The Impact of Long-Distance Cycling on the Pelvic Floor: Pudendal Nerve and Pelvic Dysfunction

By Dr. Christine Martirez PT, DPT on 10/18/2024

Long-distance cycling is a great way to stay fit, enjoy the outdoors, and challenge your body. However, many cyclists—both recreational and competitive—experience pelvic floor discomfort or pain after prolonged rides. This is often due to the impact that extended periods of sitting on a bike saddle can have on the pudendal nerve and pelvic floor muscles. In this blog post, we’ll dive into the anatomy of the pudendal nerve, how cycling can contribute to pelvic floor dysfunctions, the symptoms of pudendal neuralgia, and how pelvic floor physical therapy can help alleviate symptoms.

Anatomy of the Pudendal Nerve

The pudendal nerve is a key nerve in the pelvis that provides sensation and motor control to the pelvic floor muscles and structures of the perineum, including the genitals and anus. This nerve originates from the S2-S4 nerve roots in the sacral spine and travels through a complex pathway in the pelvis. Along its course, it passes through the pudendal canal, also known as Alcock’s canal, and provides innervation to areas that are essential for pelvic floor function, including sexual function, urinary control, and bowel control.

Given its anatomical course, the pudendal nerve is susceptible to compression or irritation, especially during activities like prolonged sitting or cycling, where pressure is applied directly to the perineum (the area between the genitals and anus).

How Long-Distance Cycling Affects the Pudendal Nerve and Pelvic Floor

Long-distance cycling involves hours of sustained pressure on the saddle, which directly compresses the perineal region. Over time, this pressure can cause irritation or compression of the pudendal nerve, leading to pudendal neuralgia, a condition characterized by pain and dysfunction in the pelvic region. In addition to nerve irritation, long periods in the saddle can cause tension and dysfunction in the pelvic floor muscles, further contributing to pain and discomfort.

Symptoms of Pudendal Neuralgia

Cyclists who develop pudendal neuralgia may experience a variety of symptoms, including:

• Perineal pain

  Pain in the area between the genitals and anus, which may worsen after prolonged sitting or cycling.

• Genital numbness or tingling

  Sensory changes in the penis, scrotum, vulva, or anus.

• Burning or stabbing pain

  These sensations may be localized to the perineal area or radiate into the buttocks, thighs, or lower abdomen.

• Urinary dysfunction

  Difficulty with urination, frequent urination, or feelings of incomplete bladder emptying.

• Sexual dysfunction

  Reduced sensation during sexual activity, erectile dysfunction, or pain during or after intercourse.

Other Pelvic Floor Dysfunctions Associated with Cycling

In addition to pudendal neuralgia, long-distance cycling can contribute to other pelvic floor dysfunctions, such as:

• Pelvic pain

  Tension in the pelvic floor muscles can cause pain in the lower abdomen, perineum, or pelvic region.

• Urinary incontinence

  Overactivity or underactivity of the pelvic floor muscles can interfere with bladder control.

• Erectile dysfunction

  Compression of the pudendal nerve or pelvic floor dysfunction can lead to difficulties in achieving or maintaining an erection.

• Rectal or anal discomfort

  Cycling can also lead to tension or pain in the muscles surrounding the rectum and anus, contributing to discomfort or difficulty with bowel movements.

How Pelvic Floor Physical Therapy Can Help

If you’re experiencing pelvic pain or dysfunction following long-distance cycling, pelvic floor physical therapy can be an effective treatment option. Here's how it can help:

1.

Assessment of Pelvic Floor and Nerve Health

A pelvic floor physical therapist will conduct a thorough evaluation, including a detailed medical history and a physical examination of your pelvic floor muscles, posture, and any potential nerve irritation. This helps identify whether your symptoms are due to pelvic floor dysfunction, pudendal neuralgia, or a combination of both.

2.

Manual Therapy and Myofascial Release

If tightness or muscle imbalances in the pelvic floor are contributing to your symptoms, manual therapy techniques such as myofascial release can help reduce tension in the muscles and improve overall pelvic floor function. This can alleviate pain and improve nerve function by relieving pressure on the pudendal nerve.

3.

Nerve Mobilization Techniques

Pelvic floor physical therapists are trained in specific techniques to gently mobilize the pudendal nerve, reducing irritation and promoting healing. Nerve mobilization techniques help improve the movement of the nerve within the pelvic region, reducing compression and discomfort.

4.

Pelvic Floor Muscle Relaxation and Strengthening

If your pelvic floor muscles are hypertonic (too tight) due to prolonged compression or tension from cycling, your therapist will work with you to improve muscle relaxation through biofeedback, guided relaxation, or downtraining techniques. Conversely, if weakness is contributing to your symptoms, strengthening exercises may be recommended to improve pelvic floor function.

5.

Posture and Bike Fit

Your therapist may also assess your posture while cycling and make recommendations to improve your bike fit or riding position. This can help reduce pressure on the pudendal nerve and pelvic floor, preventing future irritation and discomfort.

6.

Education and Lifestyle Modifications

Pelvic floor physical therapy also involves education on lifestyle modifications that can help alleviate symptoms and prevent recurrence. This may include changes to your cycling routine, tips on how to sit to reduce pressure on the perineum, and guidance on proper pelvic floor exercises to maintain pelvic health.

Healing and Preventing Pelvic Floor Dysfunction in Cyclists

While long-distance cycling can be a great form of exercise, it can also lead to pelvic floor dysfunction and pudendal neuralgia due to prolonged pressure on the perineum. If you’re experiencing pelvic pain, urinary dysfunction, or genital discomfort after cycling, pelvic floor physical therapy can help by addressing muscle imbalances, nerve irritation, and posture-related issues.

By combining manual therapy, pelvic floor exercises, and lifestyle modifications, pelvic floor physical therapy offers a comprehensive approach to treating the symptoms of pelvic floor dysfunction in cyclists, allowing you to get back to your rides pain-free and with improved pelvic health. Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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