Percutaneous posterior tibial nerve stimulation

Anal incontinence is the inability to control bowel movements and this can clearly be a distressing condition. There are many causes; these can include damage to the muscles and /or nerves around the anus. The commonest cause of such damage is childbirth, but anal incontinence can affect men as well.
When there is clear damage to the anal sphincter muscle and a wide gap in the muscle the surgeon may recommend an anal sphincter repair in the first instance.
Where there isn’t a big gap in the sphincter muscle and/ or symptoms cannot be controlled with drugs such as loperamide and physiotherapy, percutaneous tibial nerve stimulation (PTNS) may be recommended.

What does percutaneous tibial nerve stimulation  involve?

PTNS uses a small slim needle electrode which is temporarily inserted near to the ankle. The needle electrode is then connected to a battery-powered stimulator.
Upon activating the stimulator, the treating consultant or nurse can identify the response to stimulation by looking for movement in the feet and toes. Patients will lie on a couch or recliner during the treatment. Each treatment session will last for 30 minutes.
It is recommended that patients undergo an initial series of 12 treatment sessions, ideally each a week apart.
Patients will normally notice some improvement in symptoms after 8 weeks.  Where no improvement has been achieved the treatment may be discontinued. After the first twelve treatment sessions, the consultant or nurse will discuss with the patient’s their response to the treatments and will decide whether any further treatments are required to maintain results. 

What are the risks?

 Stomach aches are reported by some patients that can last a few hours.
Other rarely reported side effects include:

• transient leg or toe numbness
• transient discomfort or throbbing at insertion site
• redness and inflammation at needle insertion site

PTNS can also be used to treat patients with symptoms of over active bladder.

To find out what NICE (National Institute of Clinical Excellence) says about PTNS for treating faecal incontinence or overacctive bladder symptoms, visit the following sites:

http://www.nice.org.uk/nicemedia/live/13159/54562/54562.doc
http://www.nice.org.uk/nicemedia/live/12412/51304/51304.pdf

Click here to download this information as a PDF Factsheet

Click here to read an article in the Daily Mail about a patient undergoing the procedure
Click here to read about a patient undergoing PTNS treatment at the Birmingham Bowel Clinic

Birmingham Bowel Clinic 2012

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