Tibial nerve stimulation (TNS) for overactive bladder (OAB) is a treatment that uses electrical signals to help control bladder contractions. It can reduce the number of times a person feels the urge to urinate and can also help reduce urinary leakage.

OAB is the term experts use to describe urinary symptoms, including urinary incontinence and a frequent, urgent need to empty the bladder.

According to the National Association for Continence, OAB affects an estimated 33 million people in the United States.

Symptoms of OAB include urinary incontinence, urinary frequency, an urgent need to urinate, and waking up to urinate.

This article looks at what TNS for OAB is, who can safely have TNS, and what the potential risks and side effects are.

A person receiving tibial nerve stimulation for overactive bladder treatment.Share on Pinterest
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TNS, or percutaneous TNS (PTNS), is a nonsurgical procedure that doctors may recommend for OAB.

A 2017 review explains that PTNS derives from acupuncture, which has roots in traditional Chinese medicine.

The TN is located above the ankle and runs up the leg to the sacral nerves, which control the bladder and pelvic floor muscles.

According to the National Institute for Health and Care Excellence (NICE), scientists do not know exactly how PTNS acts on the bladder. They believe, however, that PTNS stimulates the posterior TN and the sacral nerve plexus, which can cause a change in a person’s bladder activity.

The posterior TN contains nerve fibers that stem from the part of the spine where the nerves to the bladder and pelvic floor are.

The aim of PTNS is to decrease a person’s urge to urinate. Gradually, over a number of sessions, the electrical stimulation retrains a person’s bladder and can alleviate their OAB symptoms.

PTNS is an effective treatment for OAB. A 2018 study involving 105 participants with OAB compared PTNS and medication. The study groups received either PTNS, solifenacin, which is an OAB medication, or both.

The researchers found that all treatments were effective but that PTNS alone was more effective than solifenacin alone. The group that received the combination treatment showed the greatest improvement in symptoms and had the greatest duration of effectiveness.

Other studies have compared PTNS with a sham, or pretend, treatment. For example, in one study, 71% of the participants in the PTNS group responded to treatment, compared with no one in the sham group.

PTNS is a third-line therapy, which means that doctors will only consider using it if first-line and second-line treatments have been unsuccessful. First-line OAB treatment is behavioral therapy, while second-line treatment involves the use of medication.

PTNS may be a suitable treatment option for people of all genders experiencing OAB. However, it is not appropriate for people who:

  • have an implantable defibrillator
  • have nerve damage of the TN
  • are prone to excessive bleeding
  • are pregnant or planning to become pregnant during treatment

If someone has a pacemaker, a doctor will need to communicate with the person’s cardiologist to check whether the treatment would be safe.

Doctors typically perform PTNS during an initial series of 12 weekly sessions. People usually need more sessions in the future to maintain the benefits of their first 12-week course.

Each treatment session can take 30 minutes.

The steps involved in this procedure are as follows:

  1. The person lies on a bed.
  2. The doctor inserts a slim needle electrode near the ankle in the TN, and a surface electrode on the foot.
  3. They connect the electrode and needle to a low voltage stimulator.
  4. The electrical pulse travels to the TN and then to the sacral nerve, which controls bladder function.

PTNS is generally well-tolerated and is not painful. During the procedure, a person may feel a tingling sensation in the ankle, foot, or toes.

Additionally, stimulating the posterior TN can cause a person to flex their foot and toes during the procedure.

If a person finds the procedure uncomfortable, the doctor will adjust the position of the needle or the intensity of the stimulation.

According to a 2019 study, there are very few side effects associated with TNS, and the treatment is typically safe.

Potential side effects include:

A 2017 review notes that a person’s symptoms are likely to return after PTNS treatment stops. The review authors explain that in a small study involving 11 people, 7 participants reported worsening symptoms after a 6-week break in treatment.

The review authors mention that the insertion of the needle caused most of the side effects reported by study participants, which included bruising and light bleeding.

It is possible to treat OAB with electrical NS at home, although a person will usually undergo PTNS in a doctor’s office.

However, in a 2019 study, the researchers discuss new implantable PTNS devices that can be implanted above the ankle, near the distal peripheral TN. This means a person would not have to regularly visit a doctor’s office to receive PTNS treatment.

An individual using the devices discussed in the study can adjust them to increase or decrease the frequency and strength of stimulation.

The authors note that these devices are currently undergoing Food and Drug Administration (FDA) clinical trials and may be an option for people in the future.

Behavioral therapy and medication are the preferred first-line and second-line OAB treatment options, respectively.

PTNS is a safe treatment for OAB. However, people may find it inconvenient to have to visit a doctor’s office regularly to complete the initial 12-week course of treatment.

When choosing an alternative to TNS, a person should consider:

  • any side effects the treatment may cause
  • how convenient it is to factor into their daily life
  • whether scientific studies have found it to be effective

Behavioral therapies

A person may try pelvic floor exercises, such as Kegel exercises and vaginal weight training.

Bladder training is also an option a person may wish to consider. This involves urinating at regular intervals without following the natural urge to urinate. In the beginning, the intervals may be as frequent as every 30 minutes. This interval gradually increases until a person can wait for 3–4 hours without urinating.


Medications for OAB can include anticholinergic or antimuscarinic drugs that relax the bladder muscles. These include:

  • fesoterodine (Toviaz)
  • oxybutynin (Oxytrol, Gelnique, Ditropan XL)
  • solifenacin (Vesicare)

Clinical trials show that these drugs can produce significant improvement in symptoms or stop them entirely.

However, these medications can come with side effects, including:

Additionally, these medications may not be safe for everyone to use. For instance, fesoterodine, oxybutynin, and solifenacin are not safe for:

Botulinum neurotoxin, or Botox, is an option for individuals whose bodies have not responded to anticholinergic drugs.

A doctor will inject Botox into the detrusor muscle, which helps the bladder contract. Botox decreases the ability for the detrusor muscle to contract.

However, the effects of Botox are not permanent, and a person may need to have more injections within 6–12 months.

A person should consult a doctor for advice when considering treatments for OAB.

Routine changes

A person may wish to consider natural remedies for OAB, and doctors may recommend various routine changes to help with the condition.

Lifestyle adjustments can be effective if a person factors them into their routine regularly.

These may include:


A doctor may consider surgery if all other treatments have been ineffective.

There are two types of surgery for OAB: sacral neuromodulation and augmentation cystoplasty.

In sacral neuromodulation, a surgeon will implant a small device into a person’s lower back area. The device can then send electrical signals to the muscles around the pelvic floor and bladder to stimulate them and improve bladder function.

The aim of augmentation cystoplasty is to increase the size of a person’s bladder. A surgeon will take a small portion of tissue from a person’s intestine and add it to the wall of the bladder to increase its size. Doctors will typically only recommend this surgery if all other treatment options have not helped.

A person should consider the benefits, risks, and recovery time for any type of surgery they choose.

Here, learn more about how medication compares with surgery for OAB.

PTNS is a safe and effective treatment for OAB. The procedure involves placing a needle into a person’s ankle, and an electrode on their foot, which sends electrical pulses to the TN. This can cause changes in a person’s bladder activity.

Most people require 12 weekly treatments followed by monthly maintenance treatments to ease their OAB symptoms. There are few side effects, and people typically tolerate the treatment well, according to current research.

Routine changes, medication, and surgery are also options a person can consider. A person should consult with a doctor to determine which treatment will be most effective and safest for them to try.