Stylized illustration of sacral nerves glowing with relief.

Sacral Nerve Stimulation: A New Hope for Pelvic Pain Relief?

Mira Elwood in Health & Wellness June 2025 • 3 min read.

"Exploring the anterograde sacral hiatus approach to alleviate chronic pelvic pain when traditional methods fall short."

Chronic pain can be a relentless adversary, significantly diminishing the quality of life for millions. Among the various types of chronic pain, pelvic pain stands out due to its complexity and the challenges it presents in diagnosis and treatment. Spinal cord stimulation (SCS) has emerged as a valuable tool in managing various chronic pain conditions since 1967, offering hope when other treatments prove ineffective.

Sacral nerve stimulation, a specialized form of SCS, has been utilized to address conditions like peroneal pain and irritable bowel syndrome through a retrograde approach. However, anatomical obstacles or prior surgeries can sometimes impede the successful advancement of leads using this method. In such cases, an alternative approach becomes necessary to provide effective pain relief.

This article delves into a promising technique: anterograde sacral nerve stimulation through the sacral hiatus. This method offers a new pathway to access the sacral nerves, potentially providing relief for individuals with intractable chronic pelvic pain when traditional approaches are not feasible. We will explore the procedure, its benefits, and its role in the evolving landscape of pain management.

The Anterograde Sacral Hiatus Approach: A Step-by-Step Guide

Stylized illustration of sacral nerves glowing with relief.

The anterograde sacral nerve stimulation technique involves accessing the sacral nerves through the sacral hiatus, an opening at the lower end of the sacrum. This approach is performed with the patient in a prone position, allowing the physician to visualize the area using fluoroscopy, a type of real-time X-ray.

Here’s a breakdown of the procedure:

Needle Insertion: A Tuohy needle is carefully inserted into the sacral hiatus under fluoroscopic guidance.
Lead Placement: Percutaneous leads are then passed through the needle and advanced into the posterior sacral epidural space. The leads are positioned to target specific sacral nerve roots responsible for the patient's pain.
Lead Anchoring: To secure the leads and prevent migration, a small incision is made, and the leads are anchored to the surrounding tissues.
IPG Implantation: A rechargeable implantable pulse generator (IPG) is placed in a subcutaneous pocket, typically in the upper buttock area. The leads are then connected to the IPG, which delivers controlled electrical pulses to the sacral nerves.

This meticulous approach allows for targeted stimulation of the sacral nerves, potentially disrupting pain signals and providing significant relief. The procedure is carefully monitored to ensure accurate lead placement and minimize the risk of complications.

A Promising Alternative for Intractable Pelvic Pain

While the anterograde sacral nerve stimulation through the sacral hiatus presents some challenges, it offers a valuable alternative for patients with intractable chronic pelvic pain when traditional methods are not viable. Further research and refinement of this technique may expand its application and improve outcomes for individuals seeking relief from debilitating pelvic pain.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3344/kjp.2012.25.3.195, Alternate LINK

Title: Sacral Nerve Stimulation Through The Sacral Hiatus

Subject: Anesthesiology and Pain Medicine

Journal: The Korean Journal of Pain

Publisher: Korean Pain Society

Authors: Chan Hong Park, Bong Il Kim

Published: 2012-07-31

Everything You Need To Know

What does anterograde sacral nerve stimulation through the sacral hiatus involve?

Anterograde sacral nerve stimulation is a method of accessing the sacral nerves through the sacral hiatus, which is an opening at the lower end of the sacrum. This involves the insertion of a Tuohy needle into the sacral hiatus under fluoroscopic guidance, followed by the placement of percutaneous leads into the posterior sacral epidural space. These leads are then connected to an implantable pulse generator (IPG) that delivers electrical pulses to the sacral nerves to disrupt pain signals.

How does anterograde sacral nerve stimulation relate to spinal cord stimulation and sacral nerve stimulation?

Spinal cord stimulation (SCS) has been used since 1967 to manage various chronic pain conditions, offering hope when other treatments are ineffective. Sacral nerve stimulation, a specialized form of SCS, has been utilized to address conditions like peroneal pain and irritable bowel syndrome through a retrograde approach. The anterograde sacral nerve stimulation through the sacral hiatus is considered when the retrograde approach is not feasible due to anatomical obstacles or prior surgeries.

What steps are taken to ensure the leads stay in place, and how does the implantable pulse generator function in anterograde sacral nerve stimulation?

In the anterograde sacral nerve stimulation technique, after the Tuohy needle is inserted and the percutaneous leads are advanced, the leads are anchored to the surrounding tissues via a small incision to prevent migration. Then, a rechargeable implantable pulse generator (IPG) is placed in a subcutaneous pocket, typically in the upper buttock area, and connected to the leads. The IPG delivers controlled electrical pulses to the sacral nerves.

When is the anterograde sacral hiatus approach considered, and why is it beneficial for specific patients?

The anterograde sacral hiatus approach is considered a viable alternative for individuals experiencing intractable chronic pelvic pain when traditional methods are not effective. This technique allows physicians to access the sacral nerves through a different pathway, potentially providing relief for those who cannot benefit from the standard retrograde approach due to anatomical limitations or previous surgical interventions. However, it's important to note that further research is needed to expand its application and improve outcomes.

What are the key benefits of using anterograde sacral nerve stimulation, and why is this important for pain management?

The primary benefit of anterograde sacral nerve stimulation is that it offers a new pathway to access the sacral nerves, potentially providing relief for individuals with intractable chronic pelvic pain when traditional approaches are not feasible. It is important because it addresses a gap in treatment options for those who cannot undergo the retrograde approach due to anatomical obstacles or prior surgeries, which is important to pain management. While this procedure can lead to improved quality of life, it is essential to note that results may vary, and further research is crucial to refining the technique and expanding its application.