Question from Horst R.: I am 52 years old and had an operation in 2009 for bursitis on the left side of my buttock. I was told that I wouldn't be able to cycle for three months, but after that I would be back to normal. Since then, I have suffered from buttock problems again and again, the operated area and its surroundings are often very sore, the whole thing looks like a crater. Sometimes I manage to get the wound to close, but after a few cycling sessions the problem starts again. I would be grateful for any advice.
Answer from Dr Stefan Staudte: Wound healing takes place in every surgical area, which is accompanied by more or less scarring. Scars are usually harder and less mobile, and therefore less resistant to pressure and friction than the original tissue. You are obviously overloading the scarred surgical site when cycling. There are three solutions: Firstly, avoid the strain completely. You can do this as soon as you have the sore area again. Secondly, reduce the intensity of the strain or pressure, which I would advise you to do.
To do this, you need to choose a saddle that distributes the pressure more evenly in this area. The seat pads of your cycling shorts should also be taken into account, and seat creams and ointments can be considered. Ideally, this should be done with the help of a specialist who takes into account saddle selection and adjustment, riding technique, bike adjustment and clothing.
It is important that the acute stage is assessed by a doctor so that you know what is really going on at the site. There are bursae on the buttocks above the area where the seat pressure of a fixed saddle is applied. These very rarely become inflamed, unless you ride a very large, soft saddle and sink in deeply, like in a sofa. There are no significant bursae in the seat area of harder sports saddles. The seat area is formed by the ischial tuberosities, the lower ischial and pubic arches and, unfavourably, the perineal area. There are a lot of muscle and tendon attachments here, together with the associated tendon sheaths and fat as filling material. These tissues can also become inflamed and form painful swellings or cysts which, in the worst case, have to be surgically removed.
If none of this brings any improvement, the third and final option is to have the surgical site surgically repaired again.
