Cyclist’s Syndrome, or Pudendal Neuralgia, is a diagnosis involving pain or sensory changes (numbness, tingling) around the pudendal nerve distribution. Women are not the only ones that can be affected with pelvic pain, as this can involve regions around the penis, testicles or anal opening in men. It can no doubt effect a person’s quality of life, impacting bladder, bowel, and sexual function as well as someone’s ability to sit for extended periods of time. Pudendal nerve pain can be exacerbated by sitting, driving, exercise, bowel elimination or having a full bladder, and can be alleviated by lying down, sitting on a toilet seat, or standing.
PN is commonly referred to as Cyclist’s syndrome due to the amount of time spent in a bike saddle, which can compress or irritate braches along the path of the pudendal nerve with repetitive compression or irritation from the repetitive nature of hip flexion required from cycling. Prolonged cycling on an ill fitting bike seat in this position can cause those nerve branches to become irritated.
As we described above, pain is not the only identifier of pudendal neuralgia. It can also present with bladder dysfunction such as urinary urgency, frequency, pain with bladder filling, burning with voids, or sensation of incomplete emptying. Bowel symptoms can include anything from pain, to difficulty eliminating, or even incontinence. Sexual function can be affected including pain with erection, ejaculation or orgasm, erectile dysfunction or persistent arousal. With the amount of symptoms pudendal neuralgia can present with, it’s easy to see how PN can be quite challenging to receive an accurate diagnosis.
PN can be challenging to treat, but not impossible to manage. Pelvic floor PT can be one tool to assist in normalizing muscle tone or reducing nerve irritation on the pudendal nerve, as it has a close relationship to the pelvic floor. Having a team of providers focusing on a multidisciplinary approach is essential for thorough treatment of PN. Medical management with medication, suppositories, nerve blocks, surgical decompression or ablation are some options in addition to pelvic floor PT. Dry needling can also be a tool utilized during PT visits to reset the pudendal nerve and assist with reduction in symptoms.