What is PTNS?

When you have an overactive bladder, it may be due to abnormal signaling from the bladder nerves. A non-invasive and non-medication option to treat this problem is posterior tibial nerve stimulation (PTNS). This office treatment is derived from acupuncture, where a very tiny needle is placed (much smaller than those used to give an injection) near the inner ankle area, where the posterior tibial nerve runs. When the nerve is stimulated, it travels up to where the tibial nerve communicates with the bladder nerves (the sacral nerve plexus). PTNS is a great option because it is an extremely simple therapy with no downtime or risks, and is great for patients who wish to avoid medication and have time to come to the office once a week for 12 weeks.

What does it feel like?

Since the needle is the size of an acupuncture needle, it is not painful on insertion. We can confirm that the nerve is being stimulated appropriately by observing a toe reflex response. You may feel a tingling sensation across the foot. The intensity is then adjusted so that you only feel a slight tingling and it is not uncomfortable. In fact, many women it find it relaxing to sit for the 30 minutes, undisturbed.

Is it effective?

There are several studies that demonstrate the efficacy of tibial nerve stimulation. In 2018, a study was done in 102 patients, which showed a 70% reduction in the number of urge incontinence episodes per day, at the end of the 12 weeks of therapy. There was also a 90% reduction in the proportion of patients who reported having severe or very severe symptoms with their overactive bladder (1).

Are there any side effects?

This is a very simple and noninvasive procedure that does not carry risk for side effects. It is very similar to acupuncture. If you have any minor discomfort or redness at the needle insertion site, it will typically subside within a day.

How often do I need to have it done?

For this therapy to be effective, you need to come in once a week for 12 weeks for 30-minute sessions. After that, top-up sessions are generally recommended about once every 4-6 weeks, depending on your response.

  1. Kobashi K, Khandwala S, MacDiarmid S, et al. A Prospective Study to Evaluate Efficacy with the NURO Percutaneous Tibial Neuromodulation System in Drug Naïve Patients with overactive bladder syndrome (OAB). Presented at the American Urological Association 2018 Annual Meeting. Journal of Urology. 2018;199(4) Supplement, Page e987.