Tibial Nerve Stimulation

Tibial Nerve Stimulation is an effective, less invasive way of stimulating the tibial and sacral nerves to provide relief for pelvic pain and incontinence. Visit our pelvic pain treatment page to learn more about solutions to conditions such as endometriosis, vulvodynia, and UTIs.


What is the Tibial Nerve?

The tibial nerve is found in the leg and branches off from the sciatic nerve. The tibial nerve runs from your pelvis all the way down into the ankle, and then branches into sensory nerves in the sole of your foot.


What is the Function of the Tibial Nerve?

The Tibial Nerve has both motor and sensory functions. The motor functions of the tibial nerve involve the supplying all the muscles in the back of the leg with nerves. This helps control knee, ankle, foot and toe movement.

For sensory functions, the tibial nerve supplies nerves to skin over the heel, sole, side of the foot and leg.


What is Tibial Nerve Stimulation?

Tibial nerve stimulation uses electrical impulses that travel along your nerve pathways to help retrain bladder function and relieve pelvic pain.


What Pelvic Floor Disorders can Tibial Nerve Stimulation Help?

Tibial nerve stimulation can help provide relief for a variety of pelvic floor disorders, including:

  • Overactive Bladder - A bladder spasm occurs when your bladder muscles squeezes suddenly without due warning, causing an urgency to release urine. If the spasm forces urine from the bladder, causing leakage, your bladder may be overactive.
  • Faecal Incontinence - For bowel function to work properly the nerves of the rectum and anus need to be sending the correct messages to the brain. So when you feel stool or gas arrive in the rectum, your body can send messages to the muscles that you want to hold on. However, these muscles may not function correctly if the nerves have been disturbed.
  • Pelvic Pain - Chronic pelvic pain is more prevalent in females than males, and affects up to 24% of the worldwide population. One cause of pelvic pain is neurological, where nerve can become entrapped or irritated.

What is Percutaneous Tibial Nerve Stimulation?

Percutaneous Tibial Nerve Stimulation (PTNS) is the leading surgical treatment for overactive bladder syndrome recommended by NICE for when conservative treatments have not been successful. It is an efficacious treatment for reducing symptoms in both the short and long term. It is also recommended by NICE in the management of faecal incontinence.

During the procedure, a fine needle is inserted into your leg, just above the ankle, next to the tibial nerve. A surface electrode is also placed on the foot. The needle and the electrode are connected to a low-voltage stimulator. This stimulation may cause your toes to flex or tingle as a response.

The treatment normally consists of 12 outpatient sessions that last for 30 minutes each week. However, further sessions will be needed for longer-term relief. Around 55% of patients treated with PTNS experience an improvement in their symptoms within the 12-week treatment.

The aim of percutaneous tibial nerve stimulation is to produce an effect similar to sacral nerve stimulation but less invasive.

However, side effects of the procedure may involve:

  • discomfort
  • pain
  • swelling
  • stomach ache
  • leg numbness
  • redness
  • inflammation

What is Transcutaneous Tibial Nerve Stimulation?

Trancutaneous tibial nerve stimulation is not currently recommended as a pelvic floor disorder treatment by NICE. However, there are studies that have been conducted that show its efficacy.

Transcutaneous tibial nerve stimulation is far less invasive than PTNS as it does not involve any breakage of skin or tissue. Instead the tibial nerve is solely stimulated through electrode pads.

Recent studies indicate that transcutaneous stimulation of the foot can help increase bladder capacity by 50% in healthy adults. It has been highlighted that there are beneficial effects of stimulating nerves in the foot for treating overactive bladder symptoms.

The use of low-frequency electrical stimulation increases the release of endorphins, which reduces pain in both acute and chronic pain situations. It has also been shown to be effective in reduces the pain of prostatitis in men.


How Does Tibial Nerve Stimulation Work?

For an overactive bladder, it is believed that stimulating the tibial nerve and passing an electrical current up the leg to the sacral nerves can reset the brain signals and reduce bladder hyperactivity.

Tibial nerve stimulation can improve faecal continence by stimulating the sacral nerve that controls bowel function. By repeatedly stimulating these nerves, the ability to defer stool improves, resulting in a decrease in episodes of bowel incontinence.

TENS unit can be used as physical therapy to manage pelvic pain. Stimulation of the tibial nerve can help to intercept the pain signals that are sent to the brain.


Other Methods to Stimulate the Tibial Nerve

The Kegel8 Ultra 20 Electronic Pelvic Toner uses neuromuscular electrical stimulation (NMES) to strengthen the pelvic floor. However, the electrode pads that come with the device can also be used to stimulate the tibial nerve to provide relief for pelvic pain and overactive bladder. The Kegel8 pelvic toner works by producing electrical pulses that stimulate the muscles and nerve fibres that reach into your pelvic area.

Take care when increasing the power to your electrode pads as your skin is sensitive. We recommend that you do not increase the power above 15mA, as a power higher than this could cause physical harm (skin burns). Power greater than 15mA could also cause damage to your electrode pads. You should be extra careful when using the probe and electrode pads at the same time, as the probe will need a much higher amount of power (usually 30mA or more).




Sources

Archer, M. (2017) Tibial Nerve [online]. TeachMeSeries: Educational Health Resources [viewed 10/10/2018]. Available from https://teachmeanatomy.info/lower-limb/nerves/tibial-nerve/

Bladder & Bowel Community (2014) Factsheet: Percutaneous Tibial Nerve Stimulation for Faecal Incontinence [online]. Bladder and Bowel Support Company [viewed 10/10/2018]. Available from https://www.bladderandbowel.org/wp-content/uploads/2017/05/BBC034_PTNS.pdf

Bladder & Bowel Community (2018) Tibial Nerve Stimulation [online]. Bladder and Bowel Support Company [viewed 10/10/2018]. Available from https://www.bladderandbowel.org/conservative-treatment/tibial-nerve-stimulation/

NICE (2010) Percutaneous Posterior Tibial Nerve Stimulation for Overactive Bladder Syndrome [online]. National Institute of Health and Care Excellence [viewed 10/10/2018]. Available from https://www.nice.org.uk/guidance/ipg362/chapter/2-The-procedure

RCOG (2015) Therapies Targeting the Nervous System for Chronic Pelvic Pain Relief [online]. Royal College of Obstetrics and Gynecologists [viewed 10/10/2018]. Available from https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip46.pdf

Udoji, M.A., Ness, T.J. (2013) New Directions in the Treatment of Pelvic Pain [online]. Journal of Pain Management [viewed 10/10/2018]. 3(5), pp. 387-394. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3979473/