eMedicine Specialties > Sports Medicine > Neurological

Bicycle Seat Neuropathy: Treatment & Medication

Author: John M Martinez, MD, Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center
Coauthor(s): Kenneth Honsik, MD, Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente
Contributor Information and Disclosures

Updated: Jun 17, 2008

Treatment

Acute Phase

Rehabilitation Program

Recreational Therapy

Recreational therapy should include evaluation of the rider's position on the bicycle and could include changing the seat height and tilt position.

Medical Issues/Complications

Medical issues and complications include continued injury or insult to the area, resulting in continuation of the neuropathy and long-term sequelae such as impotence. Reevaluate the patient after making changes to the bicycle or riding style or after decreasing the training volume to ensure that improvement in symptoms is occurring. Continued symptoms despite changes in the bicycle seat position and training volume may indicate a different source of the symptoms and should warrant reevaluation by the physician.

Consultations

Possible consultations include specialists in urology and neurology, based upon the patient's clinical presentation.

Related Medscape topics:
Specialty Site Neurology & Neurosurgery
Specialty Site Urology

Other Treatment

The mainstay of treatment of bicycle seat neuropathy is the adjustment of the bike seat and bike position, such as tilting the nose of the seat down or lowering the seat height to relieve pressure off the perineum. Other recommendations include having the rider change the style of riding (eg, change positions more frequently or stop riding more frequently).

Newer bicycle seats with a split nose or a center cutout may also help to reduce the prevalence of neuropathy by limiting compression on the perineal area (see Image 1). A study by Lowe et al compared pressure measurements in the perineal area of cyclists on these different bicycle seats and found that some of the newer seats reduced perineal pressure by approximately 50%.17

Medication

No medical therapy is recommended.

More on Bicycle Seat Neuropathy

Overview: Bicycle Seat Neuropathy
Differential Diagnoses & Workup: Bicycle Seat Neuropathy
Treatment & Medication: Bicycle Seat Neuropathy
Follow-up: Bicycle Seat Neuropathy
Multimedia: Bicycle Seat Neuropathy
References
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References

  1. Schrader SM, Breitenstein MJ, Lowe BD. Cutting off the nose to save the penis. J Sex Med. May 7 2008;epub ahead of print. [Medline].

  2. Kennedy J. Neurologic injuries in cycling and bike riding. Neurol Clin. Feb 2008;26(1):271-9; xi-xii. [Medline].

  3. Asplund C, Barkdull T, Weiss BD. Genitourinary problems in bicyclists. Curr Sports Med Rep. Oct 2007;6(5):333-9. [Medline].

  4. Weiss BD. Clinical syndromes associated with bicycle seats. Clin Sports Med. Jan 1994;13(1):175-86. [Medline].

  5. Silbert PL, Dunne JW, Edis RH, Stewart-Wynne EG. Bicycling induced pudendal nerve pressure neuropathy. Clin Exp Neurol. 1991;28:191-6. [Medline].

  6. Gemery JM, Nangia AK, Mamourian AC, Reid SK. Digital three-dimensional modelling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction. BJU Int. Jan 2007;99(1):135-40. [Medline].

  7. Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. Eur Urol. Mar 2005;47(3):277-86; discussion 286-7. [Medline].

  8. Andersen KV, Bovim G. Impotence and nerve entrapment in long distance amateur cyclists. Acta Neurol Scand. Apr 1997;95(4):233-40. [Medline].

  9. Oberpenning F, Roth S, Leusmann DB, van Ahlen H, Hertle L. The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal. J Urol. Feb 1994;151(2):423-5. [Medline].

  10. Goodson JD. Pudendal neuritis from biking. N Engl J Med. Feb 5 1981;304(6):365. [Medline].

  11. Kuland DN, Brubaker CE. Injuries in the Bikecentennial tour. Phys Sportsmed. 1978;6(6):74-8.

  12. Weiss BD. Nontraumatic injuries in amateur long distance bicyclists. Am J Sports Med. May-Jun 1985;13(3):187-92. [Medline].

  13. LaSalle MD, Salimpour P, Adelstein M, et al. Sexual and urinary tract dysfunction in female bicyclists. Presented at: 94th Annual Meeting of the American Urologic Association; May 4, 1997; Dallas, Tex.

  14. Potter JJ, Sauer JL, Weisshaar CL, Thelen DG, Ploeg HL. Gender differences in bicycle saddle pressure distribution during seated cycling. Med Sci Sports Exerc. Jun 2008;40(6):1126-34. [Medline].

  15. Amarenco G, Kerdraon J, Bouju P, et al. [Treatments of perineal neuralgia caused by involvement of the pudendal nerve] [French]. Rev Neurol (Paris). Jun 1997;153(5):331-4. [Medline].

  16. Bond RE. Distance bicycling may cause ischemic neuropathy of the penis. Phys Sportsmed. 1975;3(11):54-6.

  17. Lowe BD, Schrader SM, Breitenstein MJ. Effect of bicycle saddle designs on the pressure to the perineum of the bicyclist. Med Sci Sports Exerc. Jun 2004;36(6):1055-62. [Medline].

  18. Bressel E, Larson BJ. Bicycle seat designs and their effect on pelvic angle, trunk angle, and comfort. Med Sci Sports Exerc. Feb 2003;35(2):327-32. [Medline].

  19. Spears IR, Cummins NK, Brenchley Z, et al. The effect of saddle design on stresses in the perineum during cycling. Med Sci Sports Exerc. Sep 2003;35(9):1620-5. [Medline].

  20. Jeong SJ, Park K, Moon JD, Ryu SB. Bicycle saddle shape affects penile blood flow. Int J Impot Res. Dec 2002;14(6):513-7. [Medline]. [Full Text].

  21. Schwarzer U, Sommer F, Klotz T, Cremer C, Engelmann U. Cycling and penile oxygen pressure: the type of saddle matters. Eur Urol. Feb 2002;41(2):139-43. [Medline].

  22. Taylor JA 3rd, Kao TC, Albertsen PC, Shabsigh R. Bicycle riding and its relationship to the development of erectile dysfunction. J Urol. Sep 2004;172(3):1028-31. [Medline].

  23. Dettori JR, Koepsell TD, Cummings P, Corman JM. Erectile dysfunction after a long-distance cycling event: associations with bicycle characteristics. J Urol. Aug 2004;172(2):637-41. [Medline].

  24. Sommer F, König D, Graft C, et al. Impotence and genital numbness in cyclists. Int J Sports Med. Aug 2001;22(6):410-3. [Medline].

  25. Solomon S, Cappa KG. Impotence and bicycling. A seldom-reported connection. Postgrad Med. Jan 1987;81(1):99-100, 102. [Medline].

  26. Akuthota V, Plastaras C, Lindberg K, et al. The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy. Am J Sports Med. Aug 2005;33(8):1224-30. [Medline].

  27. Mellion MB. Common cycling injuries. Management and prevention. Sports Med. Jan 1991;11(1):52-70. [Medline].

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Further Reading

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Keywords

saddle numbness, erectile dysfunction, impotence neuropathy, bicycle saddle neuropathy, vascular or neurologic injury of the pudendal nerve, urinary incontinence

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Contributor Information and Disclosures

Author

John M Martinez, MD, Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center
John M Martinez, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth Honsik, MD, Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente
Disclosure: Nothing to disclose.

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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