This page tells you about percutaneous tibial nerve stimulation (PTNS). Tibial nerve stimulation, sometimes called neuromodulation, is used to treat both bladder and bowel problems, in particular problems with the control of your bladder or bowel (continence).
Bowel function is regulated by a group of nerves at the base of the spine called the sacral nerve plexus. Neuromodulation helps to stimulate these nerves through gentle electrical impulses and can bring about a change in bowel activity.
PTNS stimulates the nerves responsible for bowel function using the tibial nerve in your lower leg. Impulses are sent from your ankle to the sacral nerve plexus via the tibial nerve.
At this hospital PTNS is carried out using a system known as the Urgent® PC System for neuromodulation which is a simple device used in an outpatient setting.
You have been referred by your doctor for this treatment because of your bowel symptoms. Based on the available medical knowledge, we would expect approximately 60 per cent of patients (two out of three) to have some improvement in symptoms.
The risks of PTNS treatment are rare but reported side effects include mild, short-lived pain, throbbing or skin inflammation (at or near to the stimulation site), numbness of the toes and stomachache. However, PTNS treatment is usually well tolerated by patients.
PTNS is not used in patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding and those who are pregnant or planning to become pregnant. It is used with caution in those with abnormal heart rhythms.
You have been referred for this treatment because your doctor thinks that it may help to improve your symptoms. If you choose not to have it, your doctor will talk to you about other possible options to treat your bowel problems depending upon the cause.
The treatment you have is dependent on your bowel symptoms. Alternatives include changing your diet, exercise, use of medicines, biofeedback, and rectal irrigation. Some patients may be offered bowel surgery.
Neuromodulation can also be done through a technique known as sacral nerve stimulation (SNS) which involves an operation to place a wire directly into the sacral nerve plexus. SNS has been shown to be effective in patients with faecal incontinence. PTNS aims to modify these same nerves in a less invasive way. Your doctor will determine the level of intervention you need depending on the cause of your symptoms.
No special preparation is required. You will be asked to fill in questionnaires before your treatment and at your eighth treatment session in order to assess the progress of your treatment.
PTNS is an outpatient procedure. You will not need any help at your appointment, and you do not need to bring anyone with you.
We will explain the treatment to you fully when you come to the department, and you will have the chance to ask any questions that you might have. Please do not hesitate to ask questions or voice any worries. If you decide to go ahead with the treatment, you are confirming that you agree to have it and understand what it involves. This is known as verbal consent.
You will usually attend for eight 30-minute sessions of stimulation, given at weekly intervals. Everyone is different but in general we expect you to have several sessions (usually about six) before you see a change in your symptoms. Therefore, it is important for you to continue to receive treatment until you and the clinician decide whether it has been successful or not.
The clinician undertaking PTNS will choose a healthy area of skin near your ankle. The area will be cleaned with an alcohol swab and a small, slim needle is gently inserted into the skin. The needle is then connected to a battery-powered stimulator and a grounding pad (to complete the circuit) is placed on the bottom of your foot (there are pictures on the next page). After turning on the stimulator, you will be aware of a response in your foot which indicates that the correct nerves are being stimulated. The stimulation will last for 30 minutes, and the needle is then removed.
After the initial treatment sessions, your response to PTNS will be discussed with you so as to determine if you will need future treatments to maintain your response. If your symptoms have improved, we will arrange further sessions at less frequent intervals. Patients often return once every few months for ‘top up’ sessions.
You may experience some minor discomfort at the needle entry site, but this normally goes away very quickly. If you respond to treatment, the time between treatment sessions will be increased. If symptoms reappear or get worse, your treatment schedule will be changed so as to be as effective as possible.
You will be able to travel home and continue with your normal activities after each session. This leaflet gives you relevant contact numbers and addresses in case you should have any problems.
You can find more information about the Urgent® PC device on the company website.
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UCLH cannot accept responsibility for information provided by other organisations.
This page tells you about PTNS but if you have read the leaflet and have any queries, please contact the GI Physiology Unit.
Address: GI Physiology Unit, Lower Ground Floor, EGA Wing, University College Hospital, 25 Grafton Way, London, WC1E 6DB
Telephone: 020 3447 9130 (Monday to Friday 09:00 to 17:00)
Switchboard: 020 3456 7890 / 08451 555 000
Email: UCLH.
The GI Physiology Unit is on the lower ground floor of the EGA wing.
Page last updated: 10 September 2025
Review due: 01 September 2027