PTNS (percutaneous tibial nerve stimulation) can calm OAB – and other urinary issues – with electrical stimulation, helping you avoid the next treatment step of surgery.
About 40 percent of American women deal with overactive bladder (OAB) symptoms daily. And that’s likely a low estimate because many women who suffer with this problem never talk about it. I am always working with patients to help them identify their best treatment options to decrease their sensation that they have to urinate all of the time and in some cases leak urine because they don’t make it to the bathroom in time.
My primary goal is to work with patients and aid them with developing a treatment strategy that is suitable to their lifestyle and can provide them with long-term success in reducing their symptoms. In most cases, we start by recommending that patients modify behaviors that may be acting to worsen symptoms. This typically includes diet changes, tobacco cessation, weight loss and initiating Kegel exercises.
For those who don’t respond, we try medications, or perhaps a pessary. And if those don’t stem the tide, percutaneous tibial nerve stimulation (PTNS) is a great option for an appropriate individual and may help prevent a more invasive surgical treatment.
The Food and Drug Administration (FDA) approved percutaneous (via the skin) tibial nerve stimulation as a treatment option for many overactive bladder symptoms in 2011. In the past however, it was not covered by many insurance providers.
PTNS has grown in popularity over the past few years, as other conservative treatments don’t always work. And it is best to try a nonsurgical treatment before turning to surgery. PTNS is a very effective, low-risk procedure that can be performed in a regular office visit. Being relatively painless helps its popularity, though PTNS may tickle some.
Fortunately being at a university teaching hospital, our practice is at the forefront of treatment options, allowing me to provide PTNS when other urogynecologists are not yet offering it.
Tingling away OAB symptoms
PTNS works by providing electrical stimulation, through the tibial nerve located on the inner ankle, to the nerves responsible for bladder and pelvic floor function. During the PTNS treatment, a small needle is inserted near the nerve of the ankle, and a connected nerve simulator sends electrical pulses to the sacral nerve plexus. The sacral nerve plexus is located at the base of the spine and is responsible for regulating the control of the bladder and pelvic floor muscles.
Most women take this electrical stimulation well and don’t consider it to be painful at all. Women say they feel it as a tingling, pulsing or buzzing in the foot and ankle area. But the sensation is tolerated differently by individuals. We’ll talk to you about how it feels, and we can adjust the level of stimulation accordingly.
PTNS can change bladder activity when administered in a series of 12 weekly, 30-minute treatments. After the initial 12 treatments, occasional treatments may be needed to maintain improvements to bladder and pelvic floor function. It may take up to 5-6 weeks of treatment before patients see initial improvements. But hang in there because by 12 weeks, symptoms may be completely gone. In fact, around 60-80 percent of my patients see an improvement in their OAB symptoms with PTNS.
I prefer less-invasive PTNS when appropriate
PTNS treatment is typically used once Kegel exercises, lifestyle changes and medications have shown to be unsuccessful for a patient. It’s also a good option for women for whom pelvic floor physical therapy is ineffective or not possible to administer.
PTNS is one form of neuromodulary therapy, as it is called. The other form is sacral neuromodulation (SNM), also known as sacral nerve stimulation (SNS). That works differently, involving surgery to implant a battery-powered stimulator. I prefer to start with the less-invasive, nonsurgical PTNS, though SNS is also an option.
PTNS is not a viable option for all patients. Those with pacemakers, implantable defibrillators, prior nerve damage and a history of excessive bleeding should not try PTNS. Women who are pregnant should wait until after their pregnancy to be treated with PTNS.
Since this is a newer treatment option, the long-term benefits are still unknown. But in my experience it seems that patients will only need occasional treatment sessions to continue this as a lifelong, noninvasive treatment for overactive bladders and other pelvic floor disorders.
Regulatory agencies in other countries have approved PTNS for fecal incontinence, the loss of control over bowel movements. It has not been approved in the United States yet, but given its proven positive effects on the pelvic floor, it is possible that it may receive FDA approval for fecal incontinence in the future.
If you are interested in PTNS or any other treatment option for pelvic floor disorders, please contact the University of Colorado Urogynecology Department by calling 720-505-5063 or request an appointment online.
University of Colorado Urogynecology is a specialty women’s health practice focused on female pelvic health and surgery. Our physicians are also professors & researchers for the CU School of Medicine, one of the top-ranked medical schools in the nation.