Pudendal Nerve Entrapment

I just found out that I have a trapped pudendal nerve, sometimes called "cyclist syndrome". I felt a sharp pain in my groin wile riding 3 weeks ago and it has been downhill ever since. First the doc said it was epididymitis, but it wasn't. I cannot sit AT ALL without excruciating pelvic pain, especially in the perineum. I cannot even fathom the thought of sitting on a bike saddle. I stand at work and lay down when I get home. My doc has given me some meds to calm the nerves, but it's not a long term fix for sure. I fear my cycling career is over.

Has anyone here had to deal with this before? If so, did time heal it or was something more invasive necessary?

recumbent bike may work
toilet seat sitting may help
i hope you feel better soon
cheers
treatment meds , p.t. .. but not often surgery

Thanks for the info Fixed.

Have you had this? You talk like you know the "tricks".

Yeah, the toilet seat helps, but I'm not in any sort of chronis pain right now. It hurt like hell in the beginning, like "worst thing I've ever been through both physically and mentally".

I'm hoping I can lick this thing and be back on the bike. The doc says 6 months.

I thought about the recumbent thing too. If it does not get better, I will go there. Never thought I would, but I think it's better than nothing.

Quote:

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Originally Posted by Fixed

recumbent bike may work
toilet seat sitting may help
i hope you feel better soon
cheers
treatment meds , p.t. .. but not often surgery

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Hey, no advice to offer, but I really hope you get sorted, feel all better, and get back on the bike soon. Fingers crossed for you, man!

I'm really NOT being facetious when I ask if massage might help? Sometimes working the deep tissues in the abdomen, glutes, and the nether-regions in between can do some amazing things. Between increasing blood flow and relaxing the muscles/tissues that are pinching the nerve, it might at least help shorten the duration of the condition and promote healing. My wife is a massage therapist; I'll ask her about it when she gets home.

Obviously, it's a pretty damn intimate area so you'd have to have a great level of trust in the therapist.

Thanks for sending the good vibes Christian. I'm hoping I can look back and say "I'm glad that's over!"

Quote:

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Originally Posted by christian

Hey, no advice to offer, but I really hope you get sorted, feel all better, and get back on the bike soon. Fingers crossed for you, man!

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Thanks John. Yep, I'm looking for any help I can get at this point. I've been naked in a room with so many strangers over the past couple of weeks that I'm over being timid, much less poking me where it's not fun to be poked.

If massage would help, I'm all for it. Let me know what your wife says. There is a good massage therapist right across the street from my office that my mom visits regularly.

Quote:

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Originally Posted by echelon_john

I'm really NOT being facetious when I ask if massage might help? Sometimes working the deep tissues in the abdomen, glutes, and the nether-regions in between can do some amazing things. Between increasing blood flow and relaxing the muscles/tissues that are pinching the nerve, it might at least help shorten the duration of the condition and promote healing. My wife is a massage therapist; I'll ask her about it when she gets home.

Obviously, it's a pretty damn intimate area so you'd have to have a great level of trust in the therapist.

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i know what it is like not being able to ride and spending a lot of time dreaming about it
i may need a 3 wheeler when i start riding again ..at first the idea sucked after 10 months it is sounding almost doable .
my friend had cyclist syndrome he was back riding in under six months if i remember right
he did stretching and shots - steroids i think

hang in there bro


cheers

Thanks Fixed! This is just what I needed. I get on the 'net and read all these horror stories. The interweb is not a safe place to go to "research" things like this...though here I am?!

Anyway, this makes me feel better than the alternative of never rolling again. I'm bald as hell, but I still miss the feeling of the wind blowing across my scalp where the hair used to be; and it's only been 3 weeks!

To start, I have an appointment with the physical therapist tomorrow. I'll look into the cortisone shots too. I guess they bring the swelling down and let things settle down.

You hang in there too. I may be on a three wheeler before all is said and done. I assume you are talking about a recumbent. Some of those guys haul ass, I mean real hammerheads.

Quote:

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Originally Posted by Fixed

i know what it is like not being able to ride and spending a lot of time dreaming about it
i may need a 3 wheeler when i start riding again ..at first the idea sucked after 10 months it is sounding almost doable .
my friend had cyclist syndrome he was back riding in under six months if i remember right
he did stretching and shots - steroids i think

hang in there bro


cheers

---

As is the case with all nerve impingements/entrapments, something is taking up space that the nerve needs. Primary suspects are obturator muscle(s) or sacrotuborous ligament. Any issues with the hip, sacroiliac joint, or low back? Something is pissed off and it's taking it out on the prudendal. A good manual therapy trained PT should have some ideas. I've referred a lot of patients with funky nerve stuff to acupuncture with good results. Good luck.

ty-ro, if you get to the point of considering a recumbent, PM me, I'd be happy to share my knowledge. I had neck surgery and for 2 years following I rode a recumbent while things healed/got stronger/built my confidence to return to riding a traditional race bike.

Your comment that some are hammerheads is very true - they are however few and far in between all the bearded guys and the pocket protector types. I was able to successfully integrate myself into a traditional-bike paceline with the guys - it's not a no-brainer, the recumbent's strengths and weaknesses are opposite those of upright bikes. Bike selection is very important, there are a lot of slow recumbents that would be hopeless in this setting, hence my offer of counsel.

Although I may be derided here for saying so, my years on a 'bent were good ones - It was an effort to earn the respect of upright riders, but I did it in spades - The aero advantage is huge and if you are tactically savvy you can parlay that into some eye-opening experiences for those who would look down upon you.

massage: foam roller

might help, shouldn't "hurt", it'd be my first option.

inflammation/irritation exacerbates itself, also consider less-inflammatory nutritional choices.

and dig deep to make sure you understand how you caused it for to avoid re-occurrence. RE- injury is the worst injury.

best of recovery

Quote:

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Originally Posted by WadePatton

massage: foam roller

might help, shouldn't "hurt", it'd be my first option.

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foam rolling his crotch??

"kinky" thread

Low back pain, yes. VERY bad low back pain last year in the months leading up to this, like could not get out of bed without rolling onto the floor kind of pain. It has been going on for years, but the most recent indecent came on when I was doing some core work with a med ball swinging it around the world like a windmill. The pain came when I went to rotate my pelvis with the ball at the top of the motion. I fell to my knees. X-ray showed nothing though, so must be nerves, which would make sense to be related to the issues I'm having now.

You are right about the nerve being pissed off that something else is taking up too much space in there.

I'm seeing a good manual PT who has helped me immensely with knee issues in the past. I'll bring up the obturator muscle(s) and sacrotuborous ligament with him for sure.

I'm scheduling acupuncture for next week too. I'm going to hit this thing hard from the get go. I can't just sit around!

I have been reading about the pelvic floor muscles playing a part in these types if issues. It seems the more I cycle the tighter I feel "down there".

Thanks a ton for the help Ned. I'll check back as things progress.

Quote:

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Originally Posted by ned

As is the case with all nerve impingements/entrapments, something is taking up space that the nerve needs. Primary suspects are obturator muscle(s) or sacrotuborous ligament. Any issues with the hip, sacroiliac joint, or low back? Something is pissed off and it's taking it out on the prudendal. A good manual therapy trained PT should have some ideas. I've referred a lot of patients with funky nerve stuff to acupuncture with good results. Good luck.

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Quote:

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Originally Posted by lakeside

ty-ro, if you get to the point of considering a recumbent, PM me, I'd be happy to share my knowledge.

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I sincerely appreciate the offer lakeside. It sounds as though you used the recumbent as a therapeutic tool to get you back to riding a normal bike, which is not something I had considered. I am going to give all the treatment options a try before I got there, mainly because of the equipment issue. If I do go that route, I'll surely give you a shout. Thanks for the help!

That bike in your pic looks plenty fast to me!

Quote:

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Originally Posted by WadePatton

inflammation/irritation exacerbates itself, also consider less-inflammatory nutritional choices.

and dig deep to make sure you understand how you caused it for to avoid re-occurrence. RE- injury is the worst injury.

best of recovery

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Thanks Wade. Yeah, I'm trying to get at the core of the issue so it does not happen again, assuming ?I get better enough to try to ride again! Tough to see that as a reality right now.

Pardon the intrusion. This is important and I'd like to save the thread in our WIKI. To the OP good luck and pls. add some relevant tags to the discussion thread so that the WWW will find this discussion.

No intrusion and no need to pardon anything. I would be honored to have this thready WIKI'ed only to save others the agony.

I will add some tags to the original post and will keep everyone posted as to the progress.

Yesterday evening started having some more pain, but don't really see a pattern to it, or at least any cause-effect relationship. My conclusion: nerves are weird.

I am headed to the physical therapist today. Apparently there are some things that can be done using manual physical therapy both external and internal (blush). The link below tells of some of the options.

Physical Therapy | pudendal.info

I am also making an appointment for acupuncture next week.

I also learned yesterday that there are 4 classic places that the pudendal nerve typically gets compressed. They are listed in the following link, which happens to be from the preeminent surgeon for surgical release of the entrapped nerve.

Pudendal Nerve Entrapment Syndrome

For the moment, my advice is: if you have ANY numbness or pain (and I mean ANYTHING), stop riding immediately and address the issue. Most of you guys know the drill... This can be achieved through any combination of saddle type, position, chamois, bio-mechanical, muscle imbalance, contact points, etc. I did not have much pain cycling; only the occasional numbness on longer rides that was solved by standing for a bit, but this thing hit me like a loaded log truck going 75 mph! I may be genetically predisposed to this condition due to the specific location of my nerves in relation to saddle pressure points, but I just want my fellow riders to ride long and pain free for their entire lives.

Quote:

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Originally Posted by Too Tall

Pardon the intrusion. This is important and I'd like to save the thread in our WIKI. To the OP good luck and pls. add some relevant tags to the discussion thread so that the WWW will find this discussion.

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Please pardon my ignorance, but how do you add tags? Is it simply a list of words in the bottom of the post that may help lead someone doing a search?

Quote:

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Originally Posted by ty-ro

Please pardon my ignorance, but how do you add tags? Is it simply a list of words in the bottom of the post that may help lead someone doing a search?

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Scroll to the bottom of the thread and you will see a button to add/edit tags

An update on my condition... It's been a month since I first noticed pain.

I've been to the physical therapist who says I have oblique and twisted hips. He feels that the pressure on the saddle is the smoking gun. He suggested I not cycle again, unless I want it to come back or get worse. At this point, I am with him and NOT willing to take the risk. All I know is that I never want to go through the level of pain I was in several weeks ago. It was literally excruciating.

I am generally pain free, though I still have a high level of discomfort. I cannot put ANY pressure on my perineum area. I have a standing setup at work. The ONLY sitting I do is in the car using two pieces of foam on each buttock to elevate the middle/taint section. (It's actually two of those things you kneel on when you garden.)

I am now at the acceptance phase. I am adjusting my lifestyle to suit my current condition. I was prescribed some meds for nerve pain, which I think may be one of the reasons I am not having any issues with pain anymore. I don't want to be on meds forever, so after a while I am going to phase off of it and see how I feel. Now that I'm pain free, it has been increasingly difficult to deal with the mental/emotional side of things. The abrupt end is just a shock to the system.

I started going on short walks and swimming a little bit. My main goal is just to stay pain free.

I certainly don't want to spread mass paranoia around this place, because this is a very rare condition. I think my pudendal nerve happens to run along my undercarriage in a particularly vulnerable spot, making it more susceptible to becoming injured. I've only been cycling for about 5 years, so it sure didn't take long. If you do happen to have pain down there at any point, do yourself a favor and stop what you are doing until you get it figured out. It may be too late for me, but there are FAR worse things that could happen.

Thanks to everyone here for the continued support. The good vibes you guys have been sending my way have really helped!

Thanks for the update buster. You've done one he!! of a great job dealing with this and coming to terms.
What recumbent are you looking at?

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Originally Posted by Too Tall

Thanks for the update buster. You've done one he!! of a great job dealing with this and coming to terms.
What recumbent are you looking at?

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Thanks Too Tall. I'm just rollin' with the punches. I just keep telling myself that things could be MUCH worse!

Lakeside said that he has some good suggestions for recumbents. My plan is to give this thing a solid 6 months off every type of sitting device. If the PT isn't working any wonders or if I don't see marked improvement, I'm headed to Austin to hook up with KGreene's PT down there who helped him with a similar nerve issue. (I've got family in Austin, so I'm there some anyway.)

Anyway, I've got a "plan" if you can call it that. Helps to have a plan.

I can't stress enough how much of a help this community has been for me. Thanks to everyone!

Quote:

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Originally Posted by ty-ro

An update on my condition... It's been a month since I first noticed pain.

I've been to the physical therapist who says I have oblique and twisted hips. He feels that the pressure on the saddle is the smoking gun. He suggested I not cycle again, unless I want it to come back or get worse. At this point, I am with him and NOT willing to take the risk. All I know is that I never want to go through the level of pain I was in several weeks ago. It was literally excruciating.

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Did you ever get your knee problem figured out? I'm getting my right knee fixed in May and it causes my hips to be uneven on the bike. You're great to ride with, I hope it all works out. Hopefully I'm leaving the PNW this summer after I retire from the navy so maybe we'll ride together in Austin.

Hey Bill! Good to hear from you. Yeah, I got the knee under control with a scope and some good PT. If I were still riding, I'd be doing a little post ride stretching for the knee. That's all it really took to keep things in check. It was never 100%, more like 90-95%, which is plenty good enough.

At this point, there is no riding for me in sight. I can't even sit in a normal chair at all without significant pain. I'm either standing or laying down, period. I drive in the car to and from work using two cushions to elevate the problem area. It works temporarily, but I won't be a long-haul trucker any time soon.

I'm headed to Seattle to have an MRI to have a look at the nerves and things. I'm not so sure things will be conclusive. When they did 2 MRI's on my knee, they said it was fine. After the surgeon was in there with the scope, he said it was a "real mess" and he "took a lot of junk out of there". My knee improved because of the surgery and lots of diligent PT. It's fine now.

I think it's going to be a long road for me and it's nearly certain that cycling will not be a part of my future. I'm headed to the pool today, just to stay active and get some endorphins going. I won't lie; I miss cycling terribly, but life goes on and I have the rest of my health.

It's amazing how something like this really puts things in perspective; a real slap in the face about how lovely life is when things are just "ok". I'm in no way saying for everyone to stop cycling because this sort of thing could happen to you. It can come in any form and comes unexpectedly, but don't be paranoid; that ruins the beauty. Just carpe diem and know that life is tender, transient, and lovely at the same time.

Sorry for the rambling.

Hey, if you do end up in Austin, PM your details. I'm down there quite a bit visiting family. Great town. I think you'd love it there, especially for the sharp contrast to the Pac NW.

Hey Fixed, can you ask your buddy exactly WHERE he got the shots? Did he get a nerve block or was it in the perineum directly?

I'm reading a lot about it and there are a few different ways of getting at the nerve. I'm thinking us sycling guys might have the pinch in the same place just due to the saddle pressure location, right?

Thanks for the help!

Quote:

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Originally Posted by Fixed

i know what it is like not being able to ride and spending a lot of time dreaming about it
i may need a 3 wheeler when i start riding again ..at first the idea sucked after 10 months it is sounding almost doable .
my friend had cyclist syndrome he was back riding in under six months if i remember right
he did stretching and shots - steroids i think

hang in there bro


cheers

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Quote:

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Originally Posted by ty-ro

It's amazing how something like this really puts things in perspective; a real slap in the face about how lovely life is when things are just "ok". I'm in no way saying for everyone to stop cycling because this sort of thing could happen to you. It can come in any form and comes unexpectedly, but don't be paranoid; that ruins the beauty. Just carpe diem and know that life is tender, transient, and lovely at the same time.

Sorry for the rambling.

Hey, if you do end up in Austin, PM your details. I'm down there quite a bit visiting family. Great town. I think you'd love it there, especially for the sharp contrast to the Pac NW.

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I hear you, on 12/30 I went to see the doctor at work because I was having chest pain and shortness of breath. They wired me for sound and said my heartbeat was abnormal and did blood work. I was standing around feeling like I was going to die when the blood work came back indicating that I was having a heart attack. They laid me out and started oxygen while waiting on an ambulance. I was able to walk into the ambulance and spent the next three days at Harrison Medical Center Cardiac Unit in Bremerton. The Naval Hospital doesn't have a cardiac unit. My enzymes continued to increase until the afternoon of the 31st when they started dropping off. That night I had a stress test and mulitple cat scans. I was released on the 1st with three Cardiologists scratching their heads. I had all the indications of a heart attack but had no clots, no damage to my heart, no blockage, and a stress test that says I'm a cardiovascular horse. My cholesterol was 179 and my ratios where perfect although my triglycerides were a little high. It took me another three days to feel normal again.

The whole time I was in the ambulance on the way to the hospital I kept thinking about the frame I had just bought and if I'd ever get to ride it. I retire in September after 27 years and I'm going to be pissed if something screws up my ability to ride. For my knee, it doesn't really bother me when I ride, it bothers me when I umpire little league since I have to stay semi-crouched behind the plate. Who would have thought.

Damn Bill! I'm so sorry to hear of your heart issues. I hope it gets better or rather never happens again. We do these things for our health and someone who rides as regularly as you do is doing all the right things. Seriously, take care of yourself and take it easy. I'm headed to the pool right now for some easy laps. I figure it's better than nothing. Yeah, I was just looking at recumbents too. I know...banished forever! I guess, "You gotta do what you gotta do." I'm going to give this "taint" nerve thing about a full year of tests of pokes and prods before I go "bent", but the moral of the story is that you have to adjust your lifestyle. My priorities sure have changed too!

Bill, best of luck to you in your heart issues. I wish you MANY smooth miles and constant tailwinds in retirement. You've worked very hard need to reap the spoils!

Quote:

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Originally Posted by bigbill

I hear you, on 12/30 I went to see the doctor at work because I was having chest pain and shortness of breath. They wired me for sound and said my heartbeat was abnormal and did blood work. I was standing around feeling like I was going to die when the blood work came back indicating that I was having a heart attack. They laid me out and started oxygen while waiting on an ambulance. I was able to walk into the ambulance and spent the next three days at Harrison Medical Center Cardiac Unit in Bremerton. The Naval Hospital doesn't have a cardiac unit. My enzymes continued to increase until the afternoon of the 31st when they started dropping off. That night I had a stress test and mulitple cat scans. I was released on the 1st with three Cardiologists scratching their heads. I had all the indications of a heart attack but had no clots, no damage to my heart, no blockage, and a stress test that says I'm a cardiovascular horse. My cholesterol was 179 and my ratios where perfect although my triglycerides were a little high. It took me another three days to feel normal again.

The whole time I was in the ambulance on the way to the hospital I kept thinking about the frame I had just bought and if I'd ever get to ride it. I retire in September after 27 years and I'm going to be pissed if something screws up my ability to ride. For my knee, it doesn't really bother me when I ride, it bothers me when I umpire little league since I have to stay semi-crouched behind the plate. Who would have thought.

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Quote:

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Originally Posted by ty-ro

An update on my condition... It's been a month since I first noticed pain.

I've been to the physical therapist who says I have oblique and twisted hips. He feels that the pressure on the saddle is the smoking gun. He suggested I not cycle again, unless I want it to come back or get worse. At this point, I am with him and NOT willing to take the risk. All I know is that I never want to go through the level of pain I was in several weeks ago. It was literally excruciating.

I am generally pain free, though I still have a high level of discomfort. I cannot put ANY pressure on my perineum area. I have a standing setup at work. The ONLY sitting I do is in the car using two pieces of foam on each buttock to elevate the middle/taint section. (It's actually two of those things you kneel on when you garden.)

I am now at the acceptance phase. I am adjusting my lifestyle to suit my current condition. I was prescribed some meds for nerve pain, which I think may be one of the reasons I am not having any issues with pain anymore. I don't want to be on meds forever, so after a while I am going to phase off of it and see how I feel. Now that I'm pain free, it has been increasingly difficult to deal with the mental/emotional side of things. The abrupt end is just a shock to the system.

I started going on short walks and swimming a little bit. My main goal is just to stay pain free.

I certainly don't want to spread mass paranoia around this place, because this is a very rare condition. I think my pudendal nerve happens to run along my undercarriage in a particularly vulnerable spot, making it more susceptible to becoming injured. I've only been cycling for about 5 years, so it sure didn't take long. If you do happen to have pain down there at any point, do yourself a favor and stop what you are doing until you get it figured out. It may be too late for me, but there are FAR worse things that could happen.

Thanks to everyone here for the continued support. The good vibes you guys have been sending my way have really helped!

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Hello, I am new here, I have the same thing that ty-ro has and would like to know if he is still around this forum or even better, if someone has his email. Thank you.