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PTNS - calming the bladder from the ankle.

A drug-free treatment for overactive bladder and urge incontinence: thirty minutes of gentle nerve stimulation, once a week for twelve weeks. NICE-recommended, no anaesthetic, no downtime - and honest numbers on how often it works.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What PTNS costs in the UK.

Indicative ranges across our partner continence clinics.

In short

The full 12-week course: £1,800–£2,800 - each session 30 minutes, no downtime.

Item Indicative range
PTNS single session £150–£250
PTNS full 12-week course £1,800–£2,800
Maintenance (top-up) session £150–£250
Continence assessment with bladder diary review £200–£400
Urodynamics (where needed) £800–£1,500
Transcutaneous (home TTNS) starter package £250–£500

Urodynamics is only added where the diagnosis genuinely needs it.

The problem

Millions manage a bladder that could be treated.

Overactive bladder gets normalised - pads, mapped toilets, declined invitations. Between failed tablets and surgery there is a middle step most people are never offered. This is it.

  • The gap in the ladder

    Bladder training, then tablets, then… silence, until someone mentions Botox or an implant. PTNS is the evidence-backed rung in between that provision often skips.

  • Tablets are not free of cost

    Dry mouth, constipation - and in older patients, mounting concern over anticholinergics and cognition. A drug-free option is not a luxury; sometimes it is the safer choice.

  • Measured, not guessed

    A bladder diary before, at week six and at week twelve turns "I think it is a bit better" into numbers - so continuing, maintaining or escalating is a decision, not a drift.

When it helps

When PTNS is the right step.

The situations we see most, plus the one red flag that means investigation before any stimulation.

  • Overactive bladder - the classic case

    Urgency, frequency and rushing for the loo, with or without leaks, when bladder training and fluid advice have not been enough.

  • Urge incontinence

    Leaking on the way to the toilet. PTNS reduces leak episodes meaningfully in roughly six out of ten of the right patients.

  • Medication side-effects or failure

    Anticholinergics causing dry mouth, constipation or brain fog - or mirabegron simply not working. PTNS is the drug-free next step.

  • Older patients avoiding anticholinergics

    Growing evidence links long-term anticholinergics to cognitive decline. PTNS side-steps the issue entirely - often the deciding factor over 65.

  • Faecal incontinence

    The same nerve pathway influences the bowel. PTNS is an option for bowel leakage when conservative measures have failed.

  • Not ready for Botox or an implant

    Bladder Botox needs repeating and can cause retention; sacral neuromodulation is an implanted device. PTNS is the gentlest thing left to try first.

  • Night-time frequency (nocturia)

    Waking twice or more to pass urine, when driven by an overactive bladder rather than heart, kidney or prostate causes - which assessment separates out.

  • Red flag: blood in the urine

    Visible blood, or urgency with pain, weight loss or recurrent infections needs a bladder investigation first - cystoscopy, not a stimulation course.

Treatment options

How PTNS works, and where it sits on the ladder.

The mechanism and course structure - and the honest comparison with the treatments either side of it.

  • What PTNS actually is

    A fine needle near the ankle stimulates the posterior tibial nerve, which shares spinal roots (S2–S4) with the nerves controlling the bladder - quietening the misfiring reflex over weeks.

  • The 12-week induction course

    Thirty minutes weekly for twelve weeks. Benefit typically emerges from week four to six and consolidates through the course - patience is part of the prescription.

  • Maintenance sessions

    The effect fades without occasional reinforcement. Responders settle into a top-up every four to eight weeks, tuned to symptoms.

  • Transcutaneous version (TTNS)

    Surface electrode pads instead of a needle, usable at home. Weaker evidence than needle PTNS, but a reasonable option where weekly clinic visits are impractical.

  • Implantable tibial stimulators

    A new generation of coin-sized devices implanted at the ankle delivers stimulation without weekly visits - an emerging option in specialist UK centres.

  • Versus bladder Botox

    Botox is more potent but needs repeating every 6–12 months and carries a retention risk requiring self-catheterisation in a minority. PTNS trades power for gentleness.

  • Versus sacral neuromodulation

    SNM implants a pacemaker-like device at the base of the spine - highly effective, but surgery. A good PTNS response predicts SNM benefit, making PTNS a sensible trial run.

  • Versus continuing medication

    PTNS matches anticholinergic effectiveness in trials, without dry mouth, constipation or cognitive concerns. Many patients combine a low drug dose with maintenance PTNS.

Safety and effectiveness

What to expect - honestly.

PTNS is one of the safest treatments in urology. The honest conversation is about commitment and response rates, not complications.

  • No anaesthetic, no theatre, no recovery

    PTNS is an outpatient treatment in ordinary clothes. You walk in, sit for thirty minutes, and walk out - driving, work and exercise all unaffected.

  • The needle is genuinely minor

    A 34-gauge needle - finer than most acupuncture needles - placed a few centimetres above the ankle. Most people describe a tapping or tingling in the foot, not pain.

  • Side-effects are rare and mild

    Occasional bruising, tingling or mild discomfort at the needle site, settling within hours. Serious adverse events are vanishingly rare in published series.

  • Who should not have it

    Pacemakers and implanted defibrillators (relative caution), pregnancy, significant leg lymphoedema or broken skin at the site, and some neuropathies. All screened at assessment.

  • Effectiveness, honestly stated

    Around 55–70 percent of well-selected patients report meaningful improvement in urgency and leaks - genuinely good for this condition, but not a promise. The bladder diary keeps everyone honest.

  • The commitment is the real cost

    Twelve weekly visits is a genuine undertaking. Patients who struggle to attend weekly do better choosing TTNS at home or a different treatment - we say so upfront.

  • NICE-recommended, with a caveat

    NICE supports PTNS for overactive bladder when conservative measures and medication have failed or are unsuitable - the same criteria we apply before recommending it.

  • It is not permanent - by design

    Stimulation modulates nerves; it does not alter anatomy. Stop entirely and symptoms drift back over months - which is also why it is so safe to simply try.

  • New pain, burning urine, fever or blood in the urine between sessions deserves prompt review - usually an infection, occasionally something needing investigation.

Reading your treatment record

Your treatment record in four parts. Read the last one first.

Across twelve sessions the record builds week by week - and it keeps to the same shape throughout.

A UK continence specialist reviewing a patient’s PTNS treatment record

A quiet reminder

Bladder diaries and stimulation notes can read like spreadsheets - we translate them for you.

If you would like us to talk you through your diary numbers and what they mean for the next step, just ask.

  1. 01 Header

    Diagnosis and baseline

    The working diagnosis - overactive bladder, urge incontinence, faecal incontinence - and your baseline bladder diary numbers: voids, urgency episodes, leaks, night-time waking.

  2. 02 Technique

    Stimulation parameters and tolerance

    Needle site, stimulation amplitude, and how each session was tolerated - the details that let any trained practitioner continue your course seamlessly.

  3. 03 Findings

    Response at mid-course and completion

    The repeat diary at week six and week twelve, set against baseline - the objective answer to whether PTNS is working for you.

  4. 04 Impression

    Maintenance plan or next step

    Read this first: the top-up interval if you responded, or the recommended escalation - Botox, sacral neuromodulation - if you did not, with our honest steer.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

PTNS is commonly covered when medication has failed or is unsuitable - it is a NICE-supported treatment. Maintenance sessions vary by policy.

Frequently asked

Everything we get asked about PTNS.

Quick answers on how it works, whether it hurts, results, cost and NHS availability.

  • How does stimulating the ankle help the bladder?

    The posterior tibial nerve, which passes just behind the ankle bone, arises from the same sacral nerve roots (S2–S4) that control the bladder. Stimulating it sends signals back to those spinal segments and gradually dampens the overactive reflexes that cause urgency and leaks. It is the same principle as sacral neuromodulation, reached through a far less invasive route.

  • Does PTNS hurt?

    Very little. The needle is finer than most acupuncture needles and sits a few centimetres above the ankle. When the stimulator is switched on you feel a tingling or gentle tapping spreading into the sole or toes - the sign the nerve is being reached. Most patients read, work or watch something on their phone through the half-hour.

  • How effective is PTNS for overactive bladder?

    In randomised trials and real-world series, roughly 55–70 percent of appropriately selected patients achieve a meaningful reduction in urgency, frequency and leak episodes - comparable to bladder medications but without their side-effects. Improvement usually appears between weeks four and six, which is why the course runs to twelve: judging it at week three is judging it too early.

  • How long do the results last?

    The effect is real but not permanent - stop stimulation entirely and symptoms typically return over several months. Responders therefore move onto maintenance: a single thirty-minute top-up every four to eight weeks, adjusted to symptoms. Many patients hold their improvement for years on this rhythm.

  • How much does PTNS cost privately in the UK?

    Around £150–£250 per session, or £1,800–£2,800 for the full twelve-week induction course in 2026, plus £200–£400 for the initial continence assessment. Maintenance runs at one session every four to eight weeks. Insurers frequently cover PTNS when medication has failed, and we pre-authorise before you commit.

  • Is PTNS available on the NHS?

    Yes - NICE recommends PTNS for overactive bladder when conservative measures and medication have not worked or are unsuitable, and many NHS continence services offer it. Provision is patchy, though: some areas have long waits and others no service at all, which is the usual reason patients come to us. The private course also guarantees the same practitioner weekly, which matters for consistency.

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