Posterior Tibial Nerve Stimulation (PTNS)

What is Posterior Tibial Nerve Stimulation (PTNS)?

Posterior tibial nerve stimulation (PTNS) is an advanced nerve-based therapy used to help children with serious problems of bowel or bladder control that have not improved with standard treatments. It uses small, controlled pulses of electricity delivered near a nerve at the ankle — the posterior tibial nerve — which connects to the sacral nerves in the lower spine that help control bladder and bowel function.

Because PTNS for children is still a newer treatment and most research has focused on adults, only a small number of pediatric centers in the United States currently offer it, and even fewer have the specialized equipment and expert teams needed to use it safely and effectively in growing children. Nationwide Children’s Hospital is one of these centers and has been a pioneer in the use neurostimulation therapies for children.

What Does PTNS Treat?

In children, PTNS is used for bowel and bladder symptoms that have not responded to usual care such as medicines, diet changes, pelvic floor therapy or biofeedback. These may include:

• Functional constipation and difficulty passing stool
• Fecal incontinence (leaking stool or “accidents”)
• Pelvic floor dyssynergia (the muscles of the pelvic floor not relaxing at the right time)
• Overactive bladder or other lower urinary tract symptoms, such as urgency, frequency and urine leakage

Studies in children suggest that PTNS can improve stool consistency, fecal incontinence and other symptoms of constipation, and can also help children with overactive bladder who have not improved on medications.

Your child’s care team may consider PTNS if symptoms are severe, long-lasting and interfering with school, sleep, activities or emotional health, despite careful use of other therapies.

How Does PTNS Work?

The posterior tibial nerve runs behind the ankle and connects to the same group of nerves in the lower spine (sacral nerve roots) that help control bowel and bladder muscles. When gentle electrical stimulation is applied at the ankle, signals travel up this nerve to the sacral area. This can “reset” or modulate how these nerves send signals to the bowel and bladder.

Over time, this repeated stimulation can improve how the muscles of the pelvic floor and lower bowel work together, helping children have more regular bowel movements, fewer accidents and better control.

What Happens Before PTNS?

Before recommending PTNS, your child will be evaluated in the Neurogastroenterology and Motility Disorders Center at Nationwide Children’s. This may include:

• Detailed history of bowel and bladder symptoms
• Physical exam
• Review of past treatments such as medicines, diet changes and behavioral plans
• Specialized motility testing or imaging, if needed, to understand how your child’s bowel and pelvic floor are working

Because PTNS is usually used after other treatments have not worked well enough, your child’s team will confirm that all appropriate standard therapies have been tried and that PTNS is a good next step.

Your child’s doctor will explain how PTNS works, how many sessions are planned, possible side effects, and whether your child may be eligible for any clinical research studies using PTNS at Nationwide Children’s.

What Happens During PTNS?

PTNS is done in a clinic setting and does not require anesthesia. Your child remains awake and can usually read, watch a show or listen to music during the session.

• A very thin needle or small stick-on electrodes are placed near the ankle, close to the posterior tibial nerve.
• These are connected to a stimulator device that sends mild electrical pulses through the nerve.
• The intensity is slowly adjusted to a level your child can feel but that is still comfortable — often felt as a tingling in the ankle, foot or toes.
• Each treatment session usually lasts about 30 minutes.

Most treatment plans involve a series of visits, often weekly, over several weeks. Research shows that PTNS is generally safe and well tolerated in children, with minimal side effects. The most common issues are mild redness, temporary soreness or tingling at the site of stimulation, which usually go away quickly.

What Happens After PTNS?

After each session, your child can return home and resume normal activities. There are no restrictions on eating, drinking or going to school the next day.

Over the course of treatment, your child’s team will track:

• Number and ease of bowel movements
• Stool consistency
• Episodes of fecal or urinary incontinence
• Any pain, urgency or difficulty with toileting

Some children notice improvement within a few weeks, while others improve more slowly over the full course of treatment. In some cases, “booster” sessions may be recommended later to help maintain the benefit.

Because PTNS is part of a comprehensive plan, your team may also adjust medicines, diet, pelvic floor exercises and behavioral strategies to give your child the best chance of success.

Why Nationwide Children’s Hospital?

At Nationwide Children’s, posterior tibial nerve stimulation (PTNS) is offered through our Neurogastroenterology and Motility Disorders Center, one of the few high-volume pediatric centers with the expertise and equipment to provide this advanced therapy for both bowel and bladder symptoms.

Families travel from across the country for our experience in complex motility and gut–brain interaction disorders. Your child’s care is coordinated by a multidisciplinary team — pediatric gastroenterology, urology, psychology, pelvic floor therapy, nursing and nutrition — using state-of-the-art motility testing and evidence-based treatment pathways. We are also leading clinical trials of PTNS for children with difficult-to-treat constipation and pelvic floor problems, giving families access to therapies that are not widely available. With child-focused facilities, pediatric-trained staff and a strong focus on long-term follow-up, we work to improve your child’s comfort, confidence and quality of life so they can return to school, activities and everyday childhood.