Summary: There is a nerve in the ankle (the tibial nerve) that shares the same root as the muscles of your bladder. A small needle is inserted to stimulate that nerve with a mild electrical current to reduce bladder hyperactivity, and urinary urgency.
Details: Percutaneous Tibial Nerve Stimulation (PTNS) is a procedure that you come into the office to receive 1-2x a week for 30 minutes to help with Overactive Bladder. During this time, a thin needle is inserted near the ankle, and a mild electrical current is run between the needle and an adhesive electrode pad (placed on your foot). The current stimulates the nerve roots that run to the muscles of your bladder to help reduce frequent urination, and assist with Urge Urinary Incontinence. PTNS is an evidence-based treatment which alone demonstrates a 54.5% improvement in symptoms, but will be paired with education/behavioral modification techniques during your sessions with us to improve efficacy even further.
Typically, PTNS is a treatment provided 1x a week for 12 weeks to see the full treatment benefit of reducing the impacts of Overactive Bladder Syndrome (OAB).
However, there is emerging evidence that increasing frequency to 2x a week yields faster results and faster symptom relief. The Expedited program is 2x a week for 4 weeks, followed by 1x a week for 4 weeks for a total of 12 sessions over 8 weeks.
PTNS has evidence for treatment of overactive bladder related to neurologic conditions such as Multiple Sclerosis, Parkinsons Disease, and after a Stroke. It is one of the few treatments for overactive bladder that does not increase post-void residual volume, making it particularly attractive in neurologic patients at a risk for retention.
A very thin needle, about the thickness of a hair will be inserted in the skin near the ankle. Typically, there is mild discomfort with insertion of the needle but once it is placed, there is no discomfort associated with it. You will feel an electrical current which feels like buzzing, or tingling in the ankle and into the foot. The level of the current will be constantly monitored to ensure it is not painful.
PTNS treatments last for 30 minutes, 1-2x a week based on your availability to commit coming into the office. In the literature, the treatment is completed at 12 weeks total for full effectiveness. There is evidence to suggest that you will get better faster if you receive treatments 2x a week instead of 1x a week.
After completion of the treatment, there are typically maintenance treatments performed 1x every month. You may be taught how to perform a less invasive treatment called TTNS yourself as a maintenance as a part of a pilot program.
NoVA Dry Needling does not currently accept insurance. Most insurances (with the exception of Medicare) accept superbills to retroactively and partially reimburse you for procedures. A superbill will be provided for your initial evaluation only if requested. The full price for the initial evaluation is $120. Your subsequent sessions will be less than 50% of the industry standard, at $45/session, as success rates from this pilot may be utilized to determine if people improve faster with a combination of PTNS and education, or PTNS and a less aggressive treatment TTNS (Transcutaneous tibial nerve stimulation).
It is the acronym for transcutaneous tibial nerve stimulation. It does not involve needles, and instead utilizes electrode pads to stimulate the tibial nerve. It is generally considered much less effective than PTNS treatments as it stimulates the nerve more superficially. As a part of your treatment, your provider may be teaching you how to do this at home as an adjunct or as a maintenance program.
No serious adverse events are reported in clinical studies. Some examples of mild events include: Pain/discomfort at the puncture site (3.3%), minor bleeding/bruising at the needle site (0.9-2.7%), tingling in the leg or temporary numb feeling (0.9%), mild pain with pointing your toes, vasovagal response (passing out during needle placement: rare). PTNS is not for you if:
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