What is Percutaneous tibial nerve stimulation (PTNS)?
Percutaneous posterior tibial nerve stimulation is for treating faecal incontinence.
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 the 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. The treatment usually consists of 12 outpatient sessions of 30 minutes each, about once a week, but it can be repeated if necessary.
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. The treatment usually consists of 12 outpatient sessions of 30 minutes each, about once a week, but it can be repeated if necessary.
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 that can last a few hours are reported by some patients.
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
All risks will be discussed with you with your treating consultant prior to the procedure.
PTNS can also be used to treat patients with symptoms of over active bladder.
To find out what National Institute for Health and Clinical Excellence (NICE) says about PTNS for treating faecal incontinence or overactive bladder symptoms, visit the following website: https://www.nice.org.uk/guidance/ipg362
The content for this treatment was kindly provided to us by Mr Simon Radley, Consultant General Surgeon.