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  • Janette O'toole

A novel treatment for men and women suffering from bladder problems

Bladder issues and urinary incontinence affects 5 million Australians and can occur in both men and women.




Bladder urgency 

Bladder (urinary) urgency is a sudden and strong sensation to empty the bladder. You may also hear it referred to as an overactive bladder or detrusor instability.


If you experience bladder problems you may also:

  • feel the need to go to the toilet frequently to pass urine

  • have to rush to the toilet, with little warning

  • leak as you approach the toilet

  • experience a sudden urge to pass urine when getting up from sitting, putting the key in the front door or with running water

  • wake several times a night to go to the toilet


What causes bladder urgency?

The cause of urgency is not fully understood however it seems to become more common as we age. Bladder symptoms may get worse at times of stress and may also be made worse by caffeine (such as in tea or coffee), fizzy drinks or alcohol.


What is Transcutaneous Tibial Nerve Stimulation (TTNS)?

Transcutaneous tibial nerve stimulation (TTNS) is a treatment for men and women with urinary urgency, urgency incontinence or overactive bladder (OAB) symptoms.

TTNS involves stimulation of the posterior tibial nerve, a nerve originating from L4-S3 (in the lower back), which contributes directly to bladder control.  Stimulating this nerve is a form of neuromodulation and works by inhibiting reflex bladder contractions.  

The posterior tibial nerve runs behind the medial malleolus (ankle bone). It can be stimulated in two ways: 

  • Percutaneous tibial nerve stimulation. This requires inserting needles into the skin and is invasive and expensive.

  • Transcutaneous tibial nerve stimulation (TTNS), requires using electrode pads which stick to the skin and connect to a TENS (transcutaneous electrical nerve stimulation) machine.  TTNS is much more cost effective than percutaneous tibial nerve stimulation and much simpler to use. It can be also be used as a home treatment.


Does TTNS work?

There have been over 10 research trials evaluating the effectiveness of this treatment. So far results are very promising.

  • TTNS provided greater benefit for urinary urgency symptoms than behavioral interventions such as bladder training and pelvic floor muscle training alone

  • TTNS is as effective as medication.

  • Significant improvements in symptoms were reported by 48-93% of participants. 

  • Urinary incontinence was ‘cured’ in 25-45% of participants. 

  • Importantly, NO adverse events (harmful effects) were reported.


In summary

TTNS is a safe and effective treatment for men and women with urinary urgency or overactive bladder symptoms. If you require any further information, please contact me for further information. 


If you have any specific concerns or are experiencing any bladder symptoms, such as urinary frequency, urgency, waking up several times at night needing to empty the bladder, or incontinence, a pelvic floor physiotherapist may be able to help. This is a physiotherapist who has undertaken specialised training in this area and is able to provide specific advice and treatment to help with bladder symptoms. 

Booth et al 2018. The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review. Neurourology and Urodynamics, 37(2): 528-541.


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