Percutaneous Tibial Nerve Stimulation

(PTNS; Posterior Tibial Nerve Stimulation)

Definition

Percutaneous tibial nerve stimulation (PTNS) uses a gentle electrical pulse to stimulate a nerve. This nerve leaves the low back and passes down the leg. It splits near the knee. One part passes down the knee and ends just inside the heel. This is the part that is treated.

Reasons for Procedure

PTNS is used to treat an overactive bladder in women. The signal starts near the heel. It travels up the nerve to a patch of nerves near the spine. The signal stimulates nerves in this patch including nerves that control the bladder. The signals then help the bladder muscles relax.

Over time these signals can retrain the bladder to relax on its own. It will stop or lessen the symptoms of overactive bladder. PTNS may be used if other treatments have not been helpful.

Possible Complications

Problems from the procedure are rare. All procedures have some risk. The care team will discuss possible problems such as:

  • Muscle cramps in the leg, foot, or toes
  • Tingling in the leg
  • Lightheadedness or fainting when needle is inserted
  • Treatment does not work as expected

PTNS is not recommended in people with:

  • Pacemaker or implanted defibrillator
  • Bleeding problems
  • Nerve damage that may get worse with treatment
  • Pregnancy or plan to be pregnant

What to Expect

Prior to Procedure

The doctor will need to know about any medicine or supplements you are taking.

Description of Procedure

The sessions can be done in a doctor’s office. You will be sitting with at least one leg raised. A small needle is inserted through the skin by the ankle. A small sticky pad will be placed near the bottom of the foot. Both the needle and the pad are attached by wires to a device. Gentle electrical pulses are sent through the needle while you rest.

When the treatment is done, the needle and pad will be removed. The process will need to be repeated. It is often done once a week for 12 weeks. It may take up to 6 sessions before symptoms start to improve. Sessions may be needed to keep up the benefits after improvements start.

How Long Will It Take?

Sessions last for about 30 minutes.

How Much Will It Hurt?

You will feel a pinch as the needle is placed. You may also feel tingling or muscle jump in your ankle, foot, or toes.

Post-procedure Care

At the Care Center

You can leave after the session if you do not have any problems.

At Home

There are no changes to daily activity. It may take a few sessions before you have a change in your symptoms.

Call Your Doctor

Call your doctor if any of these occur:

  • Urinary symptoms worsen
  • Cramping, tingling, or other symptoms that last longer than you expect
  • Fall or injury due to nerve problems
  • Signs of infection at the needle site, such as bleeding, warmth, redness, or leaking fluid
  • General signs of infection, including fever and chills

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

Urology Care Foundation
https://www.urologyhealth.org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org

Women's Health Matters
https://www.womenshealthmatters.ca

REFERENCES:

Percutaneous tibial nerve stimulation (PTNS). The Simon Foundation for Incontinence website. Available at: http://simonfoundation.org/ptns. Accessed February 5, 2019.

Treating an overactive bladder by stimulating a nerve near the ankle. NICE—National Institute for Health Care and Excellence website Available at: https://www.nice.org.uk/guidance/ipg362/resources/treating-an-overactive-bladder-by-stimulating-a-nerve-near-the-ankle-315919405. Updated October 2010. Accessed February 5, 2019.

Urinary incontinence in women. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women. Updated January 23, 2017. Accessed February 5, 2019.

Last reviewed February 2019 by EBSCO Medical Review Board Adrienne Carmack, MD  Last Updated: 3/8/2019