Pelvic floor

Reducing saddle pain while riding

A guide for cyclists on avoiding pressure on the pudendal nerve.

Saddle pain, pelvic numbness, urinary changes, and changes in sexual function may be a sign that you are compressing your pudendal nerve while riding. General soreness is common with new riders and long distances, but once numbness or changes in urinary or sexual function occur, you are risking nerve trauma.

What the research shows

Stan Reents, PharmD, updated an article on bicycle seats at AthleteInMe.com on October 12, 2012. It reported these facts:

• Studies show that 35 to 81 percent of cyclists experience perineal (groin) and/or buttock pain after long-distance riding. It appears to be a more frequent complaint among women than men (Bressel E, et al. 2003).
• Pressures in the perineum while sitting on a bicycle seat can be 4 to 5 times higher than pressures known to cause pressure sores in bedridden patients (Lowe BD, et al. 2004).
• Sitting on a bicycle seat has been shown to drastically reduce blood supply to the penis, by as much as 70 percent in one study, whether riders were pedaling or just sitting. Blood flow returned to normal after a 10-minute recovery (Sommer F, et al. 2001).
• Competitive cyclists have developed numbness of the penis and scrotum, an altered sense of ejaculation, and disturbed urinary function after prolonged riding (Silbert PL, et al. 1991). This is thought to be due to irritation of the pudendal nerve from higher pressures in the perineal region, possibly leading to pudendal neuropathies (Oberpenning F, et al. 1994).
• Data from the Massachusetts Male Aging Study show that bicycling more than 3 hours per week was associated with erectile dysfunction (Marceau L, et al. 2001).

Self-help checklist

1. FitProper seat and bike alignment and fit, which may include lowering the nose of the seat, lowering the entire seat, and trying seats designed to reduce pressure. Newer split-nose seats reduce perineal pressure by 50 percent. Hobson seats (hobsonseat.com) significantly minimize perineal pressure for people with ongoing pelvic problems. One downside is that riders feel less overall control of the bike, but at least they can ride without causing further damage.
2. ShortsGood bicycle shorts or pants with padding.
3. FlexibilityGood flexibility of the hip and spine muscles reduces the overall pull and pressure on the pudendal nerve. Proper hamstring and buttock flexibility is essential.
4. Pelvic floorWell-functioning pelvic floor muscles. Tight pelvic floor muscles exacerbate compression on the pudendal nerve and can be a source of saddle soreness themselves. Already weakened pelvic floor muscles may feel the effects of diminished nerve supply more quickly, causing pelvic pressure, urinary urgency and frequency, and erectile dysfunction.
5. DecompressionOn long rides, change your position on the saddle frequently, ride with your hands on top of the handlebars, and stand frequently (several minutes for every 15 minutes of cycling). One study showed that blood flow to the penis improved after one minute of standing.
6. Get helpSee a physician and a physical therapist for ongoing problems that do not resolve with lower mileage, rest, and the suggestions above.