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Percutaneous Tibial Nerve Stimulation

Patient information factsheet

  • Percutaneous tibial nerve stimulation (PTNS) is a form of treatment called neuromodulation.
  • It is used to treat both bladder and bowel problems and in particular problems with control of your bladder or bowel. It is an out-patient procedure.
  • PTNS can help patients who feel they need to go to the toilet urgently and frequently.
  • It can also help patients who may get up to pass urine several times in the night or those who leak if they do not reach the toilet in time.
  • These are symptoms of an overactive bladder (OAB).
  • PTNS can help patients who lose the ability to control their bowel motions.
  • If you want to go ahead with PTNS we require you to commit to 12 consecutive weeks of treatment and it is important you agree to this before you start. We will ask you to sign an agreement.

Why do I need PTNS?

  • The aim of this treatment is to improve the symptoms of an OAB or faecal incontinence (FI).
  • Faecal incontinence (FI) is when patients are unable to control their bowel movements.
  • PTNS may be offered by your consultant if other simpler treatments have been tried but have not helped to improve your symptoms.
  • For OAB, you should have already tried other treatments first. These may include managing how much you drink, pelvic floor muscle exercises, bladder training, stopping smoking, and trying medicines that help relax the bladder muscles.
  • For FI you should have already tried managing your diet to help improve your symptoms, taken medication to stop diarrhoea, pelvic floor muscle training and anal sphincter training.

How does PTNS work?

  • Bladder and bowel function is regulated by a group of nerves at the base of the spine called the sacral nerve plexus.
  • PTNS (or neuromodulation) stimulates the tibial nerve which is in your lower leg through gentle electrical impulses.
  • These impulses travel to the sacral nerves. This indirect stimulation helps to reduce unwanted bladder contractions and improve symptoms of OAB and FI.

What does the treatment involve?

  • Sessions take place in groups.
  • You will be seated comfortably in a chair and your foot elevated.
  • Two thin slender needle electrodes (like acupuncture needles) will be inserted near your ankle and connected to a battery-powered stimulator which delivers a mild electrical current via the needles into the tibial nerve.
  • Treatment can be on either limb, although for some patients one may have a better response than the other.
  • Once connected to the stimulator and after turning it on you will be aware of a response in your foot which indicates that the correct nerves are being stimulated.
  • It is important to insert the needles at the right location and to use the ideal strength of impulses.
  • The nurse will check this for you by asking questions about your sensation or observing your toe movements and can adjust the stimulation accordingly.
  • You will need to sit during treatment time and not move your leg.
  • We advise you to bring something to distract you such as personal music, a magazine or a book.
  • You may experience a buzzing, tingling or throbbing sensation during the treatment.
  • The current can be turned down so that it is more comfortable.
  • The treatment session lasts half an hour and the needles are removed at the end of the session.

What are the risks?

  • As with all treatments and procedures there are a few risks with PTNS and these will be discussed with you before you begin treatment.

  • However, if you have a needle phobia this treatment may not be for you.

  • PTNS treatment is well tolerated by most patients.

  • PTNS is not used for:

    • patients with pacemakers or implantable defibrillators
    • patients who have a higher risk of bleeding
    • patients who are pregnant or planning to become pregnant
    • patients with abnormal heart rhythms are treated with caution.

  • The risks of PTNS treatment are rare but reported side effects include:

    • mild pain that usually goes away quickly
    • a throbbing feeling or inflammation (redness, swelling, or irritation) of the skin at or near the stimulation site
    • numbness of the toes and stomach ache.

  • The main limitation of this technique is the need to attend 12 weekly sessions without interruption.

  • If you miss more than one session, you will need to start the whole course again.

How effective is the treatment?

  • This is a simple procedure that does not involve major surgery and can be very effective.
  • Research shows that up to 4 out of 5 people who have this treatment notice a big improvement in their overactive bladder symptoms.
  • However, it may take up to six weeks before seeing any change.
  • It is important to complete all 12 sessions and then see how you feel.
  • The effects of this treatment can last for up to 3 years.
  • Some people may find that their symptoms return over time and may benefit from a repeat treatment session.

How should I prepare for PTNS?

  • No special preparation is required.
  • You will be asked to fill in several questionnaires.
  • You will be asked to complete bladder or bowel diaries before, part way through, and after your initial treatments.
  • We ask you to do this so that we can assess the progress of your treatment.
  • These are an essential part of the treatment programme.
  • PTNS is an outpatient procedure, which means you will not stay overnight in hospital.
  • You will not need any help and do not need to be accompanied unless you normally need assistance.

What should I expect after PTNS?

  • You may experience:

    • Some minor discomfort at the needle entry site. This normally subsides very quickly.
    • Some patients may experience redness and inflammation at the site.
    • Bruising at stimulation site.
    • Toe numbness.

  • You will be able to travel home and continue with your normal activities after the treatment.

  • Your symptoms will be checked after you have had this treatment for 12 weeks in a row to see how well it is working.

  • If it has been successful some further ‘top up sessions’ will be arranged with you.

Are there any surgical alternatives?

Botulinum toxin (Botox)- A bladder wall injection for OAB symptoms

  • This injection is only needed once.
  • It can be done under local anaesthesia.
  • There is a small risk of difficulty passing urine after Botox.
  • Patients may need to pass a catheter (a narrow tube) up their urethra (waterpipe) to help empty their bladder.
  • The benefit of this injection reduces over time. Most people need to have the injection repeated every 6 to 18 months.
  • The technique has been shown to be effective and safe and is widely used.

Sacral neuromodulation for OAB symptoms and FI

  • The treatment involves continuous electrical stimulation of the pelvic nerves which supply the bladder, rectum and anal sphincters.
  • Sphincters are muscles which control the opening to the bladder or bowel and help to keep you continent.
  • This technique directly stimulates the nerve centres that control the bladder and bowel.
  • This is a procedure that involves surgery and requires a general anaesthetic. It is carried out in two stages.
  • An implantable electronic metal device is inserted under the skin like a pacemaker.
  • From the implant a thin wire carries electrical pulses down into the nerves that control the bladder and bowel.
  • The operation involves placing a thin wire near the pelvic nerves.
  • The wire is passed through small openings in the sacrum (the bone at the bottom of your spine where the nerves pass through). This allows the nerves to be stimulated.
  • The correct placement of the wire is checked by x-ray and by the response achieved on stimulation during the procedure.
  • The procedure takes between half an hour to an hour.
  • The battery for the device needs replacement every 5 to 7 years.

Injectable bulking agents for FI

  • Increases the strength of a damaged anal sphincter.
  • This procedure is carried out under a local anaesthetic.

Major reconstructive surgeries

  • For overactive bladder (OAB) symptoms, other operations such as bladder enlargement surgery (cystoplasty) or creating a new route for urine to leave the body (ileal conduit) may be considered.
  • For faecal incontinence (FI) symptoms, surgery to repair the back passage muscle (anal sphincter) or creating a new route for bowel waste to leave the body (colonic conduit) may be considered.
  • These procedures are invasive and will change the way you pass urine or bowel motions greatly.
  • If you are thinking about having this sort of surgery you must discuss these alternatives and ask for more detailed information from your Nurse Specialist or urogynaecology/urology/colorectal Consultant.

Further information

Published:
24 Jul 2026
Review:
24 Jul 2028
Reference:
EIM/PelvPhysio/PTNS/02

If you have a compliment, complaint or concern please contact our PALS team on 020 7288 5551 or whh-tr.PALS@nhs.net.

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