Woman with hands in front of pelvis
Use of mild electrical pulses to stimulate these nerves can trigger a change in bladder activity.

Percutaneous Tibial Nerve Stimulation for Overactive Bladder

Percutaneous tibial nerve stimulation (PTNS) for overactive bladder is a minimally invasive, non-surgical treatment option for overactive bladder (OAB) that helping to manage symptoms of urge incontinence, urinary frequency and urinary urgency. While PTNS may be used as a primary therapy, your doctor may use pharmacological therapies and pelvic floor muscle training to manage your symptoms of overactive bladder before administering PTNS for optimal results.

Percutaneous tibial nerve stimulation for overactive bladder is more effective and results in far fewer side effects than many OAB medications out there. Almost 80% of patients stop using OAB medicines just a year after starting, with adverse side effects accounting for 17% of discontinuation.

In cases where conservative methods aren’t working, PTNS is emerging as an effective treatment option for overactive bladder. What’s more, its proven efficacy has been the subject of discussion in a multitude of publications.

How Does Percutaneous Tibial Nerve Stimulation for Overactive Bladder Work?

PTNS delivers an electrical stimulus to the nerve that facilitates the proper functioning of the bladder and pelvic floor. During the procedure, your foot is restfully raised and supported. Then, a small needle electrode is injected close to the nerve at the ankle called the tibial nerve. The electrode is connected to a device called the Urgent PC Stimulator that delivers gentle electrical currents to the tibial nerve. These electrical pulses move to the sacral nerve plexus, the collection of nerves at the foot of spine in charge of bladder function.

You will feel a sensation in your foot, which is a sign that the right nerves are being stimulated. To ensure that the needles are placed at the correct location and that the right strength of electrical impulses is being utilized, your doctors will carefully inspect your toe movements, ask questions concerning your responsiveness during your treatment, and make any necessary adjustments to the impulses.

Use of mild electrical pulses to stimulate these nerves can trigger a change in bladder activity. Since this change occurs slowly, patients go through a 12-week treatment program, involving weekly half-hour treatment sessions. Once the patient completes the 12 treatments, the doctor may assess the patient’s response to the treatment and make recommendations for intermittent treatments to maintain symptom improvement.

Is Percutaneous Tibial Nerve Stimulation for Overactive Bladder Effective?

PTNS is an extremely effective, low-risk treatment method that can be carried out in a typical office visit. It provides impressive results within a short duration with fewer adverse effects than medications and other neuromodulation techniques. Numerous studies have revealed that four in five people undergoing this procedure experience major recovery from their overactive bladder symptoms.

However, it’s imperative to go through 12 weekly sessions before assessing the effect, and top-up sessions may be needed over time. Keep in mind that PTNS is a relatively newer treatment method and its lifelong benefits are not known at this time.

How Popular Is PTNS?

PTNS was approved by the Food and Drug Administration as a treatment method for a wide array of overactive bladder symptoms back in 2011. Since then, it has gained massive popularity as a go-to treatment option when other conservative treatments have failed.

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Contraindications to PTNS

PTNS is an excellent treatment option for patients with overactive bladder, but it may not be the right treatment for everyone. This procedure is not suitable for patients who:

  • Have an implantable defibrillator or pacemaker
  • Have a high risk of excessive bleeding
  • Have nerve damage that disrupts the proper functioning of pelvic organs and tibial nerve
  • Are pregnant or planning to conceive during treatment

Side Effects of PTNS

PTNS outshines all other treatment methods for overactive bladder due to the fewer number of side effects and potential complications associated with it. In fact, these side effects are not only occasional but also minor, and include bruises or slight bleeding on the area pricked by the needle and tingling or slight pain close to the knee.

How Do I Prepare for PTNS?

Percutaneous tibial nerve stimulation for overactive bladder is an outpatient procedure that doesn’t need any special preparation.

What Are the Pros and Cons of PTNS?

PTNS has been demonstrated to be as powerful as anticholinergic medicines when it comes to improving overactive bladder symptoms. A recent cohort study by a team of researchers led by Gray SL that supports the use of PTNS rather than medications revealed that certain drugs that are used to treat overactive bladder may be linked with dementia.

What’s more, oral medicines can trigger many undesirable side effects such as dry mouth and constipation. Another benefit that some patients see in PTNS is that they don’t have to undress for each appointment. PTNS has only one obvious disadvantage over medication — patients must make regular trips to the physician’s office for treatment sessions, which may be inconvenient for some people.


Percutaneous tibial nerve stimulation is an effective, low-risk solution to overactive bladder symptoms including urgency incontinence, urinary frequency and urinary urgency. If you decide to go ahead with the procedure, it’s crucial that you follow through with the 12-week treatment plan in order to experience optimal benefit.