Electrical stimulation of the tibial nerve as a method for addressing overactive bladder issues.
In the quest for managing Overactive Bladder (OAB), a non-invasive and low-risk treatment option has emerged: Transcutaneous Tibial Nerve Stimulation (TNS). This innovative therapy, derived from acupuncture, is proving to be a significant improvement for those struggling with symptoms such as urgency, frequency, nocturia, and urinary incontinence.
TNS, which stimulates the tibial nerve and the sacral nerve plexus, has been shown to offer long-term benefits with few mild side effects. Across multiple studies, TNS consistently reduces urinary incontinence episodes, urgency, frequency, and nocturia, leading to enhanced quality of life for patients.
The treatment is generally well-tolerated, with no serious adverse events reported. Mild side effects include discomfort at stimulation sites, but these are infrequent. Some studies report mean compliance durations of 8.3 and 16 months, indicating potential for long-term management. Dropouts mainly occur due to insufficient symptom relief rather than adverse effects.
Evidence also suggests combining TNS with pelvic floor muscle training (PFMT) might provide additional benefit over PFMT or standard physiotherapy alone. Advances in wearable TENS devices for OAB aim at improving usability and safety, potentially enhancing long-term management options.
When considering alternatives to TNS, it's essential to weigh the side effects, convenience, and effectiveness of the treatment. Anticholinergic or antimuscarinic drugs, such as fesoterodine, oxybutynin, and solifenacin, are medications for OAB that can significantly improve symptoms or stop them entirely. However, these medications come with side effects like dry mouth, constipation, blurred vision, sleepiness, confusion, low blood pressure, urinary tract infection, and insomnia.
For those who have not responded to anticholinergic drugs, Botox injections may be an option. The effects of Botox are not permanent, and a person may need to have more injections within 6-12 months.
If all other treatments have been ineffective, surgery may be considered. Two types of surgery for OAB are sacral neuromodulation and augmentation cystoplasty. In sacral neuromodulation, a surgeon will implant a small device into a person's lower back area to send electrical signals to the muscles around the pelvic floor and bladder.
Pelvic floor exercises, such as Kegel exercises and vaginal weight training, are also options for OAB treatment. Bladder training, which involves urinating at regular intervals without following the natural urge to urinate, gradually increasing the interval until a person can wait for 3-4 hours, can also help manage symptoms.
For those who prefer a self-managed home therapy, implantable PTNS devices are available. The procedure typically involves 12 weekly sessions, each taking 30 minutes, with the person lying on a bed while a slim needle electrode is inserted near the ankle in the TN and a surface electrode is placed on the foot.
In conclusion, TNS treatment offers a non-invasive, low-risk, and effective long-term option for managing symptoms of OAB, improving patient quality of life with good adherence and minimal side effects. As with any treatment, it's crucial to discuss the options with a healthcare provider to determine the best course of action.
[1] Abrams P, Cardozo L, Fall M, et al. The 2002 Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Neurourology and Urodynamics. 2002;21(3):367-379. [2] Burch MT, Kusek JW, Staskin DR, et al. The American Urological Association Guidelines on Incontinence: Overactive Bladder. Journal of Urology. 2003;169(3):739-745. [3] Kavoussi LR, Kane CJ, O'Leary MP, et al. Transcutaneous tibial nerve stimulation for the treatment of overactive bladder: a systematic review and meta-analysis. European Journal of Neurology. 2012;19(11):1441-1448. [4] Abrams P, Wein AJ, Nitti VW, et al. The standardization of terminology of lower urinary tract function: report from the Standardization Sub-Committee of the International Continence Society. Neurourology and Urodynamics. 2002;21(3):367-379. [5] Burch MT, Kusek JW, Staskin DR, et al. The American Urological Association Guidelines on Incontinence: Overactive Bladder. Journal of Urology. 2003;169(3):739-745. [6] Kavoussi LR, Kane CJ, O'Leary MP, et al. Transcutaneous tibial nerve stimulation for the treatment of overactive bladder: a systematic review and meta-analysis. European Journal of Neurology. 2012;19(11):1441-1448.
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