Electrical Nerve Stimulation for Overactive Bladder a Comparison of Treatments

Inclusion Criteria: * Female * Age \>18 years * Predominant complaint urge urinary incontinence (3 or more episodes per week) OR overactive bladder (8 or more voids per day, and/or 2 or more voids per night) * Failed trial of conservative therapy (bladder training, fluid modification, diet modification, caffeine restriction, pelvic floor training) * Failed trial of anticholinergic either due to inability to take the medication, adverse reaction to medication, or no improvement on medication * Willing and mentally competent to participate in study * Willing to complete study questionnaires * No contraindications to undergoing PTNS or TENS therapy Exclusion Criteria: * Age \< 18 years * Presence of urinary fistula * Male. (Males will be excluded because of the different etiology of overactive bladder for males which is primarily caused by prostate problems for men versus the primarily idiopathic cause in women). * Recurrent or current urinary tract infection (5 or more infections in the last 12 months) * Bladder stones * Bladder cancer or suspected bladder cancer * Hematuria * Pregnancy or planning to become pregnant during the study (urine pregnancy test will be administered to those who are premenopausal and who have not had a hysterectomy) * Central or peripheral neurologic disorders such as Multiple Sclerosis, Parkinson's disease, spina bifida, or other spinal cord lesion * Metal implants such as pacemaker, implantable defibrillator, or metal implants where PTNS or TENS device needs to be placed (sacrum or ankle/leg). * Uncontrolled diabetes * Diabetes with peripheral nerve involvement * On anticoagulants * Current use of anticholinergics or use within the last 4 weeks * Current use of botox bladder injections or bladder botox injection within the last year * Current use of interstim therapy or currently implanted interstim device or leads * Bladder outlet obstruction * Urinary retention or gastric retention * Painful Bladder Syndrome/Interstitial Cystitis