(646) 355-8777

Herman & Wallace Blog

Using TENS to Treat Overactive Bladder in Parkinson's Patients

Tibial nerve stimulation has been shown in the literature to be effective for individuals experiencing idiopathic overactive bladder in randomized controlled trials. A systematic review was performed by Schneider, M.P. et al. in 2015 looking at safety and efficacy of its use in neurogenic lower urinary tract dysfunction. Many variables were examined in this review, which included 16 studies after exclusion. The review looked at:

Transcutaneous Electrical Nerve Stimulation Machine
  1. Acute stimulation (used during urodynamic assessment only)
  2. Chronic stimulation (6-12 weeks of daily-weekly use)
  3. Percutaneous or transcutaneous (frequencies, pulse widths, perception thresholds, durations)
  4. Urodynamic parameter changes baseline to post treatment
  5. Post void residual changes
  6. Bladder diary variables
  7. Patient adherence to tibial nerve stimulation
  8. Any adverse events

The exact mechanism of these types of neuromodulation stimulation procedures remains unclear, however it does appear to play a role in neuroplastic reorganization of cortical networks via peripheral afferents. No specific literature is currently available for the mechanism on action related to neurogenic lower urinary tract dysfunction. Different applications of neuromodulation however have been studied in the neurogenic populations.

One of the randomized controlled trials they report on included 13 people with Parkinson disease. The researchers looked at a comparison between the use of transcutaneous tibial nerve stimulation (n = 8) and sham transcutaneous tibial nerve stimulation (n=5). Transcutaneous tibial nerve stimulation (TTNS) or sham stimulation was delivered to the people with Parkinson disease 2x/week for 5 weeks, 30-minute sessions (10 total sessions). Unilateral electrode placement was utilized, first electrode applied below the left medial malleolus and second electrode 5 cm cephalad. Confirmation of placement was obtained with left great toe plantar flexion. It is important to note the use of the stimulation intensity is reduced to below the motor threshold during the active treatment to direct the stimulation via peripheral afferents.

Urodynamic testing was performed at baseline and post treatment and revealed statistically significant differences with greater volumes at strong desire and urgency in the TTNS group. Additionally, the TTNS group experienced a 50% reduction in nocturia whereas in the sham group nocturia frequency remained the same. A three-day bladder diary completed by each of the groups also revealed significant positive changes in frequency, urgency, urge urinary incontinence and hesitancy only in the TTNS group.

Conservative management of neurogenic bladder in populations such as Parkinson disease is very important. These individuals experience lower quality of life ratings related to lower urinary tract dysfunction, higher risk of falling with needs to rush to the bathroom, their caregivers experience a higher level stress and burden of care, and tolerance to anticholinergic medications is very poor with multiple unwanted side effects that compound and worsen other symptoms that might be present from the disease process.

Please join us for Neurologic Conditions and Pelvic Floor Rehab to learn how you can help your patients using this modality as one option. Participate in a lab session to learn electrode placement and other parameters to achieve best clinical results for your patients.


1. Perissinotto, M. C., D'Ancona, C. A. L., Lucio, A., Campos, R. M., & Abreu, A. (2015). Transcutaneous tibial nerve stimulation in the treatment of lower urinary tract symptoms and its impact on health-related quality of life in patients with Parkinson disease: a randomized controlled trial. Journal of Wound Ostomy & Continence Nursing, 42(1), 94-99.
2. Schneider, M. P., Gross, T., Bachmann, L. M., Blok, B. F., Castro-Diaz, D., Del Popolo, G., ... & Kessler, T. M. (2015). Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review. European urology, 68(5), 859-867.

Superior Gluteal Nerve: Such a Pain in the Butt
A Healing Journey around Boundaries, Self-Care and...

Upcoming Continuing Education Courses

Male Pelvic Floor - San Diego, CA (Postponed)

Dec 4, 2020 - Dec 6, 2020
Location: FunctionSmart Physical Therapy

Chronic Pelvic Pain - Medford, OR (Postponed)

Dec 4, 2020 - Dec 6, 2020
Location: Asante Rogue Valley Medical Center

Pediatric Functional Gastrointestinal Disorders - Ann Arbor, MI (Postponed)

Dec 4, 2020 - Dec 6, 2020
Location: Michigan Medicine

Sacral Nerve Manual Assessment and Treatment - Madison, WI (NOW REMOTE)

Dec 4, 2020 - Dec 6, 2020
Location: SSM Health

Yoga for Pelvic Pain - Phoenix, AZ (Postponed)

Dec 5, 2020 - Dec 6, 2020
Location: St. Joseph's Hospital - Phoenix

Yoga for Pelvic Pain - Remote Course (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: Replacement Remote Course

Male Pelvic Floor - Satellite Lab Course

Dec 5, 2020 - Dec 6, 2020
Location: Replacement Remote Course

Male Pelvic Floor - San Diego, CA Satellite Location (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: FunctionSmart Physical Therapy

Male Pelvic Floor - Washington, DC Satellite Location

Dec 5, 2020 - Dec 6, 2020
Location: Georgetown University Hospital

Pelvic Floor Level 1 - Satellite Lab Course

Dec 5, 2020 - Dec 6, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Little Rock, AR Satellite Location (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: Core Pelvic Physical Therapy

Pelvic Floor Level 1 - Burlington, WA Satellite Location (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: Northwest Physical Therapy

Pelvic Floor Level 1 - Self-Hosted (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: Self-Hosted Course

Pelvic Floor Level 1 - Canton, OH Satellite Location (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: Mercy Hospital

Male Pelvic Floor - Minneapolis, MN Satellite Location (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: Fairview Institute of Athletic Medicine

Pelvic Floor Level 1 - Medford, OR Satellite Location (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: Asante Rogue Valley Medical Center

Male Pelvic Floor - Self Hosted

Dec 5, 2020 - Dec 6, 2020
Location: Self-Hosted Course

Pelvic Floor Level 2A - New Orleans, LA Satellite Location

Dec 5, 2020 - Dec 6, 2020
Location: Ochsner Therapy and Wellness/Ochsner Health System

Pelvic Floor Level 2A - Self-Hosted

Dec 5, 2020 - Dec 6, 2020
Location: Self-Hosted Course

Pelvic Floor Level 2A - New Orleans, LA (SOLD OUT)

Dec 5, 2020 - Dec 6, 2020
Location: Ochsner Health System

Pediatric Functional Gastrointestinal Disorders - Remote Course

Dec 5, 2020 - Dec 6, 2020
Location: Replacement Remote Course

Pelvic Floor Series Capstone - Washington, DC (POSTPONED)

Dec 12, 2020 - Dec 13, 2020
Location: The George Washington University

Pelvic Floor Level 1 - Tallahassee, FL (Postponed)

Dec 12, 2020 - Dec 13, 2020
Location: Tallahassee Memorial HealthCare

Breathing and the Diaphragm - Remote Course

Dec 12, 2020 - Dec 13, 2020
Location: Replacement Remote Course

Manual Therapy for the Abdominal Wall - Remote Course (SOLD OUT)

Dec 12, 2020
Location: Short Form Remote Course

Pelvic Floor Capstone - Washington, DC Satellite Location

Dec 12, 2020 - Dec 13, 2020
Location: Georgetown University Hospital

Pelvic Floor Capstone - East Norriton, PA Satellite Location

Dec 12, 2020 - Dec 13, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Capstone - Salt Lake City, UT Satellite Location

Dec 12, 2020 - Dec 13, 2020
Location: Pagnani Physical Therapy

Pelvic Floor Capstone - Self-Hosted

Dec 12, 2020 - Dec 13, 2020
Location: Self-Hosted Course

Pelvic Floor Capstone - Greenville, SC Satellite Location (Postponed)

Dec 12, 2020 - Dec 13, 2020
Location: Restore Pelvic Health and Wellness