If you experience a sudden, urgent need to urinate that is difficult to defer — sometimes with leakage before reaching the toilet — you have an overactive bladder. It is far more common than most people realise, affecting approximately 1 in 6 UK adults, and it can profoundly affect work, social life, sleep, and confidence.
Pelvic floor physiotherapy is the first-line treatment. But for patients who have not achieved adequate improvement with pelvic floor rehabilitation alone, the next step should not be a lifetime of medication with its associated side effects. At LPAW, Percutaneous Tibial Nerve Stimulation (PTNS) provides a NICE-approved, evidence-based alternative — delivered using the UrgentPC device, the gold-standard system recommended in NHS pathways.
Percutaneous Tibial Nerve Stimulation is a minimally invasive neuromodulation treatment for overactive bladder and urgency urinary incontinence. It works by modulating the neural pathways that control bladder function — reducing the abnormal bladder contractions that drive urgency and urge incontinence.
The tibial nerve, which runs close to the surface at the ankle, shares nerve root origins with the sacral nerve plexus (S3) — the same nerve roots that innervate the bladder. By stimulating the tibial nerve at the ankle, PTNS sends electrical impulses back along this shared pathway to the sacral plexus, interrupting the overactive bladder signalling.
In plain English: The treatment works at the ankle to calm the bladder. There is no needle, device, or electrical current near the bladder, pelvis, or genitals.
LPAW delivers PTNS using the UrgentPC Neuromodulation System — the device evaluated in the pivotal clinical trials that established PTNS as an evidence-based treatment, and the system specified in NHS clinical guidelines as the standard of care for PTNS delivery.
The UrgentPC is an FDA-approved, CE-marked medical device with a safety and efficacy profile built across multiple large clinical trials. It is not a consumer electrical device or a generic TENS machine. It is a purpose-built neuromodulation system calibrated specifically for tibial nerve stimulation.
At LPAW, the UrgentPC is operated by trained clinicians within a structured treatment protocol
PTNS is indicated for adults with:
Urgency urinary incontinence (UUI) — leakage caused by the sudden urge to urinate that cannot be deferred in time. Also known as overactive bladder with incontinence.
Overactive bladder (OAB) without leakage — urgency, frequency (urinating more than 8 times per day), and nocturia (waking more than once per night to urinate) without associated incontinence.
Mixed urinary incontinence with a dominant urgency component — leakage involving both stress and urgency mechanisms, where urgency is the primary driver.
PTNS is most appropriate for patients who have:
PTNS is not appropriate for:
Your clinician will screen for contraindications at your initial assessment.
PTNS has a robust clinical evidence base developed over more than a decade:
The OrBIT trial (Peters et al., 2009): A large multicentre RCT published in the Journal of Urology found that PTNS produced a 54.5% overall success rate (significant improvement in overactive bladder symptoms) compared to 20.9% in the sham control group. This trial established PTNS as an evidence-based treatment and supported its inclusion in clinical guidelines.
The SUmiT trial (Peters et al., 2010): A 12-week RCT comparing PTNS to tolterodine (a standard anticholinergic medication) found equivalent efficacy, with PTNS preferred by patients due to lower side-effect burden.
Long-term outcomes (MacDiarmid et al., 2010): Demonstrated sustained benefit of PTNS at 3-year follow-up with maintenance therapy.
NICE guidance: NICE Interventional Procedures guidance IPG362 recommends PTNS for the treatment of refractory overactive bladder. The treatment is included in NHS care pathways.
Percutaneous Tibial Nerve Stimulation is a minimally invasive neuromodulation treatment for overactive bladder and urgency urinary incontinence. It works by modulating the neural pathways that control bladder function — reducing the abnormal bladder contractions that drive urgency and urge incontinence.
The tibial nerve, which runs close to the surface at the ankle, shares nerve root origins with the sacral nerve plexus (S3) — the same nerve roots that innervate the bladder. By stimulating the tibial nerve at the ankle, PTNS sends electrical impulses back along this shared pathway to the sacral plexus, interrupting the overactive bladder signalling.
In plain English: The treatment works at the ankle to calm the bladder. There is no needle, device, or electrical current near the bladder, pelvis, or genitals.
LPAW delivers PTNS using the UrgentPC Neuromodulation System — the device evaluated in the pivotal clinical trials that established PTNS as an evidence-based treatment, and the system specified in NHS clinical guidelines as the standard of care for PTNS delivery.
The UrgentPC is an FDA-approved, CE-marked medical device with a safety and efficacy profile built across multiple large clinical trials. It is not a consumer electrical device or a generic TENS machine. It is a purpose-built neuromodulation system calibrated specifically for tibial nerve stimulation.
At LPAW, the UrgentPC is operated by trained clinicians within a structured treatment protocol
PTNS is indicated for adults with:
Urgency urinary incontinence (UUI) — leakage caused by the sudden urge to urinate that cannot be deferred in time. Also known as overactive bladder with incontinence.
Overactive bladder (OAB) without leakage — urgency, frequency (urinating more than 8 times per day), and nocturia (waking more than once per night to urinate) without associated incontinence.
Mixed urinary incontinence with a dominant urgency component — leakage involving both stress and urgency mechanisms, where urgency is the primary driver.
PTNS is most appropriate for patients who have:
PTNS is not appropriate for:
Your clinician will screen for contraindications at your initial assessment.
PTNS has a robust clinical evidence base developed over more than a decade:
The OrBIT trial (Peters et al., 2009): A large multicentre RCT published in the Journal of Urology found that PTNS produced a 54.5% overall success rate (significant improvement in overactive bladder symptoms) compared to 20.9% in the sham control group. This trial established PTNS as an evidence-based treatment and supported its inclusion in clinical guidelines.
The SUmiT trial (Peters et al., 2010): A 12-week RCT comparing PTNS to tolterodine (a standard anticholinergic medication) found equivalent efficacy, with PTNS preferred by patients due to lower side-effect burden.
Long-term outcomes (MacDiarmid et al., 2010): Demonstrated sustained benefit of PTNS at 3-year follow-up with maintenance therapy.
NICE guidance: NICE Interventional Procedures guidance IPG362 recommends PTNS for the treatment of refractory overactive bladder. The treatment is included in NHS care pathways.
LPAW’s clinical team includes 19 practitioners, many holding postgraduate qualifications from UCL, King’s College London, and Guy’s and St Thomas’. Lead clinician Mr Arjun Viswanath MSc, MCSP, MPPA – Co-Founder and Consultant Physiotherapist – brings 25+ years of NHS and private experience including BMI London Independent Hospital and Harley Street.
Every clinician joining LPAW completes a mandatory intensive shadowing placement with our Consultant Physiotherapist before seeing patients independently. This is not a standard practice at most clinics – it’s our way of maintaining clinical consistency across the team.
No. The needle insertion is similar to a blood test or acupuncture needle — a brief prick. During the 30-minute treatment, most patients feel a mild tingling or sensation in the foot. It is not painful. The overwhelming majority of patients tolerate PTNS sessions easily.
Most patients begin to notice a reduction in urgency episodes and night-time waking from around sessions 6–8. Some patients notice earlier; for others, the full benefit becomes apparent after completing the 12-session course. Improvement typically continues for some weeks after the course ends as the neuromodulatory effects mature.
PTNS is NICE-approved and included in NHS clinical guidelines. Availability on the NHS varies by region and is subject to individual CCG/ICB commissioning decisions. LPAW delivers PTNS privately. Check with your GP and your local NHS trust regarding NHS availability in your area.
No. Electrical stimulation devices including PTNS are contraindicated in patients with implanted cardiac devices (pacemakers, defibrillators). This is a standard contraindication that will be screened at your assessment.
Approximately 60–70% of patients who respond to the initial course maintain their improvement with monthly 30-minute maintenance sessions. A proportion maintain their response without further treatment. Your clinician will assess your response at the end of the initial course and advise on the most appropriate maintenance plan.
Yes. PTNS addresses a different mechanism from pelvic floor exercises. Pelvic floor rehabilitation strengthens the muscles that prevent leakage. PTNS modulates the nerve signals driving the overactive bladder contractions. The two treatments complement each other and work on different aspects of the problem.
Your first appointment is an assessment session — not a treatment session. It includes:
Treatment begins at session 2. Bring a completed bladder diary if possible — this provides invaluable baseline data to track your progress.
A PTNS session is straightforward, brief, and well-tolerated by the vast majority of patients.
Duration: 30 minutes per session.
What happens:
After the session: You can dress and leave immediately. There is no recovery period. Most patients return to work and normal activities directly from the clinic.
What you feel: The most common sensation is a mild tingling in the sole of the foot or a slight toe twitch. Some patients feel nothing beyond a mild pressure at the insertion site. The treatment is not painful.
PTNS at LPAW is delivered as part of a comprehensive pelvic health service, not as an isolated procedure. Your treatment will be preceded by a full pelvic health assessment to confirm the diagnosis, exclude contraindications, and establish baseline symptom severity (using validated questionnaires such as the ICIQ-OAB).
For patients with mixed incontinence, the stress component will be addressed concurrently through pelvic floor physiotherapy and potentially biofeedback, while PTNS targets the urgency component. This integrated approach produces better outcomes than treating each component in isolation.
PTNS is available for both women and men — see our Men’s Health page for more detail on PTNS for male overactive bladder and urgency incontinence.
Pelvic floor rehabilitation is the first-line treatment for overactive bladder and should be completed before PTNS is considered. PTNS is the recommended next step when pelvic floor rehabilitation alone has not achieved sufficient improvement.
At LPAW, many PTNS patients have already completed a pelvic floor physiotherapy programme at LPAW or elsewhere. PTNS can be delivered concurrently with ongoing pelvic floor rehabilitation or as a standalone course.
Medications (tolterodine, solifenacin, oxybutynin, mirabegron) are effective for overactive bladder but are associated with significant side effects — dry mouth, constipation, blurred vision, cognitive effects, and in older patients, dementia risk with long-term anticholinergic use. Many patients discontinue medication due to side effects.
PTNS produces equivalent efficacy to pharmacological treatment (demonstrated in the SUmiT trial) without systemic side effects. For patients who are intolerant of medication or wish to avoid long-term pharmaceutical dependency, PTNS is an evidence-based alternative.
Intradetrusor botulinum toxin injection is a more invasive treatment involving cystoscopy and injection directly into the bladder muscle. It is effective but requires a urological procedure, and complications include urinary retention requiring catheterisation.
PTNS is less invasive, requires no cystoscopy, and carries no risk of urinary retention. It is the appropriate treatment to try before considering botulinum toxin.
Sacral neuromodulation involves surgical implantation of a device. PTNS is the non-surgical equivalent — targeting the same neural pathways via the tibial nerve rather than through an implant. PTNS should be offered before surgical neuromodulation is considered.
Your first appointment is an assessment session — not a treatment session. It includes:
Treatment begins at session 2. Bring a completed bladder diary if possible — this provides invaluable baseline data to track your progress.
A PTNS session is straightforward, brief, and well-tolerated by the vast majority of patients.
Duration: 30 minutes per session.
What happens:
After the session: You can dress and leave immediately. There is no recovery period. Most patients return to work and normal activities directly from the clinic.
What you feel: The most common sensation is a mild tingling in the sole of the foot or a slight toe twitch. Some patients feel nothing beyond a mild pressure at the insertion site. The treatment is not painful.
PTNS at LPAW is delivered as part of a comprehensive pelvic health service, not as an isolated procedure. Your treatment will be preceded by a full pelvic health assessment to confirm the diagnosis, exclude contraindications, and establish baseline symptom severity (using validated questionnaires such as the ICIQ-OAB).
For patients with mixed incontinence, the stress component will be addressed concurrently through pelvic floor physiotherapy and potentially biofeedback, while PTNS targets the urgency component. This integrated approach produces better outcomes than treating each component in isolation.
PTNS is available for both women and men — see our Men’s Health page for more detail on PTNS for male overactive bladder and urgency incontinence.
Pelvic floor rehabilitation is the first-line treatment for overactive bladder and should be completed before PTNS is considered. PTNS is the recommended next step when pelvic floor rehabilitation alone has not achieved sufficient improvement.
At LPAW, many PTNS patients have already completed a pelvic floor physiotherapy programme at LPAW or elsewhere. PTNS can be delivered concurrently with ongoing pelvic floor rehabilitation or as a standalone course.
Medications (tolterodine, solifenacin, oxybutynin, mirabegron) are effective for overactive bladder but are associated with significant side effects — dry mouth, constipation, blurred vision, cognitive effects, and in older patients, dementia risk with long-term anticholinergic use. Many patients discontinue medication due to side effects.
PTNS produces equivalent efficacy to pharmacological treatment (demonstrated in the SUmiT trial) without systemic side effects. For patients who are intolerant of medication or wish to avoid long-term pharmaceutical dependency, PTNS is an evidence-based alternative.
Intradetrusor botulinum toxin injection is a more invasive treatment involving cystoscopy and injection directly into the bladder muscle. It is effective but requires a urological procedure, and complications include urinary retention requiring catheterisation.
PTNS is less invasive, requires no cystoscopy, and carries no risk of urinary retention. It is the appropriate treatment to try before considering botulinum toxin.
Sacral neuromodulation involves surgical implantation of a device. PTNS is the non-surgical equivalent — targeting the same neural pathways via the tibial nerve rather than through an implant. PTNS should be offered before surgical neuromodulation is considered.
