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  1. #51
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    Quote Originally Posted by Rnk_3 View Post
    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.

    Quote Originally Posted by Rnk_3 View Post
    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.

  2. #52
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    Quote Originally Posted by Wetworks View Post
    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.



    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.
    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.
    Pudendal Neuralgia or 'cyclist syndrome'-bicycle-seat-rido2.jpg
    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.

  3. #53
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    Quote Originally Posted by Wetworks View Post
    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.



    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.
    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.

  4. #54
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    Quote Originally Posted by Rnk_3 View Post
    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.

  5. #55
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    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 .

  6. #56
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    Quote Originally Posted by Wetworks View Post
    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

  7. #57
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    Quote Originally Posted by Ken2 View Post
    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.

  8. #58
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    Pelvic floor dysfunction

    Quote Originally Posted by Rnk_3 View Post
    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.

  9. #59
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    Quote Originally Posted by Rnk_3 View Post
    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 @$$...

  10. #60
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    Quote Originally Posted by Wetworks View Post
    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 @$$...
    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.

  11. #61
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    Quote Originally Posted by Wetworks View Post
    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 @$$...
    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.

  12. #62
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    Quote Originally Posted by octave View Post
    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.
    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.
    There I was...

  13. #63
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    Quote Originally Posted by Clipped_in View Post
    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.

  14. #64
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    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.

  15. #65
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    Quote Originally Posted by Wetworks View Post
    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 @$$...
    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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  16. #66
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    Quote Originally Posted by Rnk_3 View Post
    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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    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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