Question from Thomas W.: I am 47 years old and have been riding my road bike for around ten years, about 8,000 kilometres a year - from C-races and senior races to the Ötztaler. After my last long tour, my attempts to optimise my riding position resulted in me experiencing perineal pressure that won't go away and is also annoying in the office or car. The urologist has diagnosed me with pudendal neuralgia, for which there is supposedly no real treatment. In the past, I have occasionally had increased urinary urgency after longer trips, but this has soon subsided. What is your advice?
Answer from Dr Stefan Staudte: The problem you have described is probably an overload syndrome. Unfortunately, I cannot say exactly where it is located anatomically and which structures are affected, but I can give you some hints. Theoretically, cycling is dangerous for the perineum, scrotum and anal area, especially with conventional standard saddles, which put unfavourable pressure on the middle of the perineum. This is exactly where the posterior urethra, vascular and nerve bundles are located, as well as the prostate and bladder in the depths. Irritation and inflammation are possible there. Your description of an increased urge to urinate after longer trips is an indication in this direction. The posterior perineal area, i.e. the anus, buttocks and sit bones, can also be affected - overloading complaints of the muscles, tendons, muscle attachment points and periosteum are conceivable there. In the anterior perineal area, the base of the penis with its shaft and the urethra are particularly affected.
The diagnosis of "pudendal neuralgia" is a so-called diagnosis of exclusion - this means that all other possible causes do not apply and therefore no cause-related treatment is possible. The only solution in this case would be to avoid the causative strain and wait and see, i.e. to stop cycling for the time being. This is of course not satisfactory for you as a performance-orientated road cyclist. It is therefore important that the examinations carried out so far have been comprehensive and accurate enough. If, for example, inflammation of the prostate is the cause, this would be relatively easy to treat. Another important aspect is to change the geometry of the bike as well as the saddle and other attachments if necessary so that the pressure on the affected areas of the perineum is avoided. You can have your personal characteristics analysed by bike dealers, training advice institutes or specialised sports physicians.
