Hi, I just found this forum. I have been suffering with PN for a year now. It has lessened over the year but has not completely gone away yet. I gave up cycling over the winter and then got back into it in the spring. Everything was going well until 4 months into it when the terrible burning came back. I have tried various saddles and positions but nothing has helped so far. I fear I may have to give up cycling forever. Has anyone tried riding a recumbent and If so did it also cause symptoms?
Hi @MissingRuby,
I lost the ability to sit on flat surfaces thanks to tight pelvic floor and PN…18 months on, I am still using a doughnut cushion for work and driving… I tried a friend’s bent last year and it made no difference to my pain…
I was initially diagnosed with degenerative disc disease (which I also have) and so found lots of forums on the net recommending recumbent bikes for this condition but one of the signs that my pain was due to something else came from the fact that using the bent made absolutely no difference to my back and pelvic pain.
Even today, I can possibly get away for 30 minutes in a padded chair but wooden benches, seesaws, hard surfaces cause me flare ups…
Do you know how you got PN? So when you ride a bent it causes pain?
I use a split cushion to sit on to keep pressure off the area.
I got a recumbent and rode it 4 times now without an issue. The problem is the burning usually doesn’t start right away, it can take weeks to show up and then it’s bad. I don’t really want to go through that again but I want to see if maybe a bent will work. I crashed in 2018 and fell hard on my left side which eventually caused problems with my SI joint. I went to PT for that and after a year it cleared up but then this horrible burning pain showed up. Maybe that had something to do with developing PN or the fact that I cycled A LOT.
I’m still convinced that mine was caused by a mix of massive work stress and direct pressure on the perineum from a crap saddle. So this was a mix of spasmed, super tight pelvic floor, internal muscles as well as the “saddle” pain.
Lots of stretches and relaxation of the internal muscles has helped the most, also using a saddle with a huge cutout. But it’s been 18 months or more and i still have discomfort sitting down more often than not but it’s liveable and i can ride bikes again. Interestingly on my MTB i can do 3 or 4 hour rides with no discomfort at all due to sitting more upright with the sit bones in good contact with the wings of the saddle whereas on my road bike it still feels like limiting it to 90 minutes is a good idea…
I am replying to myself as I have an update. After 10 years of pain, lots of docs, PTs injections and every other treatment you can think of, I went to see Dr Echenberg in Bethlehem, PA. He treats chronic pelvic pain. PN is part of what he does. He also figures out the specific nerves that are affected as that area has a lot of nerves that can become involved.
Today, I am 90-95% pain-free after 10 YEARS! It took most of this year for everything “down there” to calm down. I rode and trained throughout my treatment.
I cannot tell you how this man has changed my life. Please if you are suffering give him a try. https://www.theechenberginstitute.com/
Good luck
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Thanks for sharing - very kind
What treatment worked for you please ?
What does he do differently to others please?
Thank you
Broadly, what was the thing that worked?
Was it stretching, or PT, or more of a mindset change in dealing with pain?
[quote=“Anchorman, post:274, topic:18129, full:true”]
Thanks for sharing - very kind
What treatment worked for you please ?
What does he do differently to others please?
Thank you
@tfelds
@RCC @Anchorman for me, I had some “strategically placed” nerve blocks and botox injections into my pelvic floor. I was also treated with Nortryptaline and Hydroxide for 8 mos for some related Interstitial Cystitis (which can interact with pelvic floor and impact nerves). I went in January for the main treatment and back in May for some follow-up trigger point and nerve blocks. Dr Echenberg starts you out by having you fill out a profile and then having you on an in-depth 90-minute video conference where he listens to your story, provides info/prelim diagnosis and a treatment plan if you were to go and visit him in person.
The biggest thing is you have to have faith in his process and then give it time. I was able to drive home 5 hours (first time I had driven the car that distance in 10 years) that afternoon. But the real improvement came over 4-6 months and only recently can I declare “victory.” Hope this helps this group!
Dr E helps both women and men with pelvic pain. I cannot recommend him highly enough. To get started, you only need to do the paperwork and pay for the video call. From there its up to you if you think he can help you.
This is all the info I have to share. Good luck to you all.
I am about to commit this same sin, but I think it might actually be useful if we asked all participants here to share saddle models that have worked or shown at least some slight improvement in tolerability for them. Just to have a survey of “might-be-valuable-to-someone” info.
I’m actually reading through this thread now, for my mother, to try to fact-find on the internet where she won’t have looked, for information related to pudendal nerve blocks. Her doc has prescribed one, plus steroids.
I’ve also suffered with extremely pain PN issues, with no formal diagnosis. Thankfully, mine was cured in under a month and only returns if I really abuse it in a forward-tilted position with a very bad saddle. (I don’t do that, ever, after realizing that was a guaranteed trigger).
I have read the latter 65% of this whole thread.
With that context, here’s my “you have a migraine? have you tried a cup of coffee” type of useful information. (my wife has lifelong had severe migraines, I know exactly how infuriating that is)
The saddle that solved it for me was Selle SMP Kryt 3. I believe there are other Selle saddles that could have worked, but I refuse to ride anything else out of pure superstition at this point.
If I’m on my MTB I can get away any wide splitter saddle, as long as my shorts aren’t overly tight.
I’ll add the following, because I don’t think I’ve seen this extreme discussed here, and if it happens to help someone else, then great:
When I first had it, I could not wear pants. Avoiding pants seemed to be a bit of a lynchpin for me.
I was extremely grateful to work from home. I worked in my loosest underwear for a few days until the pain had started to subside. I discovered that because I have relatively large glutes, the way pants fit, they touch my underside just enough to cause ongoing irritation to my PN area.
No pants → reduced acute irritation stimulus → reduced pain over time.
I completely recognize how lucky I am. My pain went from “Honey, I think I need to go to the ER,” to 1 out of 10 in under a month.
Maybe the pants thing is such common knowledge that I’m just committing the “migraine? → take tyelenol.” sin twice. Enlighten me, if so.
Wanna hear something crazier? As I read through this thread, I actually experienced pain in my PN for the first time in more than a year. Brains & CNS are funny. I’m having sympathy pains for you all. No joke.
Thank you all for curating such an amazingly valuable thread.
For those playing along, could you maybe reply with "What saddle have you used that is better than others, for you personally?
EDIT to add: I tried Cobb/jcob, ISM, and half a dozen other commonly mentioned saddles and found Selle’s to be far superior for prevention of this one issue, and nothing else. I’d rank Selle beneath many other major brands for most other things. I recommend cobb for most my women clients, with ISM being a close second. I recommend the same, plus a wider array of others to my male clients. But for my own PN issues, only a Selle SMP does the job, and it’s a night and day difference from cobb or ISM. I believe it has to do with the curve along the sagittal plane which is mostly missing from other saddles. It lengthens the contact area where peak pressure would be spread, reducing any one point of pressure. The other saddle models did not do that, and even though they had wide/deep cut-outs, they provided absolutely zero relief and would stir up trouble for me early on. I had all of them on-hand to try because I’d kept all my wife’s (pro triathlete) old saddles as a “just in case” someday.
Mine’s been flaring up for the past few days, I’ve no idea why, but i’ve started to read a book about neuroplastic pain as i’m convinced that (nearly 2 years in) there is no longer anything wrong… but nerves can be a pain in the arse.
In terms of saddles i used the Selle SMP VT 20 Sport. I seem to have quite narrow sit bones so this was their recommended option. I’ve since also got a MTB with a Bontrager P3 Verse Elite and i can ride that for 3 or 4 hours with no pain at all.
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Hehe, my only reason for that response is every once in a while someone rolls into the forum and says something to the effect of “hey guys, if your butt hurts, change your saddle, get a bike fit, etc”.
Given the anguish most of the people on here have gone through, it just seems at best an oversimplification, and at worst, border-line insulting.
I’m all for people sharing what works for them.
1000% agree. I honestly thought your comment was merited, and funny. I thought the same thing about the prior poster’s comment.
But then I thought… wait a sec, maybe there is something here, since they’re mentioning a saddle that’s a lot like what mine was, and was literally night and day diff for me. Got to thinking about if there might have been anything different about my experience that might be valuable to someone else still struggling, and realized, it was no pants + no riding for 1-2 weeks + very very reclined seated position at desk, then Selle SMP Kryt 3, that solved it for me.
Do I think the no-pants thing is going to solve most folks’? No chance. But if it even helps one person a little, it’ll have been worth the share. I should also add that the pants vs. no-pants conditions were most markedly different when seated. Some diff while standing. But when seated, pants were unbearable. Seated without pants was bad, but not unbearable, as long as I reclined.
Best seating option for me was buck naked on the toilet. 
Apologies to anyone reading who really didn’t care to hear that detail. If you’ll read up-thread a bit, you’ll see that this situation is dire enough to merit discussion of virtually anything.
Well as someone who now works from home full time, any justification that gets me out of those “leg prisons” 
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Funny not funny. In all seriousness, this is one of the diagnostic questions that I got asked when I saw Dr Echenberg in Bethlehem, PA. My journey is documented up in the thread above if it helps.
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Wow, apparently it’s a thing. Noted.
For sure - sitting on the toilet and the momentary sense of being pain free is one of life’s simple pleasures these days.
And i get the no pants thing - i’ve had that too and so I have gravitated towards wearing baggy running shorts or PJ’s all the time. Working from home is great 
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This thread is great and a constant source of therapy for me
Was wondering if anybody had the issue where ANY pressure two inches below the belly button ( belt buckle location ) caused pain in the perineum? I have to wear yoga pants to work which is a weird look for sure . When I wear chinos or trousers after a few hours I’m really uncomfortable
Anyone had that and cured it somehow
FANKS !
@anchorman Maybe your bladder? Can all be related. My diagnosis had Interstitial Cystitis as an aggravating factor to my PN pain.
Where did you find that a forward titled saddle can be a trigger? Can you send me some info? Cheers,