The US Food and Drug Administration approved sacral neuromodulation (SNM) in 1997 as a treatment option for patients with urge incontinence and in 1999 for urgency/frequency and nonobstructive urinary retention. SNM uses direct, continuous stimulation of the third sacral nerves through implantation of a pulse generator and electrode. Off-label use of neuromodulation has been used successfully in patients with interstitial cystitis/painful bladder syndrome. This review attempts to provide an update on SNM as an off-label management option for adults with interstitial cystitis based on the available clinical evidence concerning its efficacy. © 2012 Springer Science+Business Media, LLC.