Does cycling contribute to men’s pelvic floor dysfunction?
There is conflicting evidence on the effect of cycling and pelvic floor dysfunction in men. As the sport becomes more popular, especially here in Boulder, it is imperative to review the current literature to understand the effect, if any, this sport has on your pelvic floor and how to prevent or treat impairments.
CURRENT LITERATURE REVIEW
A recent study published in 2021 in the International Journal of Environmental Research and Public Health looked at men aged 25-75 who had been cycling for “more than 10 years” or “less than 10 years.” The men answered a series of questionnaires about their urinary and sexual health. The researchers found there was a correlation between years cycling and a group of symptoms called lower urinary tract symptoms. These symptoms include increased urinary frequency (commonly called “overactive bladder”), difficulty or hesitancy to start the urine stream, weak urinary stream, post-void dribbling, urinary urgency, and nocturia (waking at night 2 or more times to urinate). Most often, these symptoms are related to pelvic floor muscle dysfunction including hypertonia (tight muscles) and nerve irritation. However, in more severe cases, symptoms have been linked to a narrowing of the urethra, called urethral stricture, in which scarring occurs in the urethra. Urethral stricture has previously been found to be linked to cycling when compared to other activities such as running and swimming (Awad et al. 2018).
Positively, the researchers found no correlation between cycling and erectile dysfunction or urinary incontinence. However, other studies have determined that the saddle and position of the rider may result in erectile dysfunction, rather than simply participating in cycling (Balasubramanian et al. 2020).
HOW CAN CYCLISTS PROTECT PERINEAL HEALTH
It is important to prevent stress on the pelvic floor and urethra when in the saddle due to constant pressure on the perineum and pudendal nerve. Several ways have proven to relieve stress including seat-post shock absorbers, elevating handle bars, and standing more than 20% of the time while cycling (Awad et al. 2018, Lee et al. 2020). A professional bike fit is always recommended to ensure ideal saddle pressure management and ergonomic setup.
If you are having any of the above mentioned lower urinary tract symptoms, pelvic floor physical therapy can help. Likely, the muscles of the pelvic floor have become overactive and manual therapy can help reduce the tension. You will also learn techniques to reduce pelvic floor tension and all about healthy bladder habits. Further, if numbness or tingling occurs in the perineum, seek out a pelvic floor physical therapist to assess the pudendal nerve and avoid progression of this dysfunction into “cyclist syndrome” or pudendal neuralgia.
Research on pelvic health and cycling continues to be a work in progress, however, just like any sport vulnerable to repetitive use injuries, it’s important to review the evidence and make the recommended adjustments to avoid tissue trauma and related injuries.