As the temperature starts to warm up and winter transitions into spring we often find ourselves transitioning out of hibernation to take advantage of the beautiful outdoors!
A great way to do so, and even get a little exercise in, is bike riding! Especially if we have not been on our bike in a little while, we may find ourselves limiting our bicycling secondary to pelvic region discomfort.
Stationary bicycling has additionally become even more popular over the last few years, offering a way to maintain and improve cardiovascular health right from the comfort of your own home! But, have you found yourself unable to participate secondary to perineal and buttock pain?
Have you or do you experience burning pain, tingling and/or numbness in the buttock, genitals or perineum (area between the buttocks and genitals)? (2) Are these symptoms limiting your ability to utilize a stationary and/or road bicycle? If you answered yes to either of these questions then you may be experiencing pudendal neuralgia!
Pelvic Physical Therapy Foundations - Pudendal Nerve and Pelvic Anatomy
The pudendal nerve carries sensory innervation to the genitals, motor innervation to the external anal and urethral sphincter, which help promote continence, and motor innervation to the musculature of sexual arousal and erection. (1)
This nerve is made up of branches from S2-S4 nerve roots which exit the pelvis below the Piriformis muscle and then courses along the pelvis prior to entering the perineum at the inferior sciatic foramen slightly above the sitz bones (ischial tuberosity). (1) Within the perineum the pudendal nerve subdivides into three branches: 1) Inferior Rectal Nerve (promotes fecal continence and provides sensation around rectum), 2) Perineal Nerve (provides sensation to genitals and promotes urinary continence), 3) Dorsal Nerve of the Penis or Clitoris (sensation for sexual function). (1) As with everything within the human body there is a considerable amount of variation in the anatomy of the pudendal nerve and its branches.
Bike Seat Fitting To Minimize Pelvic Pain
Ideally when sitting on a bicycle seat the primary weight distribution through the pelvis
should be equally distributed along the sitz bones (ischial tuberosity). If the weight distribution is too far forward, more towards the front of the pelvis, one may notice with riding some numbness, tingling and/or pain to the genitalia which may persist post-ride. With long-term and/or repeated trauma to this region this may result in more chronic issues which may more seriously begin to impact urinary and fecal continence and sexual response. Additionally, it is important to take into consideration the internal pudendal artery and vein, which follow along a similar course to the pudendal nerve, with repeated trauma to this region to potentially cause tissue changes secondary to lack of adequate oxygenated blood to the region.
Proper bike seat fitting is important to obtain in order to optimize your comfortability and reduce risk of injury. When taking into consideration bike fitting it is important to take into consideration three factors: bike seat, overall bike fit and handle placement. Additionally one may want to take into consideration the clothes that they are wearing to prevent skin chafing. Ultimately it is important to speak directly to someone who specializes in bike fitting to ensure that your bike is appropriately sized for you based upon your intended use (i.e. stationary bike/spinning, mountain biking, road cycling, etc).
And last, but not least, if you are experiencing any of the symptoms mentioned above please contact us today to set up a pelvic health physical therapy evaluation so that we may be able to help you return back to doing what you love most, symptom-free!
Kinter KJ, Newton BW. Anatomy, Abdomen and Pelvis, Pudendal Nerve. [Updated 2023 Feb 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554736/
Khoder, Waseem, and Douglass Hale. “Pudendal Neuralgia.” Obstetrics and Gynecology Clinics of North America, vol. 41, no. 3, 2014, pp. 443–452., https://doi.org/10.1016/j.ogc.2014.04.002.
“Pudendal Neuralgia - about the Disease.” Genetic and Rare Diseases Information Center, U.S. Department of Health and Human Services, https://rarediseases.info.nih.gov/diseases/10713/pudendal-neuralgia.