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Litzsinger's family is from Carmel, Indiana. She made her Broadway debut in 1983 at age eleven, as the understudy for Young Norma Jean in the short-lived Marilyn: An American Fable. In 1984, she played Bet in the Broadway revival of Oliver!, alongside Patti LuPone. She returned to New York City in 1992, at age eighteen, and was soon cast in the ensemble of Les Misérables, understudying the roles of Cosette and Eponine. She went on to star as The Narrator in the Canadian production and U.S. national touring companies of Joseph and the Amazing Technicolor Dreamcoat, with Donny Osmond. On December 2, 2000 she took over the role of Belle from Andrea McArdle in the Broadway production of Beauty and the Beast after playing it on the national tour and understudying the role on Broadway for a year. After playing Belle full time for nearly two years she left the show August 2002 and was succeeded by Jamie-Lynn Sigler. In August 2002, Sarah went right into rehearsal for Michel LeGrand's Amour on Broadway. She originated the role of Madeliene in the French musical fable. After Amour closed, Litzsinger returned to the role of Belle on February 11, 2003.
From May 30 - September 17, 2006, she once again appeared in Disney's Beauty and the Beast replacing Ashley Brown as Belle. Litzsinger holds the distinction of being Broadway's longest-running Belle.
In 2004, Litzsinger released a self-titled solo album.
She is also a member of the band TASTiSKANK, along with another Broadway actress, Kate Reinders. In 2007, they won the Breakout Award at the HBO Aspen Festival. They were also voted as two of the 25 Sexiest New Yorkers by the NY POST. Tastiskank performed their act at the 2008 TBS Comedy Festival in Las Vegas. Reinders and Litzsinger co-starred opposite Constantine Maroulis in an independent TV pilot called Teachers which aired at the fourth annual New York Television Festival.
In 2010, Litzsinger received a Wilde Award "Best Actress in a Musical" for her portrayal of Mrs. Lovett in Sweeney Todd, and most recently played 'Peter Pan' in Peter Pan at Alabama Shakespeare Festival.