I got a bike fit a few years ago and they mentioned I could use a longer stem, 1 cm more. But I think going to a shorter one would be a good thing to try.
I feel I owe it to this community to post my experience given how helpful this has been to me. I recently (2 months) found myself googling “indoor trainer groin pain,” et voilà! The first post in the thread was like, hello, this matches me. I can’t thank all of you enough for your transparency and grace sharing all these experiences.
In my case, I’m a relative newb—49 yo, started cycling proper 2.5 yrs ago, previously focused on racing sailboats and snowboarding—but kinda rapidly progressed to group rides, gravel events, etc. I rode 6000 miles last year, then moved indoors and started focusing on an 80/20 plan to get ready for Unbound this year.
Had been fiddling with the saddle on the indoor bike— a Domane on a Kickr Core with NO rocker —moving sadddle fore and aft, adjusting tilt up and down. Clearly something didn’t feel quite right, but just the usual “adjustments.” (Subsequently determined that I was about level on the trainer saddle after all adjustments, whereas the road and gravel bikes are -3 deg).
When BAM. Seemingly all of a sudden I developed all the symptoms I’ve seen described here. (Described here, I might add, more effectively than in any other source, including my PCP, sports medicine doc, bike fitter, or pelvic floor PT specialist.) Aching pain in the left “pudendals” (I.e., cock and balls). Random stabbing pain in lower abdomen. Pain that creeps around the pelvis. Tingling/burning in the perineum. Occasional stabbing pain at tip of penis. Urge to urinate frequently (when it first came on). Etc etc.
I’ve got no huge positives to share as yet—early days for me. Most symptoms went away after a few weeks rest and doing core work on my own (e.g.) planks, hollow holds, single leg deadlifts, split squats, etc.
But. went to a new bike fitter (also a PT) last week and he made some significant changes in my set up (2cm down on the saddle, 42->40 cm bars). But, just those 40 minutes on the trainer (first time on bike since onset)…. Balls hurt again.
My pelvic floor specialist PT (shout out ShirleyRyan lab in Chicago) has got me on a series of exercises that mirror what @SexyCoolguy reports here to good effect, focusing on stretching hip flexors, glutes, groin, and strengthening core around same. Love those posts sexy—everyone check them out.
Very thankful for this community. It’s awesome to see the positive vibe and helpful feedback/contributions here. The overall positivity among this group—despite the challenging situation we all face, the diverse experience/symptoms it presents, and the unpredictable course of treatment —is inspiring.
Keep it up, ya’ll. I will give updates on my end. Much love. And we WILL ride on
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Came across this forum and seemed more relevant than others out there.
Sorry you’re dealing with this. I’m 4.5 months in and still flaring with certain activities. It can be mentally very taxing but you’re not alone.
Check out the stretches that @SexyCoolguy (the OP) posted above—those are very similar to what my pelvic floor PT prescribed, and they generally work when flaring. Sexy also gave some good advice—don’t rush back in. Listen to your body, do the stretching and yoga-like exercises. Wait till things are calm and then wait some more. Everyone’s trajectory is different, but I think the consensus here is this can be a months to years process. Pelvic floor therapy (sounds like you may already be doing this). Reverse kegels. Get thing relaxed.
Also don’t discount the mind-body component (learning and unlearning pain, managing stress and anxiety). The onset of this for me coincided with my dad dying, during which time I was spending a lot of time with him and also had been doing a lot of time on an indoor trainer. Stress and anxiety are frequently associated with onset of PN, and (from what I’ve learned) dealing with that component facilitates its resolution. This and other similar resources can help : https://www.audible.com/pd/The-Way-Out-Audiobook/0593165098?action_code=ASSGB149080119000H&share_location=lib. (Linked in the thread above.)
Also, I haven’t tried it yet, but a lot of people suggest swimming is a good option to maintain aerobic fitness while recovering. Probably also good for the mental component.
Good luck and stay positive. Don’t listen to the negative voices (external or internal). Recovery can happen
My update. After basically months of rest, mine has finally started clearing up. I’m still on a low dose of Effexor to numb the nerve pain. At this point, it’s more about weaning myself off the Effexor than managing the pain.
One thing I did observe: if my bowels were irritated, it increased the pain. Effexor alone can cause some irritation. Add in an NSAID (Advil, Alleve) and I’d get spikes in the pain.
So now I’m very careful on NSAID use (avoid if possible or limit to 1 dose) and food intake with the Effexor. With that, I’m largely symptom free. Starting to get back on the bike, after 16 months of drama.
@MrBirchling thanks for your update. Sounds like you are doing really well.
I started on Amitriptyline. It didn’t do much for me and the side effects were a problem: lethargy and fatigue. Switched to Effexor and saw quick improvement. Took a couple of tries to get the dosage right. Still had some fatigue, at the higher doses (100-150 mg).
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@Journey My saga started off as enlarged prostate, that was likely masking the PN. Once the prostate issues were cleared up, my urologist was stuck on what next. He declared I had Chronic Pelvic Pain (CPP) and referred me to a pain specialist. Ultimately, I was the one that honed in on PN as the source, thanks to this thread.
Once at the pain specialist, I was also referred to a PT. She had some experience with PN and was able to provide good insight. She helped me with some of the other symptoms (my Kegel muscles were spasming).
It was with the pain specialist that I started with the Amitriptyline. Based on my symptoms and the side effects, they then recommended the Effexor. I’ve been working with the pain specialist exclusively, now that the Effexor was found to be helpful.
I also found a bike fitter who had a background in PT. They helped me address bike fit issues (which I’m pretty clear were root cause). New saddles were the main change.
I’m due to circle back with my urologist soon. He’s a cyclist, so while he’s inexperienced with PN, he is interested.
I’m also meeting with a gastroenterologist soon. I want to understand if there might be something going on there, given the PN flare ups from mild bowel irritation.
Recap: The first few months were tackling a range of symptoms. Once the Effexor started to calm things down, the other side effects finally faded. The next 6-8 months were rest, light activity and Effexor. I feel like a switch flipped around the 12-13 month mark, not sure what or why. Since then, increasing activity and managing the remaining symptoms.
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@Journey In the 6-8 month part, I was walking, stretching and trying to get back on the bike for very short rides (30 minutes of saddle time). I’d get flare ups, that a couple of days rest would alleviate. In short, I wasn’t ready for the pressure of the saddle yet.
Current pain level is 0-3. If my bowels are calm, it stays at 0-1, meaning, I might have a twinge but completely manageable. I still want to understand the role the bowels are playing in this.
I really don’t know what ultimately got me to this point. I was very sedentary for a while and, as much as that sucked, it was probably important. I’ve only recently hit this 0-3 pain phase, so I need to watch to see how it plays out. I’m optimistic, but I need to be careful to jump back in too quickly.
@MrBirchling thanks for explaining. That sounds like a big improvement.
I wouldn’t be too stressed at this point about where the baseline is when flaring. (I think stressing about the symptoms is itself generally adverse to recovery.) Also everywhere this is discussed it seems the non-linearity of recovery is mentioned.
I would try to ID what is causing the flares and don’t do those for now. Squats crush me, but strangely I can do Bulgarian split squats and single leg deadlifts. Go figure. Point being figure out what trigger flares and avoid for now. @SexyCoolguy might tell you to avoid anything but the stretches until things calm down—he mentioned to me in a PM (and I think in the thread above) that he believes his recovery was hampered by trying to get back active too soon.
The panic/stressing is part and parcel of the syndrome in my understanding. The initial injury causes the pain feedback loop, then the fear and anxiety reinforces and perpetuates it, even after the injury (nerve irritation) has healed. And the pain/anxiety causes the pelvic floor to freak out, which can actually stress the nerves, and on and on. At least this is what I’ve been coming around to believing. That book I referenced above is spot on in this regard. Mind body work is (potentially) key.
@Journey @Rumpus I agree with Rumpus’ feedback. PN is one of those that every case is different. There may be a range of common symptoms, but how you experience them and what triggers it will differ.
Walking and stretching generally weren’t issues for me. Early on, it was rowing and indoor cycling that would trigger flare ups. I never felt the symptoms during the activity, only after.
As far as range of symptoms, for me in the beginning it was difficult and painful urination; difficult and painful bowel movements; needing to frequently urinate, day or night.
Most things are normal now. Day time, generally no issues. Night time is improving – not much if any pain, but still waking up 4-6X to urinate. Bowel is better, as long as it’s not irritated. That seems to be the last puzzle piece for me.
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I’m by no means an expert here—haven’t even finished the book! But I don’t think there’s any specific time to start the “pain reprocessing” as it’s called. It takes time whether there’s still injury or not, so even if there’s still an underlying injury you can be training your brain to not fear the pain. And the ongoing “injury” (eg the pelvic floor hypertonicity) may itself be a product of the fear/anxiety loop. (To be clear, calling it a mind-body issue is not to say it’s not a real physical pain that you’re experiencing.) So you’ll never get things relaxed down there if you haven’t confronted the anxiety about the pain itself. This is my understanding of the theory behind pain reprocessing, which I imagine will work differently depending on the person and what exactly they’re dealing with.
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I have been following this thread closely for a period of time and it feels my duty to share my story.
My pudendal nerve issues started in Nov 2023. I passed a stone of some sort (maybe kidney, most likely bladder or prostate) at 6am on a Sunday morning. 10/10 pain that I will never forget. After passing the stone, I promptly jumped on the trainer to finish my workout before the family woke up (not advised).
Following the subsequent bladder infection I was found to have prostatitis. This cleared up and symptoms went away after a week or so. I started to develop classic PN pain and did not realize what it was so I tried to ride through it for about 2 months. I also battled constipation quite badly, having a bowel movement only 1-2x weekly. Sitting, even in a previously comfortable chair, was painful so I nearly always stood at my desk while at work. Even my 15 minute drive home from work was uncomfortable. My worst stretch was driving 2.5 hours to an airport followed by a 4 hour flight to Mexico. I was backed up for 5 days.
I tried PT for 8 weeks which helped, but symptoms were still present. I paused on the bike starting in Feb 2024 while in PT. I religiously performed stretches prescribed by my PT every single day without fail for about 6 months straight. I still wasn’t on the bike but was lifting weights in a style similar to Crossfit. When doing heavy lifts that engaged my core heavily (squats, deadlift, snatch, cleans) or abdominal exercises, I had shooting pudendal nerve pain immediately post workout and dull pressure/burning for a couple days following.
I was up and down with symptoms including constipation. If I didn’t exercise, I felt pretty good. If I’d lift weights more than 2x weekly, symptoms returned. It went on like this for months.
Fast forward to Jan 2025, I saw a PN specialist. She confirmed PN being my issue and suggested focusing on relaxation and pelvic floor specific PT. I have always tensed my abdominal muscles since I was a child so I began focusing on deep diaphragmatic breathing and relaxing my core. This was the turning point and first step in winning my battle with pudendal nerve pain.
In Feb 2025 my pelvic floor PT did an internal exam and noticed a tight pelvic floor. She suggested taking Miralax daily which made a huge difference in constipation and was a second big step forward. This was followed by a reduction in PN symptoms.
The third step was activating my glutes with specific exercises, especially weighted and unweighted hip thrusts. This really loosened my core and lower back and helped me move more freely. After some progress my PT suggested starting on the trainer for 15 minutes twice weekly and adding 5 minutes per week if no symptoms.
Today I am still doing my original PT exercises daily, lifting weights 2-3x weekly, and riding 2x weekly for 30 minutes. I’m planning to resume the bike outdoors as the weather improves. I hope my story gives hope that PN pain, while terrible and seemingly hopeless in the thick of it, can be overcome.
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@Rumpus thanks for this insight.
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