How can putting a needle in my ankle help with overactive bladder?

How does putting a needle in my ankle keep me from having to run to the bathroom all the time?

I’ll admit that is a fair question.

However, there is a treatment called trans-tibial nerve stimulation that does just that!

Let me explain how this can help with urinary urgency and overactive bladder symptoms!

TTNS stands for trans-tibial nerve stimulation. You may also see it called PTNS, which stands for percutaneous tibial nerve stimulation or posterior tibial nerve stimulation. The tibial nerve exits the spine in the sacrum, or the very bottom bone of the spine, and goes down the leg into the lower inside of the ankle. Interestingly, the tibial nerve comes out of the spine from the same area as the nerves that control the pelvic floor and the bladder. It has been found that by stimulating the tibial nerve at the inside of the ankle we can help improve bladder and pelvic floor function by improving the function of all of these nerves!

During TTNS, a small needle is inserted at the inside of the ankle very close to the tibial nerve, along with another needle into the sacrum where it comes out of the spine. Electrical stimulation is then applied through the needle. It is a pretty comfortable procedure; sometimes some achy discomfort can be felt when the needle is inserted but typically does not last long. Once electrical stimulation is applied, it will feel like a bump or thump at the area of the needle. TTNS works best when it is done once a week anywhere from 6-12 weeks.

Electrical stimulation applied into the body has been known to change and improve the function of nerves. It may seem strange that applying stimulation at the ankle can affect your bladder. However, because the tibial nerve enters the spine at the same spot as the bladder nerves, it is able to affect the nerves to the bladder.  This can lead to improved bladder function.

TTNS has been proven to be an effective treatment for overactive bladder symptoms. One study showed that with TTNS treatment 68-71% of patients reported improvement as compared to 0% of patients in the sham group1,2. Patients receiving TTNS treatment also reported greater improvement in symptoms than those taking medications for the bladder1.  TTNS has been found to be even more helpful in conjunction with pelvic floor physical therapy. We know that pelvic floor muscle dysfunction can cause overactive bladder symptoms, so the combination of the two treatments can give us even better results by improving both nerve and muscle function!

Although this procedure has traditionally been performed in the urology office, we can provide nerve stimulation in our PT office at Apex! As you know, most Apex PTs are trained in dry needling. We can place a needle near the tibial nerve at the inside of the ankle along with another at the sacrum and provide stimulation to the tibial nerve! Through the needles we apply electric stimulation to provide neuromodulation to the tibial nerve, thus providing neuromodulation to the nerves to the bladder due to their proximity of each other near the spinal cord. This will improve nerve function of the nerves to the bladder which will reduce overactive bladder symptoms!

Again, TTNS is just part of the physical therapy treatment. It is also important to assess and treat other structures such as the pelvic floor muscles, lower back, abdominal wall, and hips as issues in these areas can contribute to bladder dysfunction. TTNS combined with other physical therapy treatment methods can provide a great holistic approach to address multiple sources that may be contributing to overactive bladder, thus giving you the best possible results!


  1. Bhide A, Tailor V, Fernando R, Khullar V, Digesu GA. Posterior tibial nerve stimulation for overactive bladder – techniques and efficacy. Int Urogynecol J. (2020)31:865-870.
  2. Wang M, Jian Z, Ma Y, Jin X, et al. Percutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J. 2020(12):2457-2471.

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Written by:

Jill Erhmantraut, PT, DPT, WSC, CAPP

Doctor of Physical Therapy, Women’s Health Certified Specialist, Certificate of Achievement in Pelvic Physical Therapy

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