When Cycling Causes Nerve Pain: Understanding Pudendal Neuralgia

Started having pain in a region nobody wants to discuss after a series of long training rides. Took months to figure out what was wrong. Turns out extended pressure on a poorly fitted saddle can damage the pudendal nerve — and the recovery is neither quick nor simple. Here’s what cyclists should know.

The Anatomy Involved

The pudendal nerve originates from the lower spine and travels through the pelvis. It provides sensation to the perineum, genitals, and anal region. It also helps control certain pelvic muscles.

When you’re on a bike, your weight rests largely on the perineum — the area between sit bones. That’s directly over where this nerve lives. Extended pressure can compress or irritate it.

What Causes the Problem

Cycling isn’t the only cause, but it’s a common one. Prolonged saddle pressure, especially on narrow or poorly positioned saddles, creates the conditions for nerve irritation.

Other contributing factors include:

• Saddle too high, forcing excess perineal pressure
• Saddle tilted forward, putting weight on soft tissue
• Dramatically increased training volume without adaptation time
• Wearing shorts without chamois padding

Childbirth, surgery, trauma, and certain medical conditions can also cause pudendal neuralgia. Cyclists just happen to be particularly susceptible.

Recognizing the Symptoms

Pain in the pelvic region that worsens when sitting is the hallmark symptom. The pain often improves when standing or lying down.

Other symptoms include:

• Burning, tingling, or numbness in the genital or anal area
• Pain during or after riding that lingers for hours or days
• Discomfort during bowel movements
• Sexual dysfunction

Symptoms often fluctuate. Better some days, worse others. That’s what makes this condition endearing to absolutely nobody — the inconsistency makes it hard to identify triggers.

Getting a Diagnosis

This takes time and often multiple doctors. The condition mimics other pelvic issues. A thorough workup includes medical history, physical examination, and often nerve-specific tests.

Pudendal nerve motor latency testing can measure nerve function. MRI or ultrasound may rule out structural problems. A diagnostic nerve block — injecting anesthetic near the nerve — often helps confirm whether the pudendal nerve is the source.

Treatment Approaches

Conservative treatment comes first. Physical therapy focusing on pelvic floor muscles and nerve mobility often helps. Techniques like myofascial release can address surrounding tissue tension.

Medications may include nerve-pain drugs like gabapentin or pregabalin, antidepressants that help with neuropathic pain, or anti-inflammatory options. Results vary person to person.

Nerve blocks with corticosteroids can provide temporary relief and help confirm diagnosis. Some people get lasting improvement from injections.

Surgery exists as a last resort. Decompression procedures aim to release the nerve from surrounding tissue. Success rates vary. Most specialists recommend exhausting conservative options first.

What Cyclists Can Do

Prevention matters more than treatment. Bike fit is crucial:

• Proper saddle width for your sit bones
• Saddle level or slightly nose-down (never nose-up)
• Correct saddle height to avoid rocking hips
• Handlebar position that distributes weight properly

Saddle choice matters enormously. Cutout or channel designs relieve perineal pressure. Pressure mapping during bike fits can identify problem areas.

Stand up periodically during rides. Shift weight regularly. Take rest days. Gradual training progression prevents overuse injury.

Living With It

Recovery from pudendal neuralgia is often slow — months or years. Some riders recover fully. Others manage symptoms while continuing to ride with modifications. Some have to reduce or stop cycling.

Cushioned seating helps off the bike. Avoiding activities that worsen symptoms accelerates recovery. Heat, ice, and positioning strategies provide relief.

Mental health support matters. Chronic pain in sensitive areas affects quality of life. Support groups and counseling can help.

Taking It Seriously

Numbness or pain during/after cycling deserves attention, not dismissal. Early intervention prevents progression. A proper bike fit is worth the investment. Listen to your body — persistent warning signals mean something needs to change.