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  1. #1
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    Pudendal Neuralgia or 'cyclist syndrome'

    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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    You just have to HTFU

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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.
    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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    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.
    Last edited by tvad; 04-14-2015 at 04:31 PM.

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    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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    Quote Originally Posted by tvad View Post
    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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    Quote Originally Posted by Fredrico View Post
    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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    Quote Originally Posted by kookieCANADA View Post
    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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    I tried two Fiziks, an Alliante and an Antares. Neither worked for me, at all. Fizik is not for everyone. Keep searching.
    Last edited by ibericb; 04-15-2015 at 05:02 AM.
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    Quote Originally Posted by ibericb View Post
    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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    Quote Originally Posted by octave View Post
    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.
    "When man invented the bicycle he reached the peak of his attainments."
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  12. #12
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    Quote Originally Posted by Keoki View Post
    You just have to HTFU
    This, and then frequent massages of the afflicted area. You may wish to recruit a helper.

  13. #13
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    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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    Quote Originally Posted by octave View Post
    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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    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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    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.

  17. #17
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    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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    Quote Originally Posted by octave View Post
    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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    Quote Originally Posted by jfaas View Post
    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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    Quote Originally Posted by Tig View Post
    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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    Quote Originally Posted by phoehn9111 View Post
    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?

  22. #22
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    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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    Quote Originally Posted by wgscott View Post
    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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    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.

  25. #25
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    Quote Originally Posted by octave View Post
    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?
    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.

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

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