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Cycling and Pelvic Floor Health: Addressing Pudendal Neuralgia and Pelvic Pain

Long-distance cycling is an excellent way to stay fit, enjoy the outdoors, and challenge yourself. However, many cyclists—both recreational and competitive—experience pelvic floor discomfort or pain after prolonged rides. This is often due to the impact of sustained pressure on the pudendal nerve and pelvic floor muscles.

In this blog post, we’ll discuss the anatomy of the pudendal nerve, how cycling can lead to pelvic floor dysfunction, symptoms of pudendal neuralgia, and how pelvic floor physical therapy can help you recover and get back on the saddle pain-free.


Anatomy of the Pudendal Nerve

The pudendal nerve is a crucial nerve in the pelvis, responsible for sensation and motor control in the pelvic floor and perineum (the area between the genitals and anus). Originating from the S2-S4 nerve roots in the sacral spine, the pudendal nerve travels through the pelvis, passing through Alcock’s canal (pudendal canal). It innervates essential pelvic structures involved in sexual function, urinary control, and bowel function.

Due to its anatomical pathway, the pudendal nerve is particularly vulnerable to compression or irritation during prolonged sitting or cycling, which places direct pressure on the perineum.


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

Extended time in the saddle compresses the perineal region, which can lead to irritation or compression of the pudendal nerve. This repetitive pressure can cause pudendal neuralgia, characterized by pain and dysfunction in the pelvic area. Additionally, prolonged cycling may strain the pelvic floor muscles, further contributing to discomfort and pain.


Symptoms of Pudendal Neuralgia

Cyclists with pudendal neuralgia may experience:

  • Perineal Pain: Discomfort in the area between the genitals and anus, often worsened by sitting or cycling.
  • Genital Numbness or Tingling: Sensory changes in the genitals or anus.
  • Burning or Stabbing Pain: Pain that may radiate to the buttocks, thighs, or lower abdomen.
  • Urinary Dysfunction: Difficulty urinating, frequent urination, or incomplete bladder emptying.
  • Sexual Dysfunction: Reduced sensation, erectile dysfunction, or pain during or after intercourse.

Other Pelvic Floor Dysfunctions Associated with Cycling

In addition to pudendal neuralgia, cyclists may develop:

  • Pelvic Pain: Muscle tension causing discomfort in the lower abdomen, perineum, or pelvic region.
  • Urinary Incontinence: Muscle imbalances affecting bladder control.
  • Erectile Dysfunction: Compression of the pudendal nerve or pelvic floor dysfunction.
  • Rectal or Anal Discomfort: Strain or tension around the rectum.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor physical therapy provides an effective, non-invasive treatment for addressing cycling-related pelvic pain and dysfunction. Here’s how it helps:

  1. Assessment of Pelvic Floor and Nerve Health
    A therapist will evaluate your symptoms, pelvic floor muscles, and any signs of nerve irritation. This helps determine whether your pain stems from pelvic floor dysfunction, pudendal neuralgia, or a combination of both.
  2. Manual Therapy and Myofascial Release
    Tight pelvic floor muscles or fascial restrictions can contribute to pain and nerve irritation. Manual therapy techniques like myofascial release can relax these tissues, alleviating discomfort and improving nerve function.
  3. Nerve Mobilization Techniques
    Therapists use gentle techniques to mobilize the pudendal nerve, reducing irritation and promoting healing. This helps restore normal nerve function and alleviates symptoms of neuralgia.
  4. Pelvic Floor Muscle Relaxation and Strengthening
    If your pelvic floor muscles are overactive (too tight), relaxation techniques, biofeedback, and guided exercises can help. If weakness contributes to dysfunction, strengthening exercises can restore balance and improve overall pelvic health.
  5. Posture and Bike Fit Adjustments
    Proper posture and bike fit are essential for minimizing pressure on the perineum. Therapists can provide recommendations for adjustments, including saddle choice and handlebar positioning, to help prevent nerve compression.
  6. Education and Lifestyle Modifications
    You’ll receive guidance on preventing future issues, such as tips for posture, cycling duration, and pelvic floor exercises to maintain health.

Healing and Preventing Pelvic Floor Dysfunction in Cyclists

Cycling is a fantastic activity, but it can lead to pelvic floor issues like pudendal neuralgia and pelvic pain due to prolonged pressure on the perineum. If you’re experiencing discomfort, pelvic floor physical therapy offers a comprehensive solution to address nerve irritation, muscle imbalances, and posture-related issues.

With the right combination of manual therapy, exercises, and lifestyle changes, you can reduce symptoms and return to cycling with confidence and comfort.

Reach out to us at Pelvic Health Center in Madison, NJ, to schedule an evaluation and treatment. Call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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