Pain Condition
Sacral Nerve Irritation
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
The pain sits low, in the buttocks, around the tailbone, or down the backs of the thighs. It may burn or tingle, and it might come with changes in bladder, bowel or sexual function. Sitting makes it worse. The sacral nerves connect the lower spine to the pelvis and legs, and when they are irritated, symptoms can show up in several places at once.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
Understanding Sacral Nerve Irritation
The sacral nerves exit the base of the spine through openings in the sacrum. They supply the buttocks, the back of the thighs, the perineum and genitals, and they help control the bladder, bowel and sexual function. The pudendal nerve is formed from sacral nerve roots.
Sacral nerves can be irritated by disc problems at the lowest levels of the spine, by Tarlov cysts, by falls onto the tailbone, by sacroiliac joint problems, and by tight muscles in the buttock and pelvic floor that surround them after they exit. Symptoms can include burning, tingling or aching in the buttocks and thighs, tailbone pain, sitting pain, and bladder, bowel or sexual symptoms.
Because some causes need medical evaluation and imaging, your physician should be involved, especially with new bladder or bowel changes. Dr. Gordon treats the muscle and nerve contributors in the buttock, sacrum and pelvic floor.
Sacral Nerve Irritation at a Glance
Also called
Sacral radiculopathy, sacral nerve root irritation
Where it is felt
Buttocks, tailbone, back of the thighs, perineum, genitals
Possible sources
Low disc problems, Tarlov cysts, falls, SI joint, buttock and pelvic floor tension
Associated symptoms
Sitting pain, bladder, bowel or sexual changes
Important
New loss of bladder or bowel control is an emergency
The Gap in Care
What Tests Check, and What They Can Miss
Sacral nerve symptoms are easy to split into separate problems: back pain, tailbone pain, bladder symptoms. Connecting them to the sacral nerves changes the treatment approach.
What routine testing is looking for
- Disc herniation at the lowest spinal levels
- Tarlov cysts on MRI
- Cauda equina compression
- Sacral fractures
What often keeps symptoms going
- Tight buttock muscles around exiting sacral nerves
- Pelvic floor tension along the pudendal nerve
- SI joint irritation near the nerve roots
- Tailbone and sitting pressure
- Nerve sensitivity after injury
These are found by tracing the sacral nerves from the spine into the pelvis and legs.
Signs & Symptoms
Does This Sound Like You?
Symptoms vary from person to person. These are the patterns Dr. Gordon sees most often.
Buttock burning or aching
Burning, tingling or deep aching in one or both buttocks.
Tailbone pain
Pain around the tailbone, especially sitting.
Back of thigh symptoms
Tingling or aching down the backs of the thighs.
Sitting intolerance
Symptoms building quickly with sitting.
Bladder or bowel changes
Urgency, frequency or changes in sensation.
Genital or perineal symptoms
Burning, numbness or altered sensation.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one of these in play. Finding which one leads makes treatment more efficient.
Spinal sources
Disc problems or cysts at the sacral levels can irritate nerve roots, which your physician evaluates.
Buttock muscle tension
Tight gluteal and piriformis muscles surround the sacral nerves after they exit.
Pelvic floor tension
The pudendal nerve, formed from sacral roots, runs through the pelvic floor.
Sitting and tailbone load
Direct pressure from sitting aggravates the nerves.
Your First Visit
How Dr. Gordon Evaluates Sacral Nerve Irritation
The initial evaluation runs 60 to 75 minutes. You leave with a clear picture of what is driving your symptoms, a written plan, a realistic timeline, and in most cases your first treatment.
- 1
Records and history review
Dr. Gordon reviews your imaging, including any sacral or lumbar MRI, and your bladder, bowel and nerve history.
- 2
Nerve tracing
Dr. Gordon traces the sacral and pudendal nerves through the buttock, sacrum and pelvis.
- 3
Neurological screen
Dr. Gordon checks sensation, strength and reflexes in the legs and saddle area.
- 4
Buttock and sacral assessment
Hands-on assessment of the gluteals, piriformis, sacrum and tailbone.
- 5
Plan and coordination
A clear plan, plus communication with your physician, orthopedist or physical therapist when that helps your care.
When to see a physician first
- New weakness, numbness or tingling that is spreading or getting worse
- Numbness in the saddle area or loss of bladder or bowel control
- Back pain with fever, chills or unexplained weight loss
- Pain after a significant fall or accident
- Back pain with a history of cancer
- Severe pain at night that does not change with position
If you have any of these, contact your doctor or go to the nearest emergency department.
Bring to your first visit
Records
Recent lab results, imaging reports and specialist notes. These can also be faxed ahead.
Treatment history
A short list of what you have tried and what did or did not help.
Clothing
Something comfortable and loose fitting.
Treatment
How Dr. Gordon Treats It
These are the tools Dr. Gordon uses most often for sacral nerve irritation, chosen from your exam findings.
Orthopedic Dry Needling
Dr. Gordon has used dry needling for more than 18 years. Treatment releases the buttock, piriformis and deep hip muscles surrounding the sacral nerves.
See all servicesNeuro-Functional Acupuncture
Electro-acupuncture along sacral nerve pathways, which are also involved in bladder and bowel regulation, to calm irritation.
See all servicesSitting Plan & Team Coordination
Sitting and activity guidance, coordinated with your physician, neurologist or pelvic floor PT.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Find the main driver
Dr. Gordon confirms which muscles and nerves are behind your symptoms and starts calming the most reactive areas. Many people notice early changes between visits.
Lower the baseline
Day-to-day symptoms ease, flares become shorter and less frequent, and normal routines start to feel more manageable.
Build resilience
Visits are spaced out as improvement holds. You leave with a maintenance and early-flare plan.
Most patients are seen weekly or every other week during active care. Individual results vary with how long symptoms have been present and how reactive they are. Progress is reassessed at every visit.
Not sure how to describe it? Put your pain or discomfort into words before your visit
Of all the doctors I have met with Doctor G.has been the most kind, caring, empathetic and patient. I feel like most doctors don't listen but Dr. G took the time to make sure I was heard.DRIGO music, Google Review
Sacral Nerve Irritation Questions
Answers About Sacral Nerve Irritation
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
Before You Book
General Questions
About Dr. Anthony J. Gordon
Dr. Anthony J. Gordon is a Doctor of Acupuncture licensed in New York and board certified. He holds ASE certification in intrapelvic and extrapelvic dry needling, along with advanced certifications in Functional Dry Needling and Neuro-Functional Acupuncture. With more than 18 years of clinical experience and over 3,000 complex cases treated, he focuses on pelvic, spinal and orthopedic conditions that have not responded to standard care, and works closely with each patient's physicians and physical therapists.
Read Dr. Gordon's full bioBook an Evaluation for Sacral Nerve Irritation
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