Gone are the days when women have to suffer in silence. Gone are the days when women’s health issues are talked about behind closed doors.

Today is the day we talk about urinary incontinence and how it can be treated. Today is the day we say no more to leaks or trickles, and hello to overcoming them once and for all.

By now you’re saying to yourself, how is this possible? You’ve already stocked up on panty liners and dark clothes and have admitted defeat, what is left to do but daily Kegels and keeping your fingers crossed that it doesn’t happen in public?

The answer to this question could be tibial nerve stimulation. Yes, tibial as in tibia, as in your foot. But what does your foot have to do with your bladder? You’ll just have to keep reading to find out.

What is tibial nerve stimulation?


Tibial nerve stimulation, or Posterior/ Percutaneous Tibial Nerve Stimulation (PTNS), as it is formally called is a type of treatment designed to treat urinary incontinence.

It isn’t surgery, instead, it involves stimulation of the tibial nerve that has a direct link to the nerves in the spine that control the bladder. It can also be used to treat fecal incontinence in some cases since the same muscles responsible for the bladder are responsible for the anus.

What is urinary (and fecal) incontinence?


In the simplest of terms, urinary incontinence is the loss of bladder control.

The bladder is responsible for storing urine that has been made in the kidney until it is time for it to be released. A healthy adult bladder can hold 2 cups of urine for up to 9 hours. During this time, the bladder sends a message to the brain telling it that it’s time to go. This is how you know that you need to go to the bathroom.

If you can’t go yet, the sphincter muscles around the bladder contract to keep it from leaking out, i.e holding your pee. When you are ready to go, the muscles of the bladder tighten to push the urine out while your sphincter muscles relax and urine exits the body via the urethra.

Over time age or strain on these muscles from holding in urine too long causes them to weaken. When this happens, your sphincter muscles will not be strong enough to prevent urine from escaping down the urethra leading to leaks.

Leaks can happen when there is an urgent need to urinate, but you are not able to get to the bathroom fast enough (urge incontinence). Leaks can also happen because of pressure on the muscles caused by exercising, coughing, sneezing or even laughing (stress incontinence ).

Having urinary incontinence can cause you to release a lot of urine at once or a few drops at a time (overflow incontinence). It is more common in women, especially after menopause or after giving birth.

Fecal incontinence is similar, except there is a loss of control of stool or flatulence (farts). It is typically caused by damage to the muscles or nerves around the anus.

To fix the issue if incontinence, doctors typically recommend pelvic floor exercises . Another treatment option that can be recommended is tibial nerve stimulation.

How does tibial nerve stimulation work?

All the functions of the body are controlled by the brain, everyone knows that. But did you know that all these nerves are connected, and what happens to one nerve can cause a reaction in an entirely different part of the body?

That’s the whole basis of acupuncture and acupressure. For instance, the points for stomach problems lie below the knee, while pressure on the hand valley can help to stop migraines and reduce stress. By interacting with these points and nerves, medical professionals can grant persons relief from various ailments.

Tibial nerve stimulation is a type of electroacupuncture . Here, a nerve near the ankle is stimulated. This nerve has a direct link to the spine that influences the bladder function. By interacting with this nerve doctors can improve bladder activity after a few short sessions.

What happens during tibial nerve stimulation and how to prepare?

Tibial nerve stimulation is not typically the first treatment option for persons who suffer from urinary or fecal incontinence. It is usually recommended after things like diet change, Kegels and medication have failed.

To prepare for this type of treatment, you have to educate yourself on what you’re getting into. Talk to persons who have undergone this treatment before and more importantly speak to your doctor. He/she knows your medical history and condition as well as you and will be able to make a sound decision on if it is even worth a try.

If you get the go-ahead to do it, be sure to do some background checks on the healthcare professional who will treat you. Talk to him/her to get a better understanding of this treatment and discuss cost.

At your first session, you will be placed in a comfortable chair with your foot elevated. Next, the doctor or nurse will insert a thin needle electrode into your leg from a device known as an Urgent PC Stimulator. This electrode will interact with the tibial nerve and send mild electrical pulses to it.

From there, a signal is sent to the spinal cord in an area known as the sacral nerve plexus. This helps to retrain the bladder and also blocks abnormal signals that cause bladder spasms.

This type of treatment is minimally invasive and does not hurt. Persons who have undergone tibial nerve stimulation describe the feeling as a tingling sensation or a pulse in the ankle or foot, but this is a clear sign that the nerve is being stimulated correctly.

Sessions last about a half-hour and happen at least once a week. It usually takes about 12 sessions for any huge improvement to be seen. After these 12 sessions are over, an assessment will be conducted to see how well you have improved. From this assessment, you will be prescribed post-treatment visits and pelvic floor exercises that help to maintain your new level of bladder function.

How effective is tibial nerve stimulation?


Tibial nerve stimulation is effective to some extent and it all depends on the severity of each patient’s condition.

6/10 women will see an improvement in about 50% of their urinary incontinence symptoms.

What are the benefits?


The benefits of using tibial nerve stimulation to treat urinary incontinence are:

• It is minimally invasive so you won’t have to worry about surgery, scars or taking time off from your busy schedule.
• It does not require any implants so you won’t have to worry about side effects.
• It is painless for the most part but can cause mild discomfort.



Tibial nerve stimulation is relatively inexpensive when compared to other treatment methods for urinary incontinence.

A year’s worth of therapy is estimated at around $3500-$4000 and is covered by many insurance companies Be sure to check with your insurance company is this procedure is covered in your plan.

Precautions/ safety concerns

Tibial nerve stimulation is usually a good fit for both men and women and is generally safe.

However, it has been known to cause temporary skin inflammation, slight bleeding or pain where the needle was injected.

Who should not use it?


Tibial nerve stimulation should only be conducted after your doctor gives you the green light to go ahead. It is not usually recommended for persons who:

• Are pregnant or who plan to become pregnant during treatment
• Persons who suffer from anemia or have a condition that causes excessive bleeding
• Persons who suffer from nerve damage
• Persons who have an implantable defibrillator
• Persons who have a pacemaker



Like we said before, tibial nerve stimulation is not usually the first thing doctors suggest for persons who suffer from urinary incontinence.

The first options are usually lifestyle changes, such as quitting smoking or drinking, exercising and dieting, or doing pelvic floor exercises such as Kegels.

Medication may also be prescribed for urinary incontinence. One type of medication is called anticholinergic which works by blocking the chemical acetylcholine which is responsible for bladder contractions. This type of medicine is administered in pill or tablet form and is taken orally, but can come in the form of a patch.
Another type of medication is called mirabegron which works by increasing the amount of urine the bladder can hold and increasing the amount that gets released at any given time.

Other medications include imipramine and duloxetine which help the muscles of the bladder relax or causes the sphincter muscles to contract. These medications, of course, come with side effects ranging from dry mouth and constipation.

Hormonal therapy in the form of estrogen can also be administered since estrogen can help to rejuvenate the bladder and urethra.

Other treatment options include botox therapy, biofeedback and electrical stimulation (e-stim).

Worst-case scenario, you will have to do surgery.

Final Thoughts


Tibial nerve stimulation is typically a plan C or D when other treatment methods have proven ineffective. You can try it if you have an extra $4000 lying around and can’t be bothered with the side effects of medication or downtown from surgery.

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