When Pelvic Floor Exercises and Medication Have Not Been Enough
September 2026
There is a particular kind of ‘stuck’ that people with bladder or bowel symptoms know well. You’ve done the pelvic floor exercises properly, potentially for months. You may have tried a medication, possibly two, and either they did not help enough or the side effects were worse than the problem itself. You may even have reorganised your life around knowing where the toilets are. And you’ve been left with the impression that you have reached the end of the options (and your tether).
For a great many people, that’s not the case. There is a well-established treatment that sits between conservative management and surgery, and most people have never heard of it. And it’s one of the reasons why we brought pelvic floor physiotherapy – and PTNS specifically – into our offer as a clinic.
The first thing to say is that you are not the first
Bladder and bowel symptoms are common, and they are treatable. They are also, for entirely understandable reasons, the symptoms that people delay mentioning the longest. It is not unusual for someone to live with them for years before raising them with anyone, by which point the condition has quietly shaped where they go, what they drink and how well they sleep.
Nobody in the clinic is remotely surprised or embarrassed by any of this. It is routine work for us.
What is PTNS?
PTNS stands for percutaneous tibial nerve stimulation. It is a form of neuromodulation, which means it works by influencing nerve signalling rather than by acting on the bladder or bowel directly.
The tibial nerve runs down the leg to the ankle. Higher up, it shares a common origin in the spinal cord in the form of the nerves of the sacral plexus, which are the nerves that control bladder and bowel function. Stimulating the tibial nerve at the ankle sends signals up that shared pathway, and over a course of PTNS treatment this appears to help settle the overactive signalling behind urgency and leakage.
Which is why the treatment, described briefly, sounds so improbable: a fine needle, inserted near your ankle, for a bladder problem.
What a PTNS session actually involves
A very fine needle electrode is placed just above the inside of the ankle. It is thinner than a needle used for a blood test: most people describe the insertion as a brief scratch. The electrode is connected to a small stimulator, and the current is turned up slowly until you feel a tingling sensation in the foot, or see your toes curl or fan slightly. This response confirms that the right nerve is being stimulated. The level is always set to be comfortable rather than strong. You then sit for around 30 minutes with your leg still. People read, work through their emails or listen to something. At the end of the session, the needle is removed and you carry on with your day. There is no recovery period and no restriction on driving.
How long the course takes
The standard PTNS course is 12 sessions, usually once a week over about three months. Attending consistently is important, as the effect builds cumulatively rather than working after a single treatment.
Most people who respond begin to notice a change somewhere around the sixth session, although for some it takes the full course. If you miss a single appointment, treatment can normally continue as planned; missing several may mean we need to restart.
After the initial course, most people who have benefited need occasional top-up sessions to maintain the effect (often around one a month), although some go considerably longer between visits. It’s a case of ongoing management rather than a one-off cure, which is true of most treatments for these conditions.
Who PTNS tends to suit
PTNS is generally considered when conservative treatment has not delivered enough improvement. That usually means you will have already tried pelvic floor muscle training and bladder or bowel retraining, and either tried medication unsuccessfully or been unable to tolerate it.
In the research, PTNS is most established for overactive bladder, meaning urgency, frequency, needing to get up at night, and urge incontinence. It is also used for faecal incontinence when pelvic floor training and medication have not worked.
PTNS is not suitable for everyone. Pregnancy, a pacemaker or implanted electronic device, a bleeding disorder, or nerve damage or skin problems around the ankle can all rule it out, so we always start with a full assessment.
A realistic view of the outcome
Response rates reported in research studies are encouraging, with a majority of people seeing worthwhile improvement in urgency, frequency and leakage episodes, and improvements in quality of life sustained with maintenance treatment.
Improvement generally means fewer episodes, more warning before you need a toilet, and less disruption to sleep and daily life. Complete resolution happens for some people but is not the usual outcome, and it is better to begin with an accurate expectation than an inflated one.
Worth a conversation
If bladder or bowel symptoms are shaping your daily life, and you have been told or have assumed that you have run out of options, it is worth finding out whether that’s actually the case.
Book an appointment or get in touch to discuss your symptoms in confidence. An initial assessment establishes what is driving your symptoms and which treatments, including PTNS, are appropriate.
Related reading
Pelvic health physiotherapy – assessment and treatment for bladder, bowel and pelvic floor problems.
This article is for general information and is not a substitute for individual clinical assessment. New or changing bladder and bowel symptoms should always be assessed by a clinician, as they can have several causes that need investigating.
