Hi friends, May is National Bike Month! You might be thinking, “That’s great, but what does National Bike Month have to do with my pelvic floor?” 7-8% of long-distance cyclists experience a pelvic floor disorder called pudendal neuralgia (Durante, 2010).
Pudendal neuralgia is an entrapment of the pudendal nerve that can cause severe/sharp pain, genital numbness, and erectile dysfunction in men (Chiaramonte, 2021). Cyclists are at an increased risks of developing pudendal neuralgia because of pressure from the bicycle seat. The pudendal nerve can be compressed between the bicycle seat and the pelvis. This is more likely with a forward-leaning posture (Chiaramonte, 2021).
Pudendal neuralgia causes severe pain but it is often misdiagnosed causing individuals to suffer up to 10 years (Durante, 2010).
The pudendal nerve is important because it provides sensation to the genitals and maintains tone in the pelvic floor to help maintain continence.
Pudendal neuralgia is often treated with conservative treatment, like pelvic floor therapy! (Chiaramonte, 2021) If you think you may be struggling with pudendal neuralgia, you can ask your provider for a referral to a pelvic floor therapist near you, or find one at www.mypfm.com/find-a-pt. A pelvic floor therapist can help to improve the symptoms of pudendal neuralgia including pelvic pain, incontinence, and sexual dysfunction. A physical therapist can also give you specific exercises to adjust technique and ensure proper body posture and mechanics (Chiaramonte).
If necessary, nerve blocks or surgical decompression may also be performed (Chiaramonte, 2021).
In addition to treating symptoms, it is important to fix the cause of pudendal neuralgia to prevent it from returning. Bicycle set up is important. Look for a specialist near you who is certified in proper bicycle fitting for recommendations specific to your individual needs.
Here are some general guidelines for a good fit:
Soft and wide seat
Seat horizontal and not inclined
No nose or a flexible nose on the saddle
Avoid saddles with cut-outs
Handlebar height lower than the saddle height
Avoid triathalon bars
Wear padded biking shorts
In addition to the bicycle is can be helpful to take breaks or shift into a higher gear and stand on the pedals periodically.
If you are a cyclist experiencing pudendal neuralgia, there is hope! Talk with your providers to determine the best treatment options for you.
To learn more about your pelvic floor, check out these great resources:
Understanding and Treating Pelvic Pain with Dr. Lauren Trosch, PT, DPT, OCS
Orthopedic Pelvic Assessment and Treatment for the Pelvic Pain Population with Dr. Kelli Wilson, PT, DPT, OCS, FAAOMPT
Written by Emily Reul, PT, DPT
Chiaramonte R, Pavone P, Vecchio M. Diagnosis, rehabilitation, and preventative strategies for pudendal neuropathy in cyclists, a systematic review. J Funt Morphol Kinesiol. 2021;6(2):42
Durante JA, MacIntyre IG. Pudendal nerve entrapment in an Ironman athlete: a case report. J Can Chiropr Assoc. 2010;54(4):276-281.