Bladder urgency or overactive bladder (OAB) is the sudden onset of strong bladder urges that can be difficult to control and can lead to urinary leakage. In an attempt to avoid leaking women may start to have frequent trips to the toilet. It may also interfere with sleeping with the need to wake throughout the night to wee. Urgency can affect all age groups but is more common with increasing age, it affects around 11.8-16% of women.

The treatment options that are considered as first line include behavioural & lifestyle modifications and pelvic floor muscle training.  The evidence is now clear that the use of TENS should also be a first line option alongside these treatments.

Medications that can be used to treat bladder urgency and incontinence are costly and have side effects including dry mouth, constipation, and the use of anticholinergics over 3 months has also now been shown to increase the risk of dementia. 

What is TENS?

TENS is short for Transcutaneous Electrical Nerve Stimulation. When the TENS machine is applied to the Tibial nerve it is referred to as TTNS, Transcutaneous Tibial Nerve Stimulation.

The TENS machine works by delivering mild electrical impulses along the Tibial nerve located at the ankle. The Tibial nerve enters the spinal cord via the sacral nerve roots, the same location as the bladder nerves. It is then believed to modulate the reflexes that control the bladder at the micturition centre in the brain restoring balance to the bladder’s function. It is often described as neuromodulation therapy. 

Research has shown a significant improvement in urinary frequency, urgency sensation, episodes of urinary leakage and waking at night to wee (nocturia). TTNS has been shown to enhance the effects of pelvic floor muscle training and bladder retraining.  TTNS is a conservative, non-invasive treatment and lacks the side effects of alternative treatments, it is more likely to encourage greater adherence.

TTNS involves placing surface electrodes on the skin on the inside of the ankle where the Tibial nerve is easily located.  The TTNS can be self-administered at home once the parameters have been set by a physiotherapist. The TTNS is used for 30 minutes a day for 12 weeks but may be tailored for specific needs. 

There is also evidence for the use of TTNS for the treatment of neurological conditions effecting the bladder including MS or Parkinson’s, faecal incontinence, chronic anal fissures, constipation, and pelvic pain. 

Living with OAB can have significant effects on well-being.  It can impact many aspects of life including sleep, travel, social interactions, and work. TTNS offers another promising option for the self-management of OAB.

Please contact Ballarat Women’s Clinic on 5332 9940, if you would like to know more about TENS and TTNS and to find out if this treatment is right for you.

Written by Physiotherapist, Belinda Matthews