousands of pelvic floor contractions to strengthen the muscles, elevate the bladder and urethra and eliminate or significantly improve the incontinence

Do EMsella patients need to remove their clothes?

No!  One of the many desirable features of the EMsella, compared to the intravaginal treatments, is the patient can be treated with a “hands free”, no touch delivery of the electromagnetic energy and pelvic floor hypertrophy, without the SUI patient having to disrobe, or have an intravaginal probe, electrode or energy device being inserted in the vagina.

Figure 6.  The EMsella treatment is painless, safe and non-invasive allowing patients to remain fully clothed. The EMsella patient is simply positioned in the center of the chair and the treatment is delivered with the patient fully clothed.

How long is each treatment and how many treatments are needed?

Each EMsella treatment lasts 30 minutes. SUI EMsella patients require 6 treatments, twice per week for 3 weeks. At the completion of this 3 week, 6 treatment pro-am, most patients incontinence symptoms are greatly improved or eliminated.

What does Electromagnetic Energy do and is it dangerous?

The electromagnetic energy travels up from the center of the chair up, through the SUI patients clothing and into the muscles of the pelvic floor. The electromagnetic energy induces thousands of supra-maximal contractions of the pelvic floor with each treatment session, leading to much more pelvic floor hypetrophy, enlargement and strengthening than any voluntary Kegel program could ever hope to achieve.

Are there any EMsella side effects or risks?

There are almost no BTL Emsella side effects, or risks. While patients may at times experience some tingling and/or pelvic floor muscle contractions during the procedure, patients do not describe this sensation as pain and it is normal to resume daily activities immediately post-treatment. Many patients observe improvement after just a single treatment session. 

Are there any contraindications to EMsella?

Contraindications to EMsella treatment include patients who are pregnant, have a pacemaker, an uncontrolled, serious medical illness ,or cancer in the field of treatment.

What kind of results in SUI improvement can patients expect?

Patients who finish their EMsella treatment, 95% of patients report a significant improvement in their SUI incontinence symptoms. 67% of SUI patients report they no longer need absorbent pads and elimination of the order, wetting of the undergarments, improved social continence and great satisfaction with improved confidence in social settings and intimacy.

Figure 7. The EMsella induces supramaximal contractions of the muscles of the pelvice floor. Over the 6 week treatment protocol, the muscles of the pelivc floor increase in size and strength during the EMsella treatment, lifting and supporting the bladder and the urethral, greatly reduction the leaky urine and SUI symptoms.

Results tend to improve gradually and continually over the weeks that follow. Specific results, of course, depend on the specifics of a patient’s condition. Rest assured, you will be provided with a treatment plan customized to your unique needs as well as complete information about post-treatment care and results.

Are there any EMsella maintenance treatments required to prolong my SUI correction?

Yes, there is modest maintenance treatments required. Just like going to a gym and developing muscle tone, strength and increase in size, without ever having on going back to the gym to maintain your new strength, it is important for the EMsella patient return every 3 months ,for a single EMsella session. 


What other SpaMedica technologies can help with Vaginal Rejuvenation and Female Wellness?

SpaMedica leads the Canadian market in a carefully selected and diverse array of technologies designed to optimize specific elements of Vaginal rejuvenation. Fractional carbon dioxide resurfacing with the MonaLisa Touch has been shown to significantly improve the signs and symptoms of genitourinary signs of menopause, and vaginal laxity, as it is highly effective at producing vaginal tightening. Among the many potential benefits of the procedure are: improvement in any discomfort associated with vaginal dryness, a marked decreased of vaginal inflammation and/or discharge, decreased symptoms of painful urination, and stress urinary incontinence. Additionally, there is improvement in the painful symptoms which some women experience during intimacy or penetrative intercourse, as well as an increase in the level of sexual satisfaction reported by patients. This is the result of improvements to vaginal laxity syndrome in the form of increased tightening.

Figure 8.  The MonaLisa Touch is a fractional CO2 (carbon Dioxide) Laser. The Fractional hand piece is gently inserted in the vaginal canal and is slowly withdrawn as the fractional CO 2 beam is emitted and, thousands of tiny thermal injuries are created in the vaginal wall in a 360 degree pattern. These tiny ablative, thermal injuries heal with new tissue with firmer structure and more lubrication.

The CO2RE Intima is a unique fractional carbon dioxide technology. Much like the Mona Lisa Touch, the Syneron CO2RE Intima is a fractional carbon dioxide device with specific features designed to allow for a comfortable yet profound fractional rejuvenation of the lining and inner depths of the vaginal mucosa. The CO2RE Intima fractional CO2 is at times used in combination with the Mona Lisa Touch and the Fractora V (a fractional radiofrequency ablative device) over a series of treatments to provide the best possible results and the most drastic possible improvement of your stress urinary incontinence, signs of menopausal genitourinary problems, vulvo-vaginal atrophy, vaginal relaxation syndrome, and vaginal laxity.

FORMA V is a non-ablative, non-painful radio frequency heating device used in the comprehensive treatment of vaginal relaxation syndrome, atrophic vulvovaginal atrophy, symptoms of stress urinary incontinence and external labia minora and majora rejuvenation. Stress urinary incontinence patients can discuss all of these options and more with our Female Health and Vaginal Wellness Team. For best results in addressing vaginal rejuvenation goals or for mild cases of vaginovulvar atrophy or genitourinary symptoms of menopause, a package of 3 treatments performed once a month over 3 months may be recommended  The FORMA V can also be used to maintain and protect the benefits of a laser and/or radiofrequency vaginal rejuvenation.

Figure 9. A.The Votiva Female wellness workstation comes with the popular non-invasive, internal temperature controlled Forma V (B.) , for vaginal laxity, Stress Urinary incontinence and atrophy and the Fractora V (C.) fractional RF ablation for atrophy and labial rejuvenation.

The Votiva vaginal workstation, has 2 applicators, the Forma V  and  Fractora V. The Votiva female wellness workstation is very popular for its vaginal rejuvenation versatility. Votiva has the popular Forma V hand piece which  delivers non ablative, gentle RF (radiofrequency energy) used to tighten the vaginal canal to improve vaginal laxity symptoms, as well as tighten the pelvic floor for treatment of Stress Urinary incontinence. The Votiva also has the Fractora V, for fractional ablation of the Inner vaginal mucosa for the treatment of vaginal atrophy, as well as smoothening the labia minor and majora.

Figure 10.  A. The Fractora V rejuvenates and resurfaces the mucosal lining of the vaginal wall for atrophy syndromes and provides labial rejuvenation. B. The Forma V, strengthens the pelvic floor muscles and tightens the vaginal canal.

ThermiVa  and Femme 360 are non-ablative radiofrequency heating devices that works to rejuvenate the vagina. They revitalize the vaginal lining, which in turn tightens the vagina and improves symptoms of vaginal relaxation syndrome and stress urinary incontinence. ThermiVA is specially designed to treat the tissues and structures of the lax vaginal canal. This includes the vaginal side walls, ceiling, and floor, as well as the entirety of the vaginal canal. Similar to the FORMA V, the ThermiVA is temperature-controlled and safe. While the FORMA V uses multiple electrodes, the ThermiVA is a monopolar RF (radiofrequency) system.

During your consultation at SpaMedica in Toronto, you will thoroughly discuss your symptoms, your goals, your needs, and your desires in order to land upon a treatment protocol that addresses all concerns you may have related to your stress urinary incontinence, vaginal health, and your sexual pleasure. You will be given all procedure or combination procedure details so you know what to expect, both before and after your SUI treatment(s).

Why SpaMedica?

SpaMedica in Toronto offers only the best of aesthetic treatments and treatment professionals alike. We are proud to offer our patients the expertise of nationally recognized gynecologist, Dr. Sasha Syvstonyuk (Dr. “Sasha”), who is the head of the SpaMedica Female Wellness and Vaginal Health Team and specializes in minimally invasive procedures that drastically increase many women’s quality of life. You will have a labial, vaginal and vulvar examination by Dr. Sasha, who will then discuss with you the treatment programs that are available for you in order to address any symptoms you may have of vaginal laxity syndrome, labia and vulvar aging, genitourinary symptoms of menopause, post-cancer estrogen blockade treatments, or post-childbirth stress urinary incontinence. Upon your detailed assessment and discussion, a customized treatment program will be devised to treat you!

Next Steps

If you are interested in seeking a consultation with Dr. Sasha or Dr. Mulholland and their professional team of stress urinary incontinence experts, get in touch with us at SpaMedica in Toronto today. Simply fill out our online consultation request form or call SpaMedica now at 877-712-8367 to schedule a consultation without further delay.

SpaMedica Cosmetic Plastic Surgery Centre and The SpaMedica Female Health and Vaginal Wellness Team recommend the following treatments for stress urinary incontinence:


  • improve the signs and symptoms of genitourinary signs of menopause
  • improve the signs and symptoms of vaginal laxity
  • improvement in any discomfort associated with vaginal dryness
  • decreased of vaginal inflammation and/or discharge
  • decreased symptoms of painful urination
  • painful symptoms during intimacy or penetrative intercourse
  • increase in the level of sexual satisfaction
Since 1997
One of Canada’s oldest, most reputable cosmetic plastic surgery centers.
SpaMedica in Toronto, headed by Dr. Stephen Mulholland, has been expertly treating Toronto patients since 1997. Schedule a consultation with Dr. Mulholland or the SpaMedica team.
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