Introduction
An overactive bladder is when the bladder starts releasing urine at inconvenient times. The common symptom experienced is the sudden urge to urinate. Other symptoms include leakage of urine after the urge to urinate, urinating more than 8 times a day, urinating a minimum of two times at night, and losing bladder control when the bathroom is not nearby. The several treatments available to treat an overactive bladder include medications that relax the bladder, lifestyle changes, and botox injections for the bladder. Another treatment that brings relief is tibial nerve stimulation. The tibial nerve stimulation is used when other management options like lifestyle changes, medications, and Botox do not work.
What Is Tibial Nerve Stimulation?
Tibial nerve stimulation, also called percutaneous tibial nerve stimulation (PTNS), is a form of neuromodulation where the activity of the nerve is changed through medications delivered directly to the nerve or nearby area through electrical impulses.
The symptoms of an overactive bladder can be managed through the posterior tibial nerve, as tibial nerve stimulation targets the lower urinary system. This neuromodulation procedure aims to target the lower urinary tract innervation system.
The posterior tibial nerve is the sciatic nerve's distal branch, which originates and runs from the pelvic area down toward the leg. During the tibial nerve stimulation, an electrode is placed in the lower leg, near the ankle region. These electrodes send pulses to the tibial nerve during the treatments. Stimulation is done through a percutaneous needle electrode, transcutaneous surface electrode, or a wireless implantable tibial nerve stimulator.
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Percutaneous Tibial Nerve Stimulation - In this technique, posterior tibial nerve stimulation is achieved by inserting a 34-gauge needle into four to five cephalad into the medial malleolus. Once the current starts, the correct positioning of the needle (electrode) is confirmed with the movement of toes or the flexion of the big toe.
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Transcutaneous Tibial Nerve Stimulation - In this technique, stimulation is achieved through two 50-mm electrode pads. The pad is placed in a superior and posterior position to the medial malleolus, and the ground pad is kept at a distance of a 10 cm cephalad to this. A frequency of 10 Hz (hertz) and continuous stimulation in a pulse width of 200 ls is used. The amplitude is set to produce a sensory stimulus at a tolerable intensity in the ipsilateral foot, and stimulation is given for around 30 minutes.
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Implantable Devices - In a battery-less implant powered wirelessly by an external control unit that provides the therapeutic parameters. Tibial nerve stimulation can happen only when the external control unit is worn. The implant is usually placed over the tibial nerve during an open surgical procedure with a prophylactic antibiotic cover, usually with local anesthesia. The implant consists of a 25-millimeter cylinder which has a diameter of 3.4 mm and four tiny fixating wings. The cylinder has two bipolar electrodes and an electrical power receiver. Stimulation is carried out at the frequency of 5, 10, 20, and 40 hertz, a pulse width between 50 and 800 microseconds, and an amplitude of zero to 9 mA.
How Does Tibial Nerve Stimulation Help an Overactive Bladder?
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The symptoms of an overactive bladder present when there is a dysfunction in the nerve signals transmitted between the brain and the bladder.
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Dysfunction Ing or not working properly denotes that the brain and the bladder cannot communicate their functions, and the bladder starts releasing urine at the wrong times.
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This communication channel can be fixed by tibial nerve stimulation.
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The tibial nerve is a part of the nerves that control the bladder. Stimulating the nerve will help control all the other nerves that are not efficiently working, and the bladder starts releasing when required.
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Tibial nerve stimulation requires weekly treatment and an average course of 12 weeks. The best results are achieved after 12 weeks of consistent sessions and will be followed by maintenance treatment, weaned over time.
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This procedure must be done in a doctor's office for best results and safety purposes.
How Does Tibial Nerve Stimulation Feel?
Each session of tibial nerve stimulation lasts an average of thirty minutes. The sessions are usually not painful and should not be painful. In every session, the electric current will be set at its highest level, which the person can tolerate. The pinching sensation is felt whenever the needle gets inserted into the leg. Other sensations like tingling or muscle spasms in the toes, foot, and ankle may also be felt during the session.
Does Tibial Nerve Stimulation Work Well?
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Tibial nerve stimulation has been successful in individuals affected by an overactive bladder.
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According to studies, around 60 % to 70 % of people showed an improvement in their symptoms, and 47 % to 56 % also stated that they use the bathroom less often than before.
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Even though the normal course lasts about 12 weeks, tapering and prolonging treatment tend to increase efficiency, and about 77 % of people reported significant improvement.
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However, remember that it requires at least six treatment sessions before seeing an improvement.
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When tibial nerve stimulation combined with antimuscarinics or medications help the bladder relax and stop squeezing during the wrong time, leading to better results than the tibial nerve stimulation alone.
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Tibial nerve stimulation can also be used in children, and studies suggest that around 66 % of patients were cured, and the other 23 % showed significant improvement in their symptoms.
What Are the Risks Associated With a Tibial Nerve Stimulation?
There are not many side effects associated with tibial nerve stimulation. After and before each session, the patient may experience pain, inflammation, bruising, or minor bleeding around the insertion point of the needle. It is also essential to talk with the healthcare provider to understand whether the treatment is a safer option, as tibial nerve stimulation is usually not recommended for people with an underlying bleeding disorder, previous incidences of nerve damage, who have a pacemaker, or an implanted defibrillator and pregnant women.
Conclusion
Tibial nerve stimulation is opted for when a first-line treatment like medication or lifestyle changes does not improve the symptoms of an overactive bladder. It is a kind of neuromodulation and is a safe treatment option without many adverse side effects. Over 60 % of people who have undergone this treatment notice a significant improvement in their symptoms. Hence, this has been proven effective in managing overactive bladder symptoms. However, it is always essential to speak with the respective doctors to know whether this treatment option suits the person.
