# Pudendal Neuralgia or 'cyclist syndrome'



## octave (May 11, 2014)

this is about to get personal, but i think awareness of these kinds of things are important for the cycling community.

Pudendal nerve entrapment in an Ironman athlete: a case report

i am currently experience many of the symptoms discussed in the above article, namely pain in the tip of my penis and feelings of incontinence and urge to pee all the time even after having just peed.... and all this cropped up after having a proper fit on my bike with the Fizik Aliante Versus X fancy cut-out pressure relieving saddle. so, even if they claim pressure relief, beware. that might not always be the case. i am going to be trying specialized's Power saddle as soon as this clears up.

in any case, if anyone is experiencing pain, don't just say HTFU. after a few visits to my general physician, i am going in to the urologist on thursday.


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## Keoki (Feb 13, 2012)

You just have to HTFU


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## Fredrico (Jun 15, 2002)

octave said:


> this is about to get personal, but i think awareness of these kinds of things are important for the cycling community.
> 
> Pudendal nerve entrapment in an Ironman athlete: a case report
> 
> ...


Level that saddle! Put weight on the sit bones; tilt the hips back just enough to ease the pressure in the crotch. Too much pressure on the crotch is the problem, plain and simple. One can ride on most saddles simply by positioning on the saddle so that the pressure is dissipated over the entire area, mainly on the sit bones. No reason the taint has to take all the punishment. 

Also lower the saddle 1 cm. and see if that helps. In fact if you've got problems no matter what saddle, its probably too high.


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## tvad (Aug 31, 2003)

I think I had condition a month ago. It hasn't returned, but it sure freaked me out for a week or so. Never felt anything like it while on the bike.


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## kookieCANADA (Jan 20, 2011)

I was never officially diagnosed with that condition but experienced sever pain after riding a stationary bike that was hard as a rock with no cut out. I couldn't even sit down and walking was painful. I literally walked around with my hand down my pants. I went to see my doctor and did an ultrasound. They didn't find anything and just said to stay off the bicycle for a while and take Advil.


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## 9W9W (Apr 5, 2012)

tvad said:


> I think I had condition a month ago. It hasn't returned, but it sure freaked me out for a week or so. Never felt anything like it.


then I take it you haven't pleasured yourself with a left numb/asleep hand, eh?

The saddle too high advice is probably spot on for 8 out of 10 sufferers. I myself ride a hard saddle with no pressure relief gizmos, there's no excess pressure anywhere. I'm not hard, I'm a softy cube dweller. For most folks, it has to be the fit.

I'll take a flaming tip over Pes Anserine Bursitis anyday.. that shyt will [BLEEP] you up for a week and then some.


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## octave (May 11, 2014)

Fredrico said:


> Level that saddle! Put weight on the sit bones; tilt the hips back just enough to ease the pressure in the crotch. Too much pressure on the crotch is the problem, plain and simple. One can ride on most saddles simply by positioning on the saddle so that the pressure is dissipated over the entire area, mainly on the sit bones. No reason the taint has to take all the punishment.
> 
> Also lower the saddle 1 cm. and see if that helps. In fact if you've got problems no matter what saddle, its probably too high.


funny thing is, if i lowered the saddle from where it was, even if i lowered it 2mm, it was instant knee pain. that height was my sweet spot for ages (as verified by my fitter) and i was just testing the Fizik to try and eliminate saddle rub to the rear of my thighs where they connect to my glutes. saddle was dead level... i honestly just think that saddle had it out for me. it hurt a bit, but i thought it was just my nether slab getting used to a new shape and the super deep cutout on the Fizik.

but, who knows, maybe my issue has nothing to do with saddle fit. i will find out more tomorrow!


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## octave (May 11, 2014)

kookieCANADA said:


> I was never officially diagnosed with that condition but experienced sever pain after riding a stationary bike that was hard as a rock with no cut out. I couldn't even sit down and walking was painful. I literally walked around with my hand down my pants. I went to see my doctor and did an ultrasound. They didn't find anything and just said to stay off the bicycle for a while and take Advil.


yeah that sounds about like me! not the no cutout saddle, stationary bike bit, but walking around with my hand down my pants... fml, man. maybe they will do an ultrasound on me and tell me just to stay off the bike, too. i don't mind that as long as it goes away and i can get back on. i have been off the bike now for 8 days. it is getting better, for sure.


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## ibericb (Oct 28, 2014)

I tried two Fiziks, an Alliante and an Antares. Neither worked for me, at all. Fizik is not for everyone. Keep searching.


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## octave (May 11, 2014)

ibericb said:


> I tried two Fiziks, an Alliante and an Antares. Neither worked for me, at all. Fizik is not for everyone. Keep searching.


yeah, i did one ride on that fizik and took it back (it was a test saddle). i am now, or will be as soon as i am back on the bike, on a Bontrager Paradigm RL. but, as i mentioned aboved, the new Specialized Power saddle really has me interested.


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## ibericb (Oct 28, 2014)

octave said:


> yeah, i did one ride on that fizik and took it back (it was a test saddle). i am now, or will be as soon as i am back on the bike, on a Bontrager Paradigm RL. but, as i mentioned aboved, the new Specialized Power saddle really has me interested.


Funny, I'm now riding a Paradigm RL. It's pretty good, but still some room for improvement.


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## xxl (Mar 19, 2002)

Keoki said:


> You just have to HTFU


This, and then frequent massages of the afflicted area. You may wish to recruit a helper.


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## Tig (Feb 9, 2004)

I'd certainly try a different saddle since lowering didn't help. Do you have a Specialized dealer locally?

I've always experienced moderate numbness down there no matter what saddle. About 8 weeks ago I switched from my beloved Fizik Arione to the channeled version, the Arione Versus X. No more numbness of any kind. 









The nose is tilted up just a few degrees.


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## kookieCANADA (Jan 20, 2011)

octave said:


> yeah that sounds about like me! not the no cutout saddle, stationary bike bit, but walking around with my hand down my pants... fml, man. maybe they will do an ultrasound on me and tell me just to stay off the bike, too. i don't mind that as long as it goes away and i can get back on. i have been off the bike now for 8 days. it is getting better, for sure.


I stayed off of a bicycle for about 6 months and then bought saddles with a cut-out. I think its more about sitting properly. When I injured myself, I was always leaning forward (aero position) putting pressure on the nerve. Now when I feel any type of pressure, I sit more upright and make sure I am sitting on my sit-bones.


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## wgscott (Jul 14, 2013)

The only time I ever experienced this was with a cut-out gel saddle. It is reproducible (on that saddle) on different bikes. My current favorite saddle is Brooks B17. This is simply anecdotal, but might be worth experimenting with something completely unpadded.


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## Mr_Clean (Feb 12, 2012)

A saddle that doesn't agree with your junk is a big issue. I personally stay away from saddles with cutouts and thick padding. It all boils down to personal preference. The search for the right saddle continues.


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## phoehn9111 (May 11, 2005)

Same here, cutouts for some reason cause perineal pain.
Also, and trumping everything else (not saying this applies
to you at all) regarding comfort at the contact points was
losing weight. Night and day difference.


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## jfaas (Jan 31, 2014)

octave said:


> funny thing is, if i lowered the saddle from where it was, even if i lowered it 2mm, it was instant knee pain. that height was my sweet spot for ages


Crank length? -2.5 mm change in crank length will allow you 5 mm at the top with the same knee angle. Only a thought. 

Your problem sounds more like the saddle though, especially if you are trying new ones. There are so many shapes now, it is hard to choose. I would approach it like new shoes or boots: you shouldn't think "I'll get used to it", it should just fit.


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## octave (May 11, 2014)

jfaas said:


> Crank length? -2.5 mm change in crank length will allow you 5 mm at the top with the same knee angle. Only a thought.
> 
> Your problem sounds more like the saddle though, especially if you are trying new ones. There are so many shapes now, it is hard to choose. I would approach it like new shoes or boots: you shouldn't think "I'll get used to it", it should just fit.



that is an interesting thought.... i never thought about that! i will have to look into it... in any case, yeah, i do believe the saddle is the main culprit. i am definitely not one to believe in 'getting used to it'. i just need to find that perfect one, the one that kisses the backside and rubs me just right.


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## octave (May 11, 2014)

Tig said:


> I'd certainly try a different saddle since lowering didn't help. Do you have a Specialized dealer locally?
> 
> I've always experienced moderate numbness down there no matter what saddle. About 8 weeks ago I switched from my beloved Fizik Arione to the channeled version, the Arione Versus X. No more numbness of any kind.


i have a few specialized dealers locally. the toupé wasn't my thing. the romin evo pro, i think they gave me too wide (i was on the border between 143 and 155 so they sized up; no perineal problems, but the think chafed my thighs). i might have try a romin evo, 143. a bit of ass rub any day over johnson issues.

p.s. i am shocked your arione is tilted _up_!


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## octave (May 11, 2014)

phoehn9111 said:


> Same here, cutouts for some reason cause perineal pain.
> Also, and trumping everything else (not saying this applies
> to you at all) regarding comfort at the contact points was
> losing weight. Night and day difference.


yeah, for me i can't really lose much more weight. it all comes down to the saddle now... on my list to try:

1.) bontrager paradigm rl 138mm (according to the trek ass-o-meter i was solid in the 138mm, possibly could go 128mm; shocking considering on specialized's ass-o-meter i was 143/155 border... !)

2.) specialized romin evo 143mm

3.) specialized power

4.) Selle SMP something something? too many models to even know where to begin...

5.) adamo, maybe?


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## octave (May 11, 2014)

so urologist was a joke.

guy was about 90 years old, not that old fellas can't be awesome, but he was more towards the getting less awesome edge of the continuum... basically asked me a lot of standard questions, then was shocked when i said my usual ride was anywhere between 15 and 60 miles. i have the feeling i should have sought out a urologist on my own, maybe one specializing in sports or something, and not just gone to the one in the same clinic i chose because i was new to NYC and didn`t know anything.

in any case, they had already ultrasounded my nutz two days ago, and found nothing but awesomeness. no explanation there for the sore testes. today, they decided to ultrasound my kidneys and bladder to try and get to the bottom of the tingly/prickly/sometimes painful penis tip and urge to urinate way too often combo... they found my bladder wasn't getting completely emptied when i peed, so... what that means i don't know because the urologist who told me to go up, get the ultrasound, then come back down to have a chat about it had just decided to go home while i was up getting my guts looked at.

before going up, i asked him if cycling could cause my symptoms and he said, 'cyclists suffer from all sorts of ills.' and did not elaborate.

so, basically, what i learned was that maybe my issues were related to tension. i am guessing of the perineum? a friend of mine who is a PT has been saying from the beginning it might be a hypertonic pelvic floor, i.e. overly tight perineal muscles ... so. what have we learned? soak my business in the bathtub twice a day for 20 minutes in water as hot as i can stand, take advil, stay off the bike. eventually i am going to try and figure out some exercises to loosen the muscles of my pelvic floor....

anybody know how to do a pelvic floor drop out?


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## octave (May 11, 2014)

wgscott said:


> The only time I ever experienced this was with a cut-out gel saddle. It is reproducible (on that saddle) on different bikes. My current favorite saddle is Brooks B17. This is simply anecdotal, but might be worth experimenting with something completely unpadded.


i had 3 B17s.... all three got stolen. the first with the whole bike, the other two just the saddle and post. i was devastated the first two times. just utterly pissed the third. great saddle.... i might just have to give it a try. forget what people say about a brooks saddle on a carbon fiber bike. if it saves your nuts, it saves your nuts.


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## jeff400650 (Mar 29, 2014)

For what it's worth, I had constant problems with burning sensation at perineum, followed by totally numb wiener on any ride that lasted more than an hour or so. Tried 6 different saddles. Finally got a Selle SMP 209 Lite, and everything got 90% better. But I would still get uncomfortable down there on really long rides. I got Capo Padrone bibs and OMG, what a difference! I had been using Performance Ultra bibs and thought they were good, but the Padrones are vastly better for me. I can go for many hours now with the SMP and the good bibs, especially if I stand to pedal when the opportunity presents. I am a fan of the big cutout - vagina - in the seat. And don't forget to consider quality bibs... they can make a bigger difference than you would imagine.


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## Fredrico (Jun 15, 2002)

octave said:


> so urologist was a joke.
> 
> guy was about 90 years old, not that old fellas can't be awesome, but he was more towards the getting less awesome edge of the continuum... basically asked me a lot of standard questions, then was shocked when i said my usual ride was anywhere between 15 and 60 miles. i have the feeling i should have sought out a urologist on my own, maybe one specializing in sports or something, and not just gone to the one in the same clinic i chose because i was new to NYC and didn`t know anything.
> 
> ...


That's an interesting diagnosis!  I remember exactly that happening in the early years. I was so into it, so intensely wrapped up in the moment, I'd be tightening sphincter muscles that cut off urine flow so tight, I'd cut off blood flow to the johnson. 

Haven't had that feeling in years. I can only credit the art of spinning, for not only that, but also knee problems I occasionally had. Fast twitch anaerobic efforts will make you strong, but not tough. They'll tighten you up. Spinning relaxes the muscles and allows them to find the most efficient pedal stroke; it becomes internalized; so translates into the most efficient high intensity efforts, too. Training slow twitch aerobic fibers will make you tough. They don't give up. Spinning relaxes the legs enough to work those aerobic fibers. That's how I broke through the pelvic floor. :yesnod: 

Heck, sometimes it's just a simple matter of changing pace.


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## Tig (Feb 9, 2004)

jeff400650 said:


> For what it's worth, I had constant problems with burning sensation at perineum, followed by totally numb wiener on any ride that lasted more than an hour or so. Tried 6 different saddles. Finally got a Selle SMP 209 Lite, and everything got 90% better. But I would still get uncomfortable down there on really long rides. I got Capo Padrone bibs and OMG, what a difference! I had been using Performance Ultra bibs and thought they were good, but the Padrones are vastly better for me. I can go for many hours now with the SMP and the good bibs, especially if I stand to pedal when the opportunity presents. I am a fan of the big cutout - vagina - in the seat. And don't forget to consider quality bibs... they can make a bigger difference than you would imagine.


That's a good point to bring up about the quality bibs/shorts. A well designed chamois makes a big difference compared to the cheap versions out there.

I look back at the old natural chamois I used to ride with and other really crappy designs in the past and am amazed they didn't destroy my "life essence".


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## SPlKE (Sep 10, 2007)

jfaas said:


> Crank length? -2.5 mm change in crank length will allow you 5 mm at the top with the same knee angle. Only a thought.
> 
> Your problem sounds more like the saddle though, especially if you are trying new ones. There are so many shapes now, it is hard to choose. I would approach it like new shoes or boots: you shouldn't think "I'll get used to it", it should just fit.


Good suggestion. I was having problems with my left knee (and dickal numbness, now that I think about it) when I had 172.5 cranks. I changed to 170 cranks and wallah, no more knee problems or schwanschtukkerial numbness.


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## octave (May 11, 2014)

jeff400650 said:


> For what it's worth, I had constant problems with burning sensation at perineum, followed by totally numb wiener on any ride that lasted more than an hour or so. Tried 6 different saddles. Finally got a Selle SMP 209 Lite, and everything got 90% better. But I would still get uncomfortable down there on really long rides. I got Capo Padrone bibs and OMG, what a difference! I had been using Performance Ultra bibs and thought they were good, but the Padrones are vastly better for me. I can go for many hours now with the SMP and the good bibs, especially if I stand to pedal when the opportunity presents. I am a fan of the big cutout - vagina - in the seat. And don't forget to consider quality bibs... they can make a bigger difference than you would imagine.



i have often wonder if bibs made a difference. because all my bibs are fairly budget. it seems maybe i should invest in something a bit more sophisticated....


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## octave (May 11, 2014)

SPlKE said:


> Good suggestion. I was having problems with my left knee (and dickal numbness, now that I think about it) when I had 172.5 cranks. I changed to 170 cranks and wallah, no more knee problems or schwanschtukkerial numbness.


ha! i can't believe this. so many factors can contribute. how tall are you, Spike?


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## octave (May 11, 2014)

Fredrico said:


> That's an interesting diagnosis!  I remember exactly that happening in the early years. I was so into it, so intensely wrapped up in the moment, I'd be tightening sphincter muscles that cut off urine flow so tight, I'd cut off blood flow to the johnson.
> 
> Haven't had that feeling in years. I can only credit the art of spinning, for not only that, but also knee problems I occasionally had. Fast twitch anaerobic efforts will make you strong, but not tough. They'll tighten you up. Spinning relaxes the muscles and allows them to find the most efficient pedal stroke; it becomes internalized; so translates into the most efficient high intensity efforts, too. Training slow twitch aerobic fibers will make you tough. They don't give up. Spinning relaxes the legs enough to work those aerobic fibers. That's how I broke through the pelvic floor. :yesnod:
> 
> Heck, sometimes it's just a simple matter of changing pace.


spinning is definitely something i have been working on. i actually just changed my crank from a standard to a compact for that exact reason. since i am currently looking into a new bike (a frameset to be exact, which i will build up myself), i will be able to spec every exactly as i want. so this is a good time to get a bike that helps contribute to the health of my Business Bits.


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## SPlKE (Sep 10, 2007)

octave said:


> ha! i can't believe this. so many factors can contribute. how tall are you, Spike?


5' 8"


Edit to add: To cure the knee problem, it also took some futzing around with seat height and tilt and fore-aft position, and cleat position on my shoes. One of my legs, I forget which, is about a half inch shorter than the other one. My left knee was the one getting Iliotibial band syndrome. I like the 170 cranks and would never go back to 172.5. I didn't think 2.5 mm would have any effect, but apparently it does.


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## bigbill (Feb 15, 2005)

I've been riding for 30 years and haven't experienced this. I started riding on SI Turbos, then Turbomatics, Turbomatic II's, and for the last 15 years, SSM Regals. All of my bikes have the same saddle with the same center to top measurement (84cm). Regals fit me and unless something physically changes, I will continue to use them. 

As far as seeing a fitter for your saddle position, there are varying opinions about how to set up saddle height and fore/aft position over the bottom bracket. Just because a fitter set you up doesn't mean you need to look elsewhere to find a cause of numbness. If you look at costs and time spent with doctors (who probably don't ride or even understand a cyclist's position), seeing another fitter is probably worth the money.


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## Fredrico (Jun 15, 2002)

octave said:


> i have often wonder if bibs made a difference. because all my bibs are fairly budget. it seems maybe i should invest in something a bit more sophisticated....


Well its mainly how the butt fits on the saddle that determines long term comfort, but cheap bibs shorten the time it takes to go numb.  Assos bibs [F1 Mille] are ergonomically designed to provide room for the equipment so it doesn't get crushed by the fabric. Quite nice! The padding is also the best of all I've tried, Performance, Pearl Izumi, etc. I have a sneaky suspicion you get what you pay for in bibs and shorts. 

First thing to do though, is make sure its not the saddle.


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## Fredrico (Jun 15, 2002)

bigbill said:


> I've been riding for 30 years and haven't experienced this. I started riding on SI Turbos, then Turbomatics, Turbomatic II's, and for the last 15 years, SSM Regals. All of my bikes have the same saddle with the same center to top measurement (84cm). Regals fit me and unless something physically changes, I will continue to use them.
> 
> As far as seeing a fitter for your saddle position, there are varying opinions about how to set up saddle height and fore/aft position over the bottom bracket. Just because a fitter set you up doesn't mean you need to look elsewhere to find a cause of numbness. If you look at costs and time spent with doctors (who probably don't ride or even understand a cyclist's position), seeing another fitter is probably worth the money.


Right on with saddle choices. Same here. My butt is used to classic shaped saddles, precisely the Turbo and Regal. Selle Italia reissued their Turbo a few years ago. I've got one squirreled away for future use. Never had any luck with cutouts. All they did was concentrate the pressure along the ridges of the cutout! But I was probably sitting on it wrong.


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## robt57 (Jul 23, 2011)

Just a few observations, riding technique and saddle time. A lot of spinning has me putting more butt weight for longer periods. So for me not over doing it by grabbing a bigger gear and getting off the saddle more than periodically both works some diff muscles and gets some air time for my ars, as in off the saddle and some relief. Bigger gear, more weight offset, a dichotomy. 

A saddle that allows for some shifting to move pressures around seems a good thing. I also have bought extras of the ones that work. I grab used saddles as often as I can just to try different ones sans reviews which are useless IMO to extreme subjectivity. I get surprised and for example got a well used Fizik Arione for free and it works for me so well I went and got another newer one. And may watch for more in the future. 

An observation on the Arione is that is really easy to get behind it and back onto it due to the rear taper.
A few stoppies and front tire skids emergent stops shows this as an attribute from my experience.

It is so different to each rider as to make dialog have limited use I have found.


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## PBL450 (Apr 12, 2014)

I'm on the Paradigm RL. I went one size up from the ass'O'meter... I have a Selle SMP on my other bike, it's OK, but too padded. It's a huge step up from the stock Cannondale saddle. That one gave me those symptoms. The feeling of needing to pee when I didn't have to. That came back on the thinner less padded RXL I tried. I only 75-80 miles on the RXL this week and did a 21 today, so no great volume of data yet, but it's been good so far. Maybe try going one size wider than you measure? FEIW of course...


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## octave (May 11, 2014)

robt57 said:


> Just a few observations, riding technique and saddle time. A lot of spinning has me putting more butt weight for longer periods. So for me not over doing it by grabbing a bigger gear and getting off the saddle more than periodically both works some diff muscles and gets some air time for my ars, as in off the saddle and some relief. Bigger gear, more weight offset, a dichotomy.
> 
> A saddle that allows for some shifting to move pressures around seems a good thing. I also have bought extras of the ones that work. I grab used saddles as often as I can just to try different ones sans reviews which are useless IMO to extreme subjectivity. I get surprised and for example got a well used Fizik Arione for free and it works for me so well I went and got another newer one. And may watch for more in the future.
> 
> ...


that bigger gear observation is very interesting and i think may have something to it. i never had these problems until i started using 52/36 and 50/34. i spent years on a standard 53/39 and never had issues beyond discomfort on the bike that disappeared once i was off... i assumed my recent issues were just a continuation of saddle issues, but maybe it is saddle plus chainring change?


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## octave (May 11, 2014)

PBL450 said:


> I'm on the Paradigm RL. I went one size up from the ass'O'meter... I have a Selle SMP on my other bike, it's OK, but too padded. It's a huge step up from the stock Cannondale saddle. That one gave me those symptoms. The feeling of needing to pee when I didn't have to. That came back on the thinner less padded RXL I tried. I only 75-80 miles on the RXL this week and did a 21 today, so no great volume of data yet, but it's been good so far. Maybe try going one size wider than you measure? FEIW of course...


i went up one size on the specialized ass o meter, from 143 to 155, which was way to wide. no symptoms that we've been talking about, but discomfort further back where the glutes meet yhe hammy kind of. so i sm going to try a 143 specialized and see what happens. i am taking the Bontrager RL back because i got it right when all this flared up and have not been sble to ride it and won't be able to before the 30-day comfort guarantee is up. so i will take it back then buy it again when i am actually able to test it...


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## octave (May 11, 2014)

PBL450 said:


> I'm on the Paradigm RL. I went one size up from the ass'O'meter... I have a Selle SMP on my other bike, it's OK, but too padded. It's a huge step up from the stock Cannondale saddle. That one gave me those symptoms. The feeling of needing to pee when I didn't have to. That came back on the thinner less padded RXL I tried. I only 75-80 miles on the RXL this week and did a 21 today, so no great volume of data yet, but it's been good so far. Maybe try going one size wider than you measure? FEIW of course...


hey i forgot to ask. was the sensation of needing to pee when you actually didn't need to only when you were on the bike? or was it off the bike, too? if it was off the bike, too, how long did it take to go away? and to alleviate the symptoms, what did you do?


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## Fredrico (Jun 15, 2002)

octave said:


> that bigger gear observation is very interesting and i think may have something to it. i never had these problems until i started using 52/36 and 50/34. i spent years on a standard 53/39 and never had issues beyond discomfort on the bike that disappeared once i was off... i assumed my recent issues were just a continuation of saddle issues, but maybe it is saddle plus chainring change?


IOW, now that you're on "easy gears," your spin is up, you lose track of how hard your butt is taking the faster cadences, and the poor ole perineum gets hit hard. When you were in bigger gears, pushing the pedals lightened up the taint and it didn't hurt after the ride?

Robt57 is definitely on to something. :yesnod:

I've had the sensation of wanting to pee after crushing the urethra on a long ride. The same nerves are stimulated as the ones telling you to pee. It went away after a good night's sleep.


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## Bevo (Dec 26, 2012)

I love the Romin, I have 3 of them, TI, full carbon minimal padded race one that I can't remember the model and the last is the carbon with the gel. The minimal padded seats are very much the same but the gel is not, it's good for an hour then starts to hurt, on 3 hour rides I would be sore for hours after.
I narrowed it down to the gel, beginning of ride I sit on top of the seat, after an hour the seat has a noticeable indent from my sit bones, it's also softer if you squeeze. I think you sink into it and the gel moves coming out at other areas without weight on it.

long story but it's now on my MTB where there is more standing and less sitting.

One other thing I find most don't do is pay attention to your Posistion and reset constantly, winds, hills or efforts put you in a different area on the seat, take a second to get back on your sit bones.
Last one Is flex ability, try to pivot above your pelvis with your lower back, this keeps you planted in the seat for the hoods or bar tops. Once you go into the drops it's another story but do what you can to feel the pressure, adjust or move around till better.

Bottom line is measure comfort and adjust constantly, don't just sit there and get hurt..
Hope something there helps you.


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## PBL450 (Apr 12, 2014)

octave said:


> hey i forgot to ask. was the sensation of needing to pee when you actually didn't need to only when you were on the bike? or was it off the bike, too? if it was off the bike, too, how long did it take to go away? and to alleviate the symptoms, what did you do?


It was after riding. I didn't ride that saddle a second time. It lasted about 2-3 hours and went away on it's own. I kept going to the bathroom for nothing because I had the sensation constantly. Weird. Hasn't happened on my current saddle.


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## stanseven (Nov 9, 2011)

One easy fix is find an experienced and knowledgable fitter. They can likely spot problems quickly. Self diagnosis, trying various saddles, many adjustments that can cause other problems, etc. turns into a long, long experiment.


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## octave (May 11, 2014)

so i went ahead and rode 53 miles yesterday, in spite of the worry of saddle-related issues. and the result? surprisingly, i seem to be doing better than before! less of a feeling of needing to piss all the time, although the pain in the tip of penis is still there, but not as bad as it was at its worst. testicular pain is more or less gone... crazy. i have my fingers crossed that it will continue to get better, though i have to admit i am still a bit nervous to really ride like i used to...

that being said, here were the changes i made:

new bike (i know right?) where my reach is the same, though the saddle to bar drop was about 4 centimeters less, i.e. 6.5cm now instead of 10.5.

new crankset 53/39 chainrings with 172.5mm crankarms instead of 50/34, 175

new saddle - surprisingly, it was a Fizik Arione Versus (not the versus X with the extra deep channel) as that was all i had on hand having recently sold my old bike and saddles that had caused troubles.... the Fizik curse seemed to have been lifted, at least for yesterday.

and, that's about it for changes.

i am hesitant to go out and try another ride to see if it still feels ok, or now that i AM feeling better to stay off the bike a bit longer and see if that helps.

in any case, thank you all for contributing to this conversation. i will keep everyone up to date on what happens with my Business.


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## siclmn (Feb 7, 2004)

My PN happened about a year ago. My life was riding bicycles and motorcycles. I have easily over 200,000 miles on my butt between the two. I averaged 6,000 miles on the bicycle a year for over 30 years, it was what I did every chance that I got. So ignoring pain was part of my life, a pain would always go away or "fix itself" as I would say. Well last year the pain that I was experiencing was not going away, even off the bike, so I rode more on the motorcycle and even that induced pain. After two months I started the merry go round of doctors, therapy, chiropractors, pills. Nothing would touch it. I found that some people had heard of it but no one had a cure. One of the therapies was a pelvic nurse sicking her finger up the butt and saying "now just relax the muscle" yeah right.
I let 6 months go by and I gave up the bicycle and motorcycle but I could still work as a landscaper. The only time the pain went away was when I was asleep. Thank god I could sleep good. But the whole time I was fighting the pain and around month 6 it was winning and I was failing. I would sit in my truck and ice it till I was numb and then work for 10 min and go back to the truck. This was not working. I became suicidal because I had tried everything and nothing worked. I had to sit on a rubber donut to sit in a chair or drive. I had learned that there is no cure for PN and was devastated. By this time I had stopped working because I couldn't, my business was in the toilet. I was telling people that I had picked out a bridge to jump from and this was true. The thought of living in chronic pain for the rest of my life was unbearable. Well word of all this had gotten to a distant relative and I got a phone call saying that she was taking me to a pain doctor that day, I was open to that. 
2 weeks later I was back to being myself and working again. He gave me a pill called Subutex.It is an opiate. It only works for pain on some people and I got lucky, it has many side effects that are not so great. My whole life I was against cures like this but then all my ills would go away in time, this one wouldn't. For the next 4 months I did not dare sit on my cycles and I was just enjoying my pain free existence. Then I tried riding for an hour, it was ok, no hurt. But I knew the pill was masking the pain, but that was ok I was riding again. Now I am up to 35 miles but I am afraid to go any further because all this pill does is turn off pain receptors in your brain, but it works and I am happy now.
The only lesson I have learned from all this is don't ignore pain, especially if it's "down there".


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## Wetworks (Aug 10, 2012)

So, this lovely problem just cropped up for me out of nowhere 2 weeks ago. I've ridden on a Selle Italia Flite Flow for years with no problems, proper fitting beginning and mid-season, couple of metric centuries since. It seemed to have happened after one of my 30 mile training rides, so that adds to the oddness of why it cropped up. I tried one 10 mile ride after a week of improved symptoms, only to see them return. 

I'm pretty diligent about getting out of the saddle and I certainly take advantage of the real estate while on saddle, so that isn't it. I've taken to getting a Romin Evo Pro to see if that helps, as the canal is wider, longer, and the seat offers a less flat profile compared to the Selle. Unfortunately, I am not particularly optimistic as just sitting on the seat for a few minutes to get a sense of position has flared up the symptoms again. 

I've recently gone to the urologist, so I am pretty confident nothing is going on there, but I guess a f/u is in order to at least discuss the problem. I'm starting to lean towards this being more pudendal artery than nerve, but who knows. Just wanted to put this out there and get a little feedback.


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## octave (May 11, 2014)

hey there!

yeah... it does seem to just crop up out of nowhere... my own PN is better, but still not great. some rides i am fine, some rides my symptoms (pain in the perineum or tip of penis and/or increased urgency to piss) come back and stick around for a few days even off the bike. i have found that going to a "men's health physical therapist", i.e. a PT specializing in pelvic floor disorders, helps a ton (some things are not fun that they do, i.e. internal activation via the rectum of the pelvic floor muscles to get them to loosen, but they help if you are serious about wanting to get back on the bike). this summer i was able to do a 120-mile ride with no problem, which is unbelievable. but, strangely enough, it seems shorter, less intense rides cause more issues. the 120 was the longest i had ever done, and also at a fairly hard tempo (for me) of 19.6 mph all told.... so, there is help to be had from a PT.... i have also found that the saddle choice is huge. Specialized Power Saddle is my go-to. i can't even sit on certain brands (e.g. Fizik, Selle Italia) without instant pain. almost all of specialized's offerings work well, but the Power especially. not sure what else... oh, yeah. start stretching! start foam-rolling! especially the glutes, but also work on loosening up your adductors, your quads, and your hip-flexors...

sorry for the slow response... hope that helps!

o


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> So, this lovely problem just cropped up for me out of nowhere 2 weeks ago. I've ridden on a Selle Italia Flite Flow for years with no problems, proper fitting beginning and mid-season, couple of metric centuries since. It seemed to have happened after one of my 30 mile training rides, so that adds to the oddness of why it cropped up. I tried one 10 mile ride after a week of improved symptoms, only to see them return.
> 
> I'm pretty diligent about getting out of the saddle and I certainly take advantage of the real estate while on saddle, so that isn't it. I've taken to getting a Romin Evo Pro to see if that helps, as the canal is wider, longer, and the seat offers a less flat profile compared to the Selle. Unfortunately, I am not particularly optimistic as just sitting on the seat for a few minutes to get a sense of position has flared up the symptoms again.
> 
> I've recently gone to the urologist, so I am pretty confident nothing is going on there, but I guess a f/u is in order to at least discuss the problem. I'm starting to lean towards this being more pudendal artery than nerve, but who knows. Just wanted to put this out there and get a little feedback.


How did this turn out? I had the same thing. Happened out of nowhere last summer. Aching pain in my perenium after a ride. I bike a handful more times after but it did not go away. It did get alot better but never disappeared. I took 5 months of the bike, seen a pelvic floor pysio, drs, chiro and nothing really helped or was able to tell me what was going on. The PT and chyro didn't think it sounded like PN as I only have the pain in the centre of my perenium, no other symptoms. Anyway, Tuesday I decided I was feeling pretty decent the last month and decided to try a 20 minute trainer ride and that was a bad idea. Now at square one. 

Another interesting thing is that I never have pain during the ride, or even immediralty after. It is in bed when I am trying to sleep it starts happeneing and then last at its highest intensity for several weeks.
My saddle is a Specilized Power.


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## Wetworks (Aug 10, 2012)

Rnk_3 said:


> How did this turn out? I had the same thing. Happened out of nowhere last summer. Aching pain in my perenium after a ride. I bike a handful more times after but it did not go away. It did get alot better but never disappeared. I took 5 months of the bike, seen a pelvic floor pysio, drs, chiro and nothing really helped or was able to tell me what was going on. The PT and chyro didn't think it sounded like PN as I only have the pain in the centre of my perenium, no other symptoms. Anyway, Tuesday I decided I was feeling pretty decent the last month and decided to try a 20 minute trainer ride and that was a bad idea. Now at square one.
> 
> Another interesting thing is that I never have pain during the ride, or even immediralty after. It is in bed when I am trying to sleep it starts happeneing and then last at its highest intensity for several weeks.
> My saddle is a Specilized Power.


So the key for me was that I was more often than not experiencing RELIEF when riding. This, of course confounded the GP, urologist, and GI doc (I suspected possible internal hemorrhoids). Ultimately, I conceded and sought out a proctologist as both the GI and uro felt it may be pelvic floor dysfunction. 

Sure enough, the proctologist said I had a classic case, so I began a low dose regimen of Elavil (amitriptyline), a tricyclic antidepressant. I also incorporated a daily regimen of consuming coarse fiber Metamucil. Both of these interventions have completely eliminated the symptoms I experienced, although I do occasionally see a mild flare-up when particularly stressed (don't have an easy life, unfortunately). When this happens, I take a dose of Cialis to increase blood flow to the region and that pretty much solves it. 

Why did I get relief on the bike? The working theory is that I was entering a zone of significantly decreased stress, coupled with the increase in sympathetic tone, thereby stopping the spasming of the pelvic floor muscles. Is it correct? I'm inclined to believe so as it makes sense from a physiological standpoint, but it's highly subjective as well. 

TL;DR- if your pain/paresthesia is located in the penis and perirectal region, consider pelvic floor dysnfunction.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> So the key for me was that I was more often than not experiencing RELIEF when riding. This, of course confounded the GP, urologist, and GI doc (I suspected possible internal hemorrhoids). Ultimately, I conceded and sought out a proctologist as both the GI and uro felt it may be pelvic floor dysfunction.
> 
> Sure enough, the proctologist said I had a classic case, so I began a low dose regimen of Elavil (amitriptyline), a tricyclic antidepressant. I also incorporated a daily regimen of consuming coarse fiber Metamucil. Both of these interventions have completely eliminated the symptoms I experienced, although I do occasionally see a mild flare-up when particularly stressed (don't have an easy life, unfortunately). When this happens, I take a dose of Cialis to increase blood flow to the region and that pretty much solves it.
> 
> ...


Interesting, I would say I had relief on the bike too, at least the pain never popped into my mind. 
I have seen a pelvic floor pysio a number of times but felt that was making things worse and was uncomfortable af. How long would you say it was from when you first had symptons to when you were able to ride again and be pain free after? 

Before I was rode the other day, my pain was just a mild discomfort. It doesn't help I sit for 8 hours a day at work. That was the only time it was sztart to hurt a little, after 6 hours or so, but the pain wouldn't linger at the end of the day. I will mention this to the doctor next time I go in. I have an ultgra sound of the perenail area on Tuesday. (I know it won't show anything but it's the steps you have to take to get anywhere)


Thanks for the quick resonse.


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## Wetworks (Aug 10, 2012)

Rnk_3 said:


> Interesting, I would say I had relief on the bike too, at least the pain never popped into my mind.
> I have seen a pelvic floor pysio a number of times but felt that was making things worse and was uncomfortable af. How long would you say it was from when you first had symptons to when you were able to ride again and be pain free after?


My symptoms lasted the better part of a year, but I rode despite that. I was treated empirically for prostatitis, had blood flow tested (it was decreased, no surprise if I was in spasm), and went to a PT before finally getting on Elavil. I'd recommend going to a proctologist instead of pursuing the physio. 



Rnk_3 said:


> Before I was rode the other day, my pain was just a mild discomfort. It doesn't help I sit for 8 hours a day at work. That was the only time it was sztart to hurt a little, after 6 hours or so, but the pain wouldn't linger at the end of the day. I will mention this to the doctor next time I go in. I have an ultgra sound of the perenail area on Tuesday. (I know it won't show anything but it's the steps you have to take to get anywhere)
> 
> 
> Thanks for the quick resonse.


I'd wager that, much like saddles, the softer the chair you sit in the worse your symptoms? I took to sitting on a piece of wood when at the desk, actually experienced moderate relief. 

I'm not saying that there can't be PN involvement, either, but I'd almost bet your symptoms are stemming from pelvic floor spasming.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> My symptoms lasted the better part of a year, but I rode despite that. I was treated empirically for prostatitis, had blood flow tested (it was decreased, no surprise if I was in spasm), and went to a PT before finally getting on Elavil. I'd recommend going to a proctologist instead of pursuing the physio.
> 
> 
> 
> ...


Yep that is bang on. Took me a while to learn, but a couch with soft cusions that puts pressue on the perenium can case a bad fliar up for a week or two, similar to riding a bike. I bought a cusion your assets seat which has helped quite alot. I take it anywhere I may have to sit on a soft surface. 



I also have found that underware and tight clothing casues discomfort and I find I have to constantly readjust myself when wearing certain underware, does that sound familiar?

I was riding the specialized power saddle and had it pressure mapped this summer and it was determined my pressure mapping was very good. One thing I did have the seat too high wghich may have caused the issue in ther first place. 

I then did quite a lot of reserch, and ended up purchasing the Rido R2 which is essentially a noseless saddle, with a nose.







I got my fitter to put it on the day before I rode this week and he confirmed with the pressure mapping that the weight was 100% all on my sit bones. No pressure what so ever on any of the soft tissue areas. 

Did you do any type of pelvic floor pysio? 
Also, did you have any other symptons besides perenium pain? I don't really have any other symptons associated with pelvic floor disfuction or PN besides the dull aching perrenial pain. 

Again thank you very much for your help. Your case sound the most similar to mine that I have heard.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> My symptoms lasted the better part of a year, but I rode despite that. I was treated empirically for prostatitis, had blood flow tested (it was decreased, no surprise if I was in spasm), and went to a PT before finally getting on Elavil. I'd recommend going to a proctologist instead of pursuing the physio.
> 
> 
> 
> ...


So update, I went and purchased a recumbent (Bacchetta Carbon Aero) assuming that would solve the issue. Nope, later on in the night after the first ride, that all too familiar dull ache in my perineum returned in full force. I was stupid and bought with out trying it ( no where to try it with in hundreds and hundreds of miles) and 4 grand later, it solved nothing. I assumed the reclined position with all of my wight on my back would of solved the issue. 

Must be something with the pedal motion itself.


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## Wetworks (Aug 10, 2012)

Rnk_3 said:


> So update, I went and purchased a recumbent (Bacchetta Carbon Aero) assuming that would solve the issue. Nope, later on in the night after the first ride, that all too familiar dull ache in my perineum returned in full force. I was stupid and bought with out trying it ( no where to try it with in hundreds and hundreds of miles) and 4 grand later, it solved nothing. I assumed the reclined position with all of my wight on my back would of solved the issue.
> 
> Must be something with the pedal motion itself.


If I am right (and I think I am) that you have pelvic floor syndrome, then a recumbent is actually going to make it worse. You really need to go back and re-read what I wrote to you. After that, pitch this the same way you did to a PT, proctologist, or urologist. Trust me, alarm bells will go off and they will treat this as what it is, pelvic floor dysfunction.


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## Ken2 (Jan 30, 2004)

I had a similar pelvic disfunction for over a year. Urologists know next to nothing about it--they treat you for "prostatitis" with drugs, when that doesn't work they call it "neuropathic pain" and have no remedies.

I recommend a pelvic floor physiotherapist--that's what finally helped me. Also have a look at this book http://tinyurl.com/PelvicPain222 .


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> If I am right (and I think I am) that you have pelvic floor syndrome, then a recumbent is actually going to make it worse. You really need to go back and re-read what I wrote to you. After that, pitch this the same way you did to a PT, proctologist, or urologist. Trust me, alarm bells will go off and they will treat this as what it is, pelvic floor dysfunction.


I have an appointment set up with another PT physio in July, and with an Osteopath in a couple weeks. 


Re reading what you experienced, did the cycling flare you up bad after the fact? I know you said you experienced relief while biking, but if you had been feeling a little better, then biked, would it flare it up?

Since my ride last Thursday I have been aching bad, especially while sleeping. It's slowly improving, but every time I bike it is back to square one. I guess I have to give it up for a period longer than 5 months like I did


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## Rnk_3 (Feb 16, 2018)

Ken2 said:


> I had a similar pelvic disfunction for over a year. Urologists know next to nothing about it--they treat you for "prostatitis" with drugs, when that doesn't work they call it "neuropathic pain" and have no remedies.
> 
> I recommend a pelvic floor physiotherapist--that's what finally helped me. Also have a look at this book http://tinyurl.com/PelvicPain222 .


I actually read headache in the pelvis and have been doing some of the stretches, though I am not sure how much they are helping.


What were your symptoms? My only symptom is an ache in the centre of perineum, somewhere in the prostate area. It gets a little better if I don't cycle and try avoiding to sit as much as possible, but easily gets flared and anytime I cycle it is back to square one.


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## Ken2 (Jan 30, 2004)

*Pelvic floor dysfunction*



Rnk_3 said:


> I actually read headache in the pelvis and have been doing some of the stretches, though I am not sure how much they are helping.
> 
> 
> What were your symptoms? My only symptom is an ache in the centre of perineum, somewhere in the prostate area. It gets a little better if I don't cycle and try avoiding to sit as much as possible, but easily gets flared and anytime I cycle it is back to square one.


I had perineal pain as you describe, also tip of penis pain. Worse when sitting, in fact I got a standing desk for work because I couldn't concentrate through the pain while sitting. Also got a portable laptop stand so I could lie down and work in bed http://tinyurl.com/LaptopStand11 .

Like WetWorks, I found some (relative) relief cycling, but only on a noseless saddle like the Hobson. My theory was likewise, that cycling improved circulation some, but it was still far from comfortable, and it was impossible with standard saddles.

I tried biofeedback, acupuncture, meditating, and exercises after I came to understand that I had pelvic floor spasms/dysfunction. What helped me most was a pelvic floor physical therapist, whom I saw weekly for about a year. If you are located in or near a large metropolitan area you are more likely to find someone who knows what they are doing.

Also there are seatpads with cutouts for the tailbone area that I found gave me relief when I had to sit, like when driving. Still use one in my car.


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## Wetworks (Aug 10, 2012)

Rnk_3 said:


> I have an appointment set up with another PT physio in July, and with an Osteopath in a couple weeks.
> 
> 
> Re reading what you experienced, did the cycling flare you up bad after the fact? I know you said you experienced relief while biking, but if you had been feeling a little better, then biked, would it flare it up?


It would eventually revert to baseline post-ride, but it wouldn't worsen, no. Ken kind of touched on the reason for improvement during riding; increased blood flow. But that's not how I'd explain it as it obscures the mechanism, which is at the heart of the matter IMO. 

Everyone is going to experience decreased circulation when sitting on a saddle for an extended period of time. The problem for us is we are starting off that process already at less than optimal circulation. So why the improvement? I believe it has to do with sympathetic and parasympathetic parts of the pelvic floor, particularly the external anal sphincter. If you tend to be an internalizing person, there's a good chance you are clenching your external sphincter without even realizing it. A good test is to go sit on the bowl and have a BM. I would wager most people experience immediate relief, followed by a gradual return of symptoms within 30 minutes.

So, when sitting on a saddle, your mind is concerned more with sympathetic responses, so the parasympathetic nervous system is taking a back seat with decreased motility, increased contraction of the INTERNAL anal sphincter, while the sympathetic nerves are doing their job of keeping you in motion on the bike, looking out for obstacles, etc. The EXTERNAL sphincter, which as opposed to the internal, is innervated by the pudendal nerve, gets a bit of a break due to the anatomical position assumed when sitting on the saddle along with some (possible) partial relaxation of sympathetic external rectal tone. 

So, that's my THEORY as to why I and others may experience relief. And like Ken said, urologists and other MDs are clueless, especially when you lead with "I feel better sitting on a narrow, hard bike saddle." Of course, I could just be talking out of my @$$...


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## Fredrico (Jun 15, 2002)

Wetworks said:


> It would eventually revert to baseline post-ride, but it wouldn't worsen, no. Ken kind of touched on the reason for improvement during riding; increased blood flow. But that's not how I'd explain it as it obscures the mechanism, which is at the heart of the matter IMO.
> 
> Everyone is going to experience decreased circulation when sitting on a saddle for an extended period of time. The problem for us is we are starting off that process already at less than optimal circulation. So why the improvement? I believe it has to do with sympathetic and parasympathetic parts of the pelvic floor, particularly the external anal sphincter. If you tend to be an internalizing person, there's a good chance you are clenching your external sphincter without even realizing it. A good test is to go sit on the bowl and have a BM. I would wager most people experience immediate relief, followed by a gradual return of symptoms within 30 minutes.
> 
> ...


Good points. 

I can remember years ago when ramping up fitness, the pelvic floor would tighten up severely when pedaling hard, internal sphincters indeed, and when I rested up after the ride, it would hurt like a bruise. It subsided overnight with slight sensitivity the next day. Learning how to spin solved that problem. I did do some purposeful pedaling up hills careful to keep the power in the legs. The anal muscles still go isometric, but after some training, no longer over-tighten in sympathy with the legs. Definitely something to think about.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> It would eventually revert to baseline post-ride, but it wouldn't worsen, no. Ken kind of touched on the reason for improvement during riding; increased blood flow. But that's not how I'd explain it as it obscures the mechanism, which is at the heart of the matter IMO.
> 
> Everyone is going to experience decreased circulation when sitting on a saddle for an extended period of time. The problem for us is we are starting off that process already at less than optimal circulation. So why the improvement? I believe it has to do with sympathetic and parasympathetic parts of the pelvic floor, particularly the external anal sphincter. If you tend to be an internalizing person, there's a good chance you are clenching your external sphincter without even realizing it. A good test is to go sit on the bowl and have a BM. I would wager most people experience immediate relief, followed by a gradual return of symptoms within 30 minutes.
> 
> ...


So I went to a Sports Dr and he believes what I have is Osteitis Pubis. Basically inflammation of the pubic symphisis. I could never really pin point the source of the pain, just deep in the pelvis and sure enough, when he pressed down hard on the area it increases the pain. I am going for a bone scan to confirm. This is typically something runners get, but I wager I got it from riding on my saddle 3 cm too high with poor mechanics. 

Causes
Overload or training errors

Exercising on hard surfaces (like concrete)
Exercising on uneven ground
Beginning an exercise program after a long lay-off period
Increasing exercise intensity or duration too quickly
Exercising in worn out or ill-fitting shoes
Biomechanical inefficiencies[edit]

Faulty foot and body mechanics and gait disturbances
Poor running or walking mechanics
Tight, stiff muscles in the hips, groin, and buttocks
Muscular imbalances
Leg length differences

Alot of that fits me. Went from zero to 100 doing 2k in 6 weeks with my intensity going from 25kph average to 32kph, my posture on the bike is bad, I never stretched and have poor flexibility, I never warmed up, I never cooled down.

Cure is to rest for 6+ months from all running and cycling and lots of stretching. I have been playing basketball every week since so I haven't given it a chance to heal at all.


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## Clipped_in (May 5, 2011)

octave said:


> this is about to get personal, but i think awareness of these kinds of things are important for the cycling community.
> 
> Pudendal nerve entrapment in an Ironman athlete: a case report
> 
> ...


Every two or three years in the spring when I really increase my ride volume I experience very similar symptoms. In my case it is a UTI for which my family doctor perscribes a round of Ciprofloxacin antibiotic and I'm good to go after a few days on the medication.

I hope your doctor can find for you a similar easy solution to your problem.


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## Ken2 (Jan 30, 2004)

Clipped_in said:


> Every two or three years in the spring when I really increase my ride volume I experience very similar symptoms. In my case it is a UTI for which my family doctor perscribes a round of Ciprofloxacin antibiotic and I'm good to go after a few days on the medication.
> 
> I hope your doctor can find for you a similar easy solution to your problem.


I avoid Cipro: the FDA now requires "black box" warnings on this medication, alerting doctors and patients that the drug can increase the risk of tendinitis and tendon rupture in some patients.

There have been reports of runners and cyclists getting Achilles tendon ruptures while on this drug.


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## BlazingPedals (Apr 4, 2013)

Octal, have you had your prostate checked? Not being able to fully empty the bladder can be an indication of an enlarged prostate. I don't know if it can cause those other symptoms, though.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> It would eventually revert to baseline post-ride, but it wouldn't worsen, no. Ken kind of touched on the reason for improvement during riding; increased blood flow. But that's not how I'd explain it as it obscures the mechanism, which is at the heart of the matter IMO.
> 
> Everyone is going to experience decreased circulation when sitting on a saddle for an extended period of time. The problem for us is we are starting off that process already at less than optimal circulation. So why the improvement? I believe it has to do with sympathetic and parasympathetic parts of the pelvic floor, particularly the external anal sphincter. If you tend to be an internalizing person, there's a good chance you are clenching your external sphincter without even realizing it. A good test is to go sit on the bowl and have a BM. I would wager most people experience immediate relief, followed by a gradual return of symptoms within 30 minutes.
> 
> ...


The wild goose chase continues. I had a bone scan the ruled out OP I mentioned above.

I ended up going to a massage therapist last week and she found a trigger point in my adductor. I did the research, and sure enough, those trigger points refer pain to the pelvis. Makes sense as to why the pelvic physio never found anything internally. It also seems to be triggered by excessive cycling, and likely especially in my case when I had my saddle too high, and explains why the recumbent flared it up too. 

I'm going to have her work on it a few sessions and then possibly try fry needling/ trigger point injections. Hopefully this is something that can be fixed.


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## Fredrico (Jun 15, 2002)

Rnk_3 said:


> The wild goose chase continues. I had a bone scan the ruled out OP I mentioned above.
> 
> I ended up going to a massage therapist last week and she found a trigger point in my adductor. I did the research, and sure enough, those trigger points refer pain to the pelvis. Makes sense as to why the pelvic physio never found anything internally. It also seems to be triggered by excessive cycling, and likely especially in my case when I had my saddle too high, and explains why the recumbent flared it up too.
> 
> ...


Lowering the saddle should do it. The legs can take weight off the sit bones not possible when saddle was too high, and ease the saddle pain going hard. That tightens the muscles around the sit bones, and rider has better support.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> If I am right (and I think I am) that you have pelvic floor syndrome, then a recumbent is actually going to make it worse. You really need to go back and re-read what I wrote to you. After that, pitch this the same way you did to a PT, proctologist, or urologist. Trust me, alarm bells will go off and they will treat this as what it is, pelvic floor dysfunction.


So, I am still as bad off as ever. I went to another pelvic physio and this one said I was super tight but got no improvements. I think I am ready to talk to my doctor about Amitriptyline.

Have you had any side effects from it? One thing that worries me is weight gain. Since I stopped cycling I’m already up 35lbs.

Are you able to sit on what ever now with out pain?


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## Wetworks (Aug 10, 2012)

Rnk_3 said:


> So, I am still as bad off as ever. I went to another pelvic physio and this one said I was super tight but got no improvements. I think I am ready to talk to my doctor about Amitriptyline.
> 
> Have you had any side effects from it? One thing that worries me is weight gain. Since I stopped cycling I’m already up 35lbs.
> 
> Are you able to sit on what ever now with out pain?


I'm on an extremely low dose, the only side effect for me was sleepiness, which I overcame after being on the med for a week or two. No issues with weight gain at all. I am presently looking to find the reason for decreased blood flow to my pelvis, waiting for approval for a CT-A. Most of my symptoms have been addressed, but I still have flare-ups from time to time.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> I'm on an extremely low dose, the only side effect for me was sleepiness, which I overcame after being on the med for a week or two. No issues with weight gain at all. I am presently looking to find the reason for decreased blood flow to my pelvis, waiting for approval for a CT-A. Most of my symptoms have been addressed, but I still have flare-ups from time to time.


Appreciate the quick reply. Do you think Amitriptyline healed your pelvic floor dysfunction or is just masking the pain? Do you think if you went off now it would return? I just want this pain to end and get back on my bike so badly! 

I just took up jogging this week but I had a good chunk of miniscus removed from my knee a decade ago and the surgeon specifically said to become a cyclist not a marathon runner, but I would rather have knee pain I think than this miserable dull aching **** show I have going on now. I feel like it flares me up as well a little, though not nearly as bad as cycling.


One other question, when you had the pain before going on the medication did you have the dull aches at night that caused issues sleeping ? That’s the big thing with me, I can power through the pain during the day, but if it is bothering me at night it becomes unbearable. Luckily last summer my paid wasn’t bothering me at night, but this past 4 months it has been bad at night and i have no idea why

The biggest difference with you and I is that you said your pain would revert to baseline after you biked. For me it flares me up as bad as I ever get after I ride. 

I made the appointment with the doctor so i hope I can get the relief you did. You’re the closest person to my issue as I have found in my 100s of hours reserching through various forums, FB Groups, Sub Reddit’s etc. If there is a forum or group for PN or pelvic floor issues I am probably in it


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## Wetworks (Aug 10, 2012)

It doesn't mask the pain for me as much as it relaxes the pelvic floor. I was also experiencing the dull aches you described and have since had them disappear for the most part. I do occasionally experience flare-ups, but they tend to be much shorter in duration than previous to Elavil. 

Not sure if it's been mentioned before or if you've come across it, but check into internal hemorrhoids as well. Anything that takes up extra real estate in that region is a problem.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> It doesn't mask the pain for me as much as it relaxes the pelvic floor. I was also experiencing the dull aches you described and have since had them disappear for the most part. I do occasionally experience flare-ups, but they tend to be much shorter in duration than previous to Elavil.
> 
> Not sure if it's been mentioned before or if you've come across it, but check into internal hemorrhoids as well. Anything that takes up extra real estate in that region is a problem.


I’ll look into that, but doc when checking the prostate would have likely felt that, no? Or even the pelvic physio. My pain feels like it is coming from just behind the testicles in the centre of the perenium. 

I do have an appointment in May with a Urologist who I know is probably going to say it’s prosititis and put me on antibiotics which won’t do anything for me. I will contact my GP next week but I am guessing they won’t want to do anything for me until I see the urologist.


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## Fredrico (Jun 15, 2002)

Rnk_3 said:


> I’ll look into that, but doc when checking the prostate would have likely felt that, no? Or even the pelvic physio. My pain feels like it is coming from just behind the testicles in the centre of the perenium.
> 
> I do have an appointment in May with a Urologist who I know is probably going to say it’s prosititis and put me on antibiotics which won’t do anything for me. I will contact my GP next week but I am guessing they won’t want to do anything for me until I see the urologist.


Pain just behind the testicles? I had that when starting long rides and found when going hard, I'd put too much weight on the exactly this area. Wouldn't notice it until the end of the ride, sometimes by that time painful. That night it felt mildly bruised. A couple of times making it painful to pee.

So I experimented with positioning on the saddle. I rotated the hips back just enough to alleviate principle weight on the perineal nerve area, concentrating more weight on the sit bones at the wide back of the saddle. I leveled the saddle so I could sit up and peel a banana without sliding forward, and moved back and forth on the saddle to find the most comfortable weight distribution all around. It took a couple of years for this new positioning to become instinctive. The pain went away. 

Look at the position of the hips on the pros. They're not doing a superman. They're bending forward at the waist.

Basically, positioning on the saddle injured my nether parts, and I kept doing it. When I finally figured out how to sit properly on the saddle, the muscle tissue around the injury recovered, got stronger, and healed the perineal area. So now when "on the rivet" it never lasts long and I won't hurt after the ride.

Try it, man! Leave the drugs at home. :thumbsup:


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## Rnk_3 (Feb 16, 2018)

Fredrico said:


> Pain just behind the testicles? I had that when starting long rides and found when going hard, I'd put too much weight on the exactly this area. Wouldn't notice it until the end of the ride, sometimes by that time painful. That night it felt mildly bruised. A couple of times making it painful to pee.
> 
> So I experimented with positioning on the saddle. I rotated the hips back just enough to alleviate principle weight on the perineal nerve area, concentrating more weight on the sit bones at the wide back of the saddle. I leveled the saddle so I could sit up and peel a banana without sliding forward, and moved back and forth on the saddle to find the most comfortable weight distribution all around. It took a couple of years for this new positioning to become instinctive. The pain went away.
> 
> ...


I haven't ridden in 13 months and the perennial pain still bothers me every day. I cannot sit on anything soft, and couldn't even ride the $5k recumbent I bought or I can't even go to the gym with out flaring myself up very bad. 

Trust me, this is a last resort. See this post 

https://forums.roadbikereview.com/g...-syndrome-346073-post5216759.html#post5216759


My last ride last February was on essentially a noseless saddle and it flared me up to high heaven with all my pressure on my sit bones.


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## Fredrico (Jun 15, 2002)

Rnk_3 said:


> I haven't ridden in 13 months and the perennial pain still bothers me every day. I cannot sit on anything soft, and couldn't even ride the $5k recumbent I bought or I can't even go to the gym with out flaring myself up very bad.
> 
> Trust me, this is a last resort. See this post
> 
> ...


Dunno man. If blood flows into the soft tissue when it isn't resting on something, swells it up so it hurts, seems like a "chronic" injury. The soft tissue needs time to heal. It's not back together yet from the saddle being too high.

_I was riding the specialized power saddle and had it pressure mapped this summer and it was determined my pressure mapping was very good. One thing I did have the seat too high which may have caused the issue in the first place. _

So good pressure mapping points renders the way you're distributing weight on the saddle unlikely to be the cause. The saddle being too high was the culprit. How much time have you had to recover? It took me 2-3 seasons riding, but it would go away when walking or sitting. What's the pain feel like on a brisk walk? What's the tissue that's swelling or the source of the pain? I guess a decent urologist would know all that, as others are suggesting. 

But it seems to me, if at one time you could ride without perineal pain, you could do it again. Maybe take a few months off, take walks, do light weight lifting. Lifting has a magical way of pulling the musculature together, evening out weaknesses and stress in areas one never thinks about. It eliminates toxins, crotches being prime locations as the miles add up. A local infection could produce pain when not resting on something. 

If medicines work, great. But I have a bad attitude about taking drugs more than temporarily, only to get one through the healing process worked out by exercise and regeneration, what the body does. Old folks get ginned up with meds for every damn thing. The only drugs I need are Gas-x and Tums. 

Just some thoughts from a 75 year old guy who's been there. We're all different.


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## Rnk_3 (Feb 16, 2018)

Fredrico said:


> What's the pain feel like on a brisk walk? What's the tissue that's swelling or the source of the pain? I guess a decent urologist would know all that, as others are suggesting.



That's the thing I have no idea where the pain is actually coming from. It is just a dull ache that feels like it is in the perineum but it isn't tender at all. There is no where that hurts to the touch.


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## Fredrico (Jun 15, 2002)

Rnk_3 said:


> That's the thing I have no idea where the pain is actually coming from. It is just a dull ache that feels like it is in the perineum but it isn't tender at all. There is no where that hurts to the touch.


How about the urethra? Ever had a hard time peeing after a ride?

The urologist should track down where the pain is coming from and diagnose the cause, which so far seems like the saddle was too high and it crushed and injured the soft tissue. I remember having a hard time peeing a few times; saddle too high or leaning forward like Superman. It felt like the urethra was flattened. The adjacent nerves would be numb for a day and I couldn't get it up. 

Other riders have had this problem from saddles being too high, leaning forward at the hips, not at the waist, or from sitting on the nose of the saddle. Then when they take all the weight off the perineum, sure enough, the soft tissue swells up and hurts, all the more when the legs are going up and down. Assume you got rid of that funky Rido R2 saddle, or aren't 100# overweight. 

If it didn't used to happen and was induced by the saddle being too high, its an injury that can heal. Don't assume you're screwed. It will heal if you take your vitamin C, drink plenty of liquids, and nurse it back to fitness. Aspirin works great, too, if you don't bleed easily. Aspirin thins the blood, enhances the flow, as well as dulls the pain. 

Just my opinion, after having these problems myself, and talking with many riders who raised their saddles too high, probably the most common mistake competitive guys make to get a little more power out of the stroke. One coach said the first thing he does in training camps is lower saddles.

In the meantime see what the urologist finds. Fingering the prostate gland won't do it. It's right inside the anus wrapped around the urethra. Doc wouldn't feel anything amiss unless its enlarged. Then he'd do a CAT scan to see how much space it's taking up. I've been riding with an enlarged prostate for 10 years. Can't feel it. It shares space with the bladder and colon, both very elastic organs that expand when full.


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## Rnk_3 (Feb 16, 2018)

Wetworks said:


> It doesn't mask the pain for me as much as it relaxes the pelvic floor. I was also experiencing the dull aches you described and have since had them disappear for the most part. I do occasionally experience flare-ups, but they tend to be much shorter in duration than previous to Elavil.
> 
> Not sure if it's been mentioned before or if you've come across it, but check into internal hemorrhoids as well. Anything that takes up extra real estate in that region is a problem.


Go perscribed it yesterday. Starting at 10mg this week and up to 20mg next week. 
Had my first pill last night and didn’t really improve my sleep
at all but didn’t really feel any more tired when I woke up.


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## Salsa_Lover (Jul 6, 2008)

Saddle height could be the culprit.

During years I used my saddle too high, I did set it up where it felt “right” for pedalling, so where I felt my pedalling was more efficient.

I had problems with pudendal nerve sindrome or sometimes numbness specially on mostly flat rides, because I spent most of the time on the saddle, on hilly rides I had to stand more often so I had less problems...
But always I had on more or less intensity discomfort on the area after the rides.

I then got better information about saddle height placement, particularly the inseam-10cm rule and the one pedalling with the heels.

I found out that had been riding for so many years with a saddle 3 cm too high ! Incredible

Lowered the saddle and the saddle problems magically disappeared


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