Tibial Nerve Stimulation for Overactive Bladder: How It Works

When it comes to bladder weakness and urinary incontinence, many people suffer in silence, often feeling too embarrassed to seek help. Research shows that, on average, women wait around 6.5 years and men 4.2 years from the onset of symptoms before speaking to a healthcare professional. This delay can have a significant impact on both physical health and emotional wellbeing, with higher rates of anxiety and depression reported among those affected.

So, what causes the bladder to lose control and leak when it shouldn’t?

Common causes of urinary incontinence include pregnancy, childbirth, and ageing, with women affected around twice as often as men. It’s estimated that 25–30% of women aged 45 to 65 experience some form of incontinence. However, urge incontinence (overactive bladder) affects men and women in similar numbers, impacting up to 40% of sufferers. According to the NHS, between three and six million people in the UK live with bladder problems.

The most common types of incontinence include Overactive Bladder —defined as needing to urinate more than eight times in 24 hours—and stress incontinence, where leakage occurs during activities such as coughing, sneezing, laughing, or exercise.

Leaking? What Does a Nerve Near Your Ankle Have to Do With It?

It might sound surprising, but a nerve near your ankle plays an important role in bladder and bowel control.

Tibial nerve stimulation (TNS)—also known as posterior tibial nerve stimulation (PTNS)—works by improving communication between the brain and the bladder. When these signals become disrupted, the bladder can become overactive or fail to function properly, leading to urgency, frequency, and leaks.. TTNS uses gentle electrical impulses to stimulate the tibial nerve, which connects directly to the spinal nerves responsible for controlling the bladder, bowel, and pelvic floor muscles. This form of neuromuscular electrical stimulation (NMES) helps to “reset” these signals, calming overactive bladder activity and encouraging better muscle coordination. Over time, consistent treatment can help restore normal bladder function and improve control.

A Clinically Recognised Treatment

In March 2010, NICE (National Institute for Health and Care Excellence) recommended PTNS as an effective treatment for overactive bladder (OAB). It is widely used to help reduce symptoms such as urgency, frequency, and urge incontinence—and in some cases, significantly improve or even resolve symptoms.

Different Ways to Use Tibial Nerve Stimulation

Traditionally, PTNS is delivered via percutaneous tibial nerve stimulation, where a fine needle electrode is inserted near the ankle in a clinical setting.

However, there is also a non-invasive alternative.

Transcutaneous tibial nerve stimulation (TTNS) uses external electrode pads placed on the skin near the ankle. These pads deliver a mild electrical current that penetrates the skin to stimulate the nerve—no needles required.

A Drug-Free Treatment for Urinary and Faecal Incontinence

When it comes to urinary and faecal incontinence treatment, many people are prescribed medication—but these don’t always work long term. Research suggests that nearly 80% of people stop taking incontinence medication within the first year, with up to 17% discontinuing due to unwanted side effects. Surgical options, while sometimes effective, also carry risks such as complications, recovery time, and discomfort.

Tibial nerve stimulation (TTNS) offers a different approach. While traditional percutaneous PTNS (using a needle near the ankle) can cause minor side effects like swelling, discomfort, or infection, there is now a safer, more convenient alternative.

A Safer, Home-Use Solution

Transcutaneous tibial nerve stimulation (TTNS) uses external electrode pads placed on the skin, allowing you to receive treatment at home, without needles or invasive procedures. This makes it a more accessible and comfortable option for managing bladder weakness and bowel control issues.

Clinical research from Glasgow Caledonian University found that 48–68% of patients using transcutaneous TTNS experienced significant improvement or resolution of bladder symptoms. While needle-based PTNS shows slightly higher success rates (around 60–80%), TTNS still delivers meaningful results—without the associated risks—supporting its use as a first-line, non-invasive treatment for overactive bladder.

TTNS is also believed to be an effective treatment for Faecal Incontinence (FI) which can be an extremely debilitating. In a survey carried out by Gut (an international peer-reviewed journal for health professionals and researchers in gastroenterology and hepatology) it was found that 45% of their subjects receiving transcutaneous TTNS saw more than a 50% reduction in weekly episodes of Faecal Incontinence. So, for those that want to rebuild muscle strength, as well as confidence, TTNS treatment with Kegel8 could help you to do just that.