TENS machines for Overactive Bladder - too good to be true?
Overactive bladder (OAB) is a common condition characterised by a frequent, sudden urge to urinate, often accompanied by incontinence. This condition can significantly impact your quality of life, leading to social, psychological, and physical distress. Needing to know exactly where all of the public toilets in Ballarat are situated is a common story that we hear! While medications are commonly prescribed to manage OAB, they often come with undesirable side effects. As a result, conservative treatment options like Transcutaneous Tibial Nerve Stimulation (TTNS) have emerged as effective alternatives. This blog will explore how TTNS works, the evidence supporting its use, and why our pelvic health osteopaths and physiotherapists are well-placed to deliver this treatment and other complementary strategies for managing OAB.
a pelvic health clinician can talk you through your options for OAB
What is TTNS?
Transcutaneous Tibial Nerve Stimulation (TTNS) is a non-invasive, neuromodulatory technique used to treat OAB by stimulating the tibial nerve, which runs from the sacral plexus to the lower leg — the nerve group responsible for bladder control. TTNS modulates the signals between the brain and bladder, reducing the symptoms of OAB by decreasing bladder overactivity. It is typically performed by placing adhesive electrodes on the ankle to stimulate the tibial nerve using a small handheld device that delivers a mild buzzing feeling.
How TTNS Works for OAB:
The tibial nerve shares neural pathways with the sacral nerve roots (S2-S4), which are key in controlling bladder function. By stimulating the tibial nerve, TTNS influences these pathways, inhibiting abnormal bladder contractions. This method helps in reducing the urge to urinate frequently and can improve bladder capacity and continence.
TTNS is similar to Percutaneous Tibial Nerve Stimulation (PTNS), a more commonly known treatment option but differs in its delivery. PTNS involves inserting a needle to stimulate the tibial nerve, whereas TTNS uses surface electrodes, making it non-invasive, less painful and much easier for you to do yourself at home.
Evidence Supporting TTNS:
Several studies support the efficacy of TTNS in treating OAB. A 2012 randomized controlled trial found TTNS to be effective in reducing urinary urgency, frequency, and incontinence in OAB patients. Moreover, a review of the literature highlighted that TTNS offers significant improvement in bladder symptoms compared to placebo groups, with benefits comparable to those of PTNS but with greater ease of administration .
In a 2016 study, participants who received TTNS therapy showed a 50% reduction in daily urgency and incontinence episodes . Another 2021 study supported these findings, demonstrating that TTNS was well-tolerated and effective, with minimal side effects.
TTNS vs. Medications for OAB:
Pharmacological treatments, such as antimuscarinics and beta-3 agonists, are often prescribed to manage OAB. While these drugs can be effective, they come with risks and side effects such as dry mouth, constipation, blurred vision, cognitive impairment, and increased heart rate. For elderly patients, in particular, these side effects can be severe and lead to discontinuation of therapy. Some patients are also balancing the effects and side effects of multiple medications which can be a juggle.
In contrast, TTNS is a safer, conservative treatment option with minimal risks. Common side effects associated with TTNS, such as mild skin irritation at the electrode site or tingling sensations, are typically temporary and non-invasive.
TTNS Treatment Protocol:
TTNS is generally administered in a clinical setting but can also be done at home with our guidance. A typical TTNS session involves:
Placement of surface electrodes around the ankle.
Stimulating the tibial nerve for 30 minutes (while you relax and read a book or watch some tv) using a small hand held device.
We generally trial regular session for 6 weeks and then assess the success of the treatment and make a plan for maintenance.
Pelvic Health Osteopaths and Physiotherapists: Key Players in OAB Management
Our pelvic health osteopaths and physiotherapists are uniquely positioned to deliver conservative treatments for OAB, including TTNS, deferral strategies, fluid and diet modifications, constipation management and bladder retraining. Our specialised training in pelvic floor dysfunction allows us to assess and manage OAB comprehensively.
Conclusion:
Transcutaneous Tibial Nerve Stimulation (TTNS) represents an effective, non-invasive, and conservative treatment option for those with OAB. With compelling evidence supporting its use and minimal side effects compared to medications, TTNS can improve quality of life for many patients. Pelvic health professionals, including osteopaths and physiotherapists, play a crucial role in delivering this therapy and providing comprehensive management of OAB through bladder retraining, pelvic floor strengthening, and patient education.
If you're suffering from OAB, consider TTNS as part of a conservative treatment plan. Book a pelvic health consultation one of our pelvic health clinicians so that we can can tailor a treatment approach to suit your needs, reduce reliance on medications, and improve bladder control.
References:
Peters, K. M., et al. (2010). Randomized trial of transcutaneous vs percutaneous tibial nerve stimulation for overactive bladder. The Journal of Urology, 183(4), 1438-1443.
Booth, J., et al. (2018). The role of transcutaneous tibial nerve stimulation in the management of urinary incontinence: A systematic review. International Urogynecology Journal, 29(5), 645-657.
Finazzi-Agro, E., et al. (2016). Percutaneous tibial nerve stimulation effects on detrusor overactivity incontinence are not related to changes in bladder afferent or efferent excitability. The Journal of Urology, 196(5), 1533-1538.
NICE Guidelines for Urinary Incontinence and Pelvic Organ Prolapse (2019).
Groen, J., et al. (2016). Neuromodulation for pelvic floor dysfunction: Effectiveness and outcomes. Current Bladder Dysfunction Reports, 11(4), 305-315