Lahey Health is now part of Beth Israel Lahey Health.  Explore Lahey locations below or reach Lahey Hospital & Medical Center, Beverly Hospital and Winchester Hospital.

by Carmack A
(PTNS; Posterior Tibial Nerve Stimulation)

Definition

A large nerve leaves the low back and passes down the leg. Near the knee the nerve splits. One branch passes down the knee and ends just inside the heel. This is the tibial nerve.

Percutaneous tibial nerve stimulation (PTNS) uses a gentle electrical pulse to stimulate this nerve.

Reasons for Procedure

PTNS is used to treat an overactive bladder in women. A signal from PTNS travels up through the nerve. It moves to patch of nerves at the base of the spine. Nerves that control the bladder can be found there.

The signals from PTNS can help the bladder muscles relax. Over time these signals can retrain the bladder to relax. This 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. Your doctor will review potential problems such as:

  • Muscle cramps in the leg, foot, or toes
  • Tingling sensation in the leg
  • Lightheadedness or fainting during the needle insertion
  • 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
  • Plan to be or are already pregnant

What to Expect

Prior to Procedure

Let your doctor 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. PTNS will need to be repeated. It is generally done once a week for 12 weeks. It may take up to 6 sessions before symptoms start to improve. Once improvement is seen, maintenance sessions may be needed.

How Long Will It Take?

Each session lasts 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. These are usually not painful.

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 notice a change in your symptoms.

Call Your Doctor

Call your doctor if any of these occur:

  • Urinary symptoms worsen
  • Cramping, tingling, or other nerve symptoms last longer than expected or interfere with normal activity
  • Fall or injury related to nerve problems
  • Signs of infection at the needle insertion site, including bleeding, warmth, redness, or unusual discharge
  • 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: https://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women. Updated January 23, 2017. Accessed February 5, 2019.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
  • Review Date: 12/2018
  • Update Date: 03/08/2019