Hi there, I’m a 30yr old Female case with pudendal nerve entrapment. I have road cycled since 2018, I also have a peloton, I sit 8 hours a day at work. August this year (2023) I suddenly got what I now know to be pudendal nerve entrapment. For the last few months my doctors quickly just labeled it coccydynia and took X-rays of my coccyx and it was 2cm anteriorly displaced, thus they assumed I had an old coccyx injury which was causing the pain. I have been to over 150 inclusive appointments to PT, osteopath, rehab program, different chiropractors, pelvic floor PT, acupuncture, massage…. FINALLY I found an amazing chiropractor who diagnosed me appropriately right at first assessment and did Active Release Therapy (ART) and for the first time ever start to get a few days in a row of relief, he’s now given me at home stretching to do daily along with pudendal nerve “flossing” (be gentle while doing so). He showed me how to sit on a tennis ball between sitbone close to pelvic floor muscles obturator internus (do this daily). I’m also on 150mg of Lyrica/Preglabin which has less side effects than gabapentin. I don’t know how long until I heal but it’s been a depressing and unbearable 5 months until I found this chiropractor and was finally prescribed this medication, my pain has gone from 10/10 to about 5/10. I haven’t missed a day of stretching though. Hope this helps someone else. I live in Canada and my doctor literally told me “I don’t know what to do or who to refer you to so what do you want?”- that’s when I asked for nerve meds and a nerve block - which I am waiting for the referral now. I was told by a PT that a client went to France for nerve unentrapment surgery but didn’t have great success with it but he never paused Cycling to heal. I haven’t cycled in 5 months. I don’t know when I will cycle again but I look forward to the day I can. For now I’m just getting used to the idea of sitting again and contemplating going back to work… thanks!
Hi all,
Just wanted to say a huge thank you to all of you for discussing this so open. I have the same issue as a lot of you since the spring, and also had a lot of problems getting the right help. Found this forum after 2-3 months into all my problems and thanks to your suggestions found a physiotherapist who was able to provide me with some help. That lowered the pain significantly and helped with most bladder issues as well.
Still a long way to go, but I’m happy you helped me set the first steps towards recovery!
Every now and then, I re-post this from earlier in this long thread.
I have been cured of my PN. Please explore this thread. Look at Dr Eichenberg in Bethlehem, PA in the USA.
Good luck.
First, thank you to all who have been so open in sharing their symptoms, their challenges in finding relief and their (on-going) progress. I’m very happy to have found this topic, as it was very eye opening.
I too have been dealing with many of the symptoms that have been called out. My saga started with an enlarged prostate, which two rounds of treatment dealt with. But, then related but different symptoms kicked in. After reading this topic, I’m pretty confident it’s PN.
I’ve been doing PT for the pelvic pain. The therapist is pretty knowledgeable and has been very helpful. But, I’ve plateaued in my recover with just PT and Baclofen to relax the pelvic floor. Next stop, at the PT’s suggestion, is a sport & spine physiotherapist, in 10 days. This topic has armed me with valuable info and I hope that this will fast track the next stage in my treatment.
In my case, I think 3 things have aggravated my symptoms. I do think that the prostate treatments were a stress on the system and may have set me up for these later challenges. Second, unfortunately, I bought Specialized Power Mirror saddles for both my road bike and my indoor trainer. I love the saddles, but the perineum channel is shallow and the saddles are firm. So, all of the saddle recommendations have been super helpful. Once I’m ready to get back on the bike, it will be with a new saddle. Last aggravation is that I’m recently pretty sedentary when I’m not riding. I’m now pushing myself to not sit as much during the day and/or at least stand more and get some more walking in.
Again, thanks all for the discussion. Anyone want to buy 2 Specialized Power Mirror saddles?
Out of interest, what treatments?
I’ve been on Tamsulosin for a couple of years now. But, that wasn’t enough. The first treatment was Rezum, the steam based therapy. There was some initial relief but after a few months, the symptoms returned. Next was TURP. Better for a while but then symptoms returned, although not exactly the same. This is where I believe the PN became a factor.
For me, the nocturia has been the worst symptom. I’m getting up to pee 8-10 times per night. Luckily, I can fall asleep quickly. I haven’t had a solid nights sleep in a couple of years. With the PN, what wakes me up now is not the bladder being full but the pain associated with the PN. Bladder or bowel pressure can cause the pain to kick in. Even if only 1 or 2 out of 10, it wakes me up at night.
There have been a few references to the Headache book in this topic. I bought it, I’m part of the way through but I’m concerned that it may not be as relevant to the cycling community. IMO, it seems to focus more on stress & anxiety vs. a physical source, like an injury or the stress of riding.
I found the discussion on PN and Cycling more targeted to us. I certainly agree with both that each persons case is unique.
I’m still gathering info at this point, but I know for my own personal symptoms and reaction, there is definitely a physical stimulus as a factor. I do recognize the symptom spiral can have multiple entry points, but once you are on the carousel, there is commonality. I just know that I have to also address the external factors, which are around the bike/saddle fit at a minimum.
Others have a similar reaction to the Headache book?
Long time lurker to this thread. It was time for me to add to the discussion. Sorry for the random nature of my post in advance, just felt the need to get my thoughts down!
Want to first say thanks to all of you who contribute your honest and vulnerable thoughts and experiences to help gain awareness and understanding (and mental relief) to everyone. This is a rare example of the internet’s positive potential in action. I am going to be as detailed and honest as I can be, so be aware that some details aren’t always so politically correct. I think being open and exposed only helps others, so off I go, be warned! 
I am avid cyclist, have been since I was 19, I am 52 now and credit my health and lack of aging almost squarely on my persistence to be an active cyclist all my life. Cycling has been a godsend to me.
That said, I am now on my second bout of PN. My last one happened 2 years ago. Lasted for about 2 months. I was not educated about PN at the time. Through common sense and staying off the bike (and some luck!) being easy on my bottom I was lucky to be able to get rid of it.
Since then I had gained about 20 unwanted pounds though, and in Sept of last year I started training and changed my diet dramatically on both counts. I don’t do things half way, I tend to go full bore… that was/is probably not always the smart solution to some problems! The common denominator of the PN in both cases was me being slightly overweight (about 20lbs) and overtraining.
In sept last year I did about 12 rides from Sept 15th to end of the month. Oct I did 22 rides, and in November I did 24 rides, my last two rides were 30 minute climbing/standing only (zero sitting), back to back days. The second one I did some dumbell squats after the ride, and the next day, you guessed it, I was peeing frequently, had major anxiety, numbing, odd sensations… Yep PN again. I was training for a race. That training ended with the PN.
In December I had only done two short rides, 15-20 minutes (sad to give up the bike, desperate), but I have taken up hiking, treadmill, and elliptical to keep fit. My PN has slowly been healing, I celebrate every single little victory (less and less pain or odd sensations that are often difficult to find words for). The PN is still here though. And not being someone with ever having sustained injury it has been a journey of learning patience and mental management (I’m a hypochondriac and doubt/think really crazy things like it’s cancer or some other thing). The mental management is the hardest part. And the timing of this PN couldn’t be worse, both for the race and a new girlfriend (she is a star though, very supportive).
There’s good news though. I’ve lost 20lbs, 9% body fat though which is good! I’m feeling almost totally fit again, but still wake up from PN every day. For the last 30 days it has slowly, agonizingly got a bit better every day.
Some of my prior “major” symptom’s- A deep pulling/uncomfortable/stuck sensation deep at the root of my penis when I leaned forward mainly, some numbness on the left side of my genitals/region, feeling of a ball in my rectum, always a full bladder, difficulty in reaching climax (slowly getting better on that front, erections have been no issue thankfully), frequent urination (always when its at the very worst), and incomplete vacation of defecating. Most of the “big” issues have subsided within the last three weeks of taking really good care of myself.
Currently, I get tingling sensations in my left leg at times, and feel a tinge of discomfort near my left inner thigh tendon that connects to my pelvis (a little shock feeling, like I’m pulling something a little bit). I am now able to sit on a cushion I found with a pudendal nerve cut out (I tried about 8 cushions before I FINALLY found one that worked, link: https://www.amazon.com/dp/B0C1N3JRQR?psc=1&ref=ppx_yo2ov_dt_b_product_details. I have one in my car and my computer chair (I work from home).
I just started having normal bowel functions (day 4 in a row!), but omg they are massive- and so I wanted to share something else I hadn’t seen on this thread, constipation!
I have had issues with constipation my whole life, but it got worse when I started training, I cant seem to drink enough water to keep things loose. I had done some research on chronic constipation and found that it absolutely can and does affect your PN. Internal pressure on P nerves can be constant, its not just the outside pressure!
So I decided to start doing some cleansing, and sorry for the details but I was backed up much more than I realized. Part of my diet change was adding in a lot of fiber to help with weight loss. The double whammy effect of cycling (hydration issues) and high fiber, created so much bulk inside, bowel swelling I presume (although any effects from constipation were mild, couple of hemorrhoids too but not big). It’s only been a few days but I am going to continue to strive for softer dailies with diet changes.
Just another part of the process of elimination of what could be adding to PN. Usually it is a combination of things someone does, in my case it was too much time in the saddle (not giving the nerves a break), daily constipation (full rectum), two standing/climbing cycling only days, and the straw that broke the camels back so to speak, two sets of squats. All that I have since read contribute to aggravation of the nerves in the pelvic floor.
Willing and able to continue to contribute if any of you have found this post helpful. I have avoided so far seeing a PT because I am seeing progress, and I think our medical system in the US is terrible, I am not on any pain meds (Ibuprofen sometimes, but it doesn’t really help). I don’t want the PN to get any worse. I’m not used to being injured and have prided myself on that all my life. I am in really good health otherwise. Figure the details can help others!
Thank you all again, I will continue to monitor and contribute where I can.
Anyone else worry it could be something else bad like cancer or something? Mess with your mind?
Is it hard for you to keep hope it will heal sometimes?
I have days I’m sure it’s going to be gone completely the next day only to wake up and there’s a minor setback
I almost always feel better in the morning, but by the end of the day symptoms have creeped in a bit, some days worse than others
Anyone else have the same experiences?
I’ve had similar, although some of the setbacks aren’t minor. I nowhere near being able to sleep through the night — that will be ultimate victory.
I had a doctor’s appointment today that I had hoped would start me down a good path. Unfortunately, they don’t have real PN experience. The search continues.
That’s tough man. I can sleep. On bad days I get up to pee a few times, and I get tingling down my left leg, in my toes sometimes too- no major pain. I’m sorry yours is so bad, I feel lucky mine isn’t that bad.
The hardest thing for me is not thinking it’s something like cancer or something inside messing with my nerves etc. PN disrupted normal evacuations on the toilet for quite a while, only aggravating the nerve more and causing hemorrhoids. Vicious cycle of small irritating things like that I’m dealing with. Plus this like vibrating feeling in my hamstring/inner thigh, not a cramp but almost like involuntary spasms- very light comes and goes. Stupid nerves.
Getting older makes it harder to heal faster too, got to love it. With all that said, I know it could be much worse and I am grateful it isn’t so far. I took my saddle off my trainer bike to be sure I don’t tempt myself. I want to go months without symptoms before I think about riding again and even then it will be very limited, once a week will keep me feeling like a cyclist, twice I feel like I’m training pretty good. I can accept that, if I ever get back there.
Quick update: Was able to find a different saddle that doesn’t immediately irritate the nerve when I sit. In abundance of caution, I did a 7 minute (yes seven) ride on my Zwift Trainer alternating sitting and climbing/standing. The next day I felt no real effects, perhaps a little tenderness but no shooting nerve sensations different than I’ve been feeling lately. The next day I did another 7 min workout, same type, only higher wattage (first day was 200w avg, second day was 215w avg). Woke up this morning feeling a tad tender in the region but again did not notice any shooting nerve sensations, perhaps a little tightness deep inside where the “buffalo soldier” starts- but not fully confident that is from the cycling (I’ve been trail running and doing the treadmill too).
So out of abundance of caution I’m going to give myself at least at 3 day break, continue the treadmill and hiking/trail running on those days. To me a back to back training day on the bike is a huge victory since my last ride was Nov 30th of 2023, even if the sessions were 7 minutes (you can do a lot in 7 minutes actually).
I have two more saddles on order (the one I’m using now is my 3rd since Nov 30th), I will keep trying new saddles until I feel perfect comfort- everyone is different and there’s nothing wrong with trial and error. Selle’s SMP line, Venzo (cheapo but comfortable!), and SQLab are the brands I feel that seem to be more aware of what PN is and how to avoid it. Generally I’ve found that saddles are not wide enough in the back, are too rounded, and despite buying wider sizes, my sit bones (117mm center to center) tend to sit on the outside of the highest point of the saddle, which means the round center of the saddle goes up inside and puts pressure the perineal area (taint). SQLabs seems to have addressed this better by providing a wider flatter rear section for your sit bones so that they do not straddle the apex of the saddle. Fitting properly is so important, we need to continue to raise awareness to the companies who are making saddles incorrectly! Get your sit bone measurement and follow the proper fitting guide on SQLabs website, they are on the ball (I’m not endorsing the company but they seem to be the only one addressing this issue head on transparently). If anyone has info on another company doing the same please feel free to add them to the comments!
I forgot to add some physiological improvements (warning I hold no punches and I’m not shy):
Constipation is improving with some diet changes (full evacuation is the main victory here, PN caused all kinds of issues there for me). Have had some help with some mild tea that helps constipation, added more beans to my diet as well. I’m hoping in time that I don’t need either. Nine days of “normalcy” on the morning throne, I do believe constipation was a major player to getting PN in the first place.
Urination has been totally normal for about 3 1/2 weeks, no crazy multiple every 15 min trips to the bathroom or getting up in the middle of the night 3-5 times, no more constant feeling of having to go.
I really hope all of this extra detail helps readers!
My update. I was referred to a chronic pain specialist. She has experience with PN. She agrees that I seem like a text book case. She’s starting me on Amitriptyline. As a bonus, it should help my sleep. Fingers crossed.
Excellent news, has it helped much? Hoping you get some relief, sounds positive!
My update:
I started taking turmeric and curcumin, also capsaicin supps daily, in the am, every day. One is to reduce inflammation and pain, the other is to help increase circulation. Started 6 days ago. I was on the bike tonight, and 3 days ago too! Just doing indoor Zwift training rides for now, intervals, to get some power back.
Zero delayed nerve issues the next morning after either ride. I think the supps are helping matters, still being very careful doing all the preventive and post measures I did before. I also did a custom fit set up for my new seat and position on the bike. My seat was too high, but not by far, also angled my nose down. Those adjustments and the new seat (ISM PR 3.0 saddle), have made a difference I can feel. Still using my seat pad for my work chair, just in case. Two months in and I think I may be out of the dark tunnel, giving myself at least 3 days rest between rides going forward (what I used to do). Tonight was my longest ride since Nov 28th last year. Huge victory. Hitting 210 watt averages for 20 mins, not bad after that much time off I think.
Congrats on your progress!
Thanks for asking. Some improvement. Pain is less frequent and generally down a point or two. Not getting up as often at night. Before the meds, I was getting up 8-10x; last night only 5 times, with a solid 3 hour block of sleep.
I have some side effects I’m dealing with. Tired and lethargic, mild headache about 10 hours after a dose; it’s like having a daily mild hangover. Doc wants me to stay the course, that I should get more used to it. I see the doc again in 2 weeks.
Okay man, at least some steps forward overall. Hope it continued to improve.
I am back on the bike, it’s unbelievable but I am. Some residual effects from the last injury but very minor (desensitization in certain areas). I will be back on the MTB outdoors very soon as well doing rides with good friends now and then. All the changes I made and discipline paid off. I still use that pad I bought on Amazon for my computer chair daily, just to be safe and not add unnecessary pressure to the area when I’m off the bike. I’m staying the current course.
I developed pudundal neuralgia on 11/6/23 during a century ride. I purchased a new bike and the seat was flat.
The following items helped me:
- Purchased an ISM 3.0 seat and put the seat pointing downward at 6%. Also paid for an extensive bike fit.
- Completed the PRP treatment to my pudundal nerve on 12/26/23. This procedure has really helped me. I plan to get a booster shot in November. The cost for the first procedure was about $3,500. The booster shot will cost about $2,000.
- Sit in the hot tub as much as I can after a workout.
- Go to PT and do dry needling twice a week.
- Purchased a Zynex device and use this stem machine one hour a day. Insurance paid for 80% of the cost of this machine.
- Purchased two high end pillows that have a hard cushion and a space for the pudundal nerve.
- Was subscribed a few prescriptions that I can share individually that helped me.
- Changed my routine from riding six days, 16 hours a week to:
Saturday: Bike two hours, followed by 30 minute swim.
Sunday: Stairmaster 30 minutes (high level) followed by lifting.
Monday: Swim for 30 minutes followed by lifting.
Tuesday: Bike two hours.
Wednesday: Stairmaster followed by lifting.
Thursday: Day off or sometimes or bike for two hours.
Friday: Swim for 30 minutes.
I sincerely hope this helps someone. I have worked every day to recover from this difficult injury. I feel like I am 80% healed after approximately five months. Stay positive and know there is a path to recovery.
I went through all of this a couple of years ago. It sucked big style!
What helped and fixed it for me was:
I gave up cycling entirely and focused on running to keep fit and sane. This was actually really good and i was happily running 35-40 miles per week and stayed super fit.
I did loads of stretching and mobility. - not sure if this helped but it was good for me in other ways.
I bought a stand-up desk so that i wasn’t sat down all day while working from home. I also bought a comfy cushion with a cut out - i still use this today.
I obviously thought it was cancer so went to my doctor and urologist and got fully checked out. The side benefit of all this was that i learned a ton about internal muscles and got a thorough health check out while confirming that there wasn’t a massive tumor in my pants.
I got checked out by medical physio (finger up the bum style) - this didn’t find anything wrong either.
I didn’t go too far down the medical route as i didn’t want needles stuck in me and surgery is a huge no-no. I was initially given drugs like amitriptyline but this just made me shitfaced. I know of people that take gabapentin or something for long periods of time to sort it but i didn’t fancy swapping a physical problem for a medicalised addiction problem so gave the pills back to the doctor.
Then i bought a Selle SMP saddle with a big cutout - this is a game changer.
I bought this book https://amzn.eu/d/7CJQ1if - this was the total game changer. The premise is that your body and mind gets used to feeling sensations as pain. This teaches you to not correlate these feelings as pain, just as non-pain sensations. This was the final piece of the puzzle for me.
I eventually got back on the bike and had dropped from 320W to about 200W but it all came back very quickly. I’ve been fine ever since. Occasional pelvic feelings but nothing to worry about.
Good luck!!
I have the same condition since one year now. Strangely enough, I’ve had this feeling before after some bike rides but it always went away after a day, so I didn’t think much of it, only a year ago it just became permanent.
I did all the standard tests, but nothing was found.
I have a pain level usually between 1 and 5, but when sleeping the pain goes away, so when I wake up I am completely pain free but it comes back soon after getting up. It can also go away when using the toilet. And it is mostly on the left side. So all the symptoms for PN are there.
I didn’t use any medication, yet (besides of ibuprofen), as I was a little bit scared of side effects. My plan is now to wait at least another 6 month before taking medication.
I have a physio therapist and it helps sometimes. But the thing is, many things help, like heat, stretching, cold, going to a sauna, swimming in water etc etc. but they are all temporary and it comes back when I stop doing for example the stretches.
The thing that actually helps me most is one of those TENS devices which I use sometimes in the evening. When using it with a low frequency I do not feel any pain while using it (perhaps just because the nerve system is just distracted by it).
The pain is not really better after one year, it’s just up and downs, but I am still optimistic that it will go away (I actually had other chronic pain some years ago which lasted for around 2 years and then just vanished, so there is that). Interesting is although that the pain is not exactly the same like one year ago, it is less extensive and more focused on one point but the pain level is about the same.
I use the bike still from time to time with another saddle and it doesn’t get worse with the new saddle, but I mostly stick to running right now (which also kind of helps, after a run I usually feel less pain).
Well, from what I read people with this syndrome usually get better but it takes a pretty long time, so it can take 2-3 years or something like that.
Well, my plan is to see how it goes this year and to think about meds like gabapentin next year, if it doesn’t improve in any way. It absolutely sucks… but hang in there, I will post updates if I have more news.
(Actually I am getting an MRT soon, to rule out that its not something that has been overlooked, but I guess they won’t find anything there).