Cycling and The Pelvic Floor
Author: Samantha Edwards, Physiotherapist
I recently signed up for my first ever women’s triathlon. This will include a 400m swim, 20km bike ride, and 5km run. I wouldn’t call myself a strong cyclist and the times that I have gone for a leisurely ride I find my pelvic floor becomes sore pretty quickly; which sparked my interest to learn more about the effects of cycling on the pelvic floor. As a Physiotherapist, I often recommend cycling to individuals with joint pain, osteoarthritis or following a knee replacement as cycling is generally a low impact activity. With that said, I have never really considered or explored the involvement or impact of cycling on the pelvic floor, until now.
I will start off by saying that these thoughts or situations are not “one size fits all” and there are some people who may feel or experience absolutely no effect on their pelvic floor with cycling, we are all built differently. Some pelvis’ are wider or more narrow than others, some people have more soft tissue surrounding their pelvis, and some individuals may feel more discomfort due to past experiences. When it comes down to it, we typically will experience pain or discomfort when the demand we put on the tissues is too much for the tissues to handle. Therefore, there are some people who don’t max out their tissues capacity and will have no issues while riding a bike. This principle also explains why you may feel discomfort the first few times you try a new activity (because your tissues haven’t adapted yet), but eventually that activity will become less uncomfortable because those tissues have been able to adapt over time and exposure. In summary, when load > tolerance we often experience pain or discomfort, and this concept applies throughout the body.
Based on my reading into this topic, cycling can actually be very demanding for the pelvic floor, one study done in males found up to an 82% decrease in penile oxygen after 20 minutes of cycling. While that study was only done in males, it is safe to assume a female pelvic floor would also lack oxygen after 20 minutes of cycling. The best way I can think to describe this is to think of when your arm “falls asleep” after being in an awkward position for a prolonged period of time. You start to experience tingling, numbness, and soreness in the arm, but as soon as you change positions the sensation slowly starts to come back and the pain goes away. This happens because your nerves are lacking blood flow (& oxygen), which makes them cranky; but as soon as you change positions, blood flow returns, nerves are happy again. This is essentially what can happen to the pelvic floor when you are cycling. The constant pressure on the pelvic floor muscles and nerves can lead to restricted blood flow (& oxygen), and in turn, pain and/or numbness in that area. The good news is that there are some strategies you can use to help alleviate these symptoms.
The first strategy is one that may be out of your control (i.e in a spin class), but if you can choose your seat size, preferably a wide seat to help distribute weight through out your pelvis; and wearing padded bike shorts can help to take pressure off your sit bones. Secondly, try standing up to peddle every so often to take pressure off your pelvic floor; this will help to restore some blood flow. Thirdly, raise the handlebars up. Lower handlebars cause you to lean further forward which will put more pressure on your perineum, which is where a key bundle of nerves live. And remember what happens when you compress a nerve for too long, they get cranky! And lastly, but definitely not least, remember to breathe. When you hold your breath during an activity it causes an increase in pressure in your pelvic floor, which is very hard on the muscles and pelvic organs. If you find that you are holding your breath, try slowing down or turning down the resistance to give your body a chance to catch up.
In summary, there are many great benefits to cycling and as I mentioned before it can be a low impact activity that is beneficial for many forms of injury rehab. However, if you are having issues with your pelvic floor while you are cycling give the above strategies a try. If your symptoms persist, reach out to a physiotherapist or your health care provider for further assessment and guidance.
References:
Kotler D; Babu A; Robidoux G. “Prevention, Evaluation, and Rehabilitation of Cycling-Related Injury.” Current Sports Medicine Reports. Training, Prevention, and Rehabilitation. 15 (3). May/June (2016)
Partin SN; Connell KA; Schrader S; LaCombe J; Lowe B; Sweeney A; Reutman S; Wang A; Toennis C; Melman A; Mikhail M; Guess MK. “The bar sinister: does handlebar level damage the pelvic floor in female cyclists?” J Sex Med. 2012 May;9(5):1367-73. doi: 10.1111/j.1743-6109.2012.02680
Schwarzer; Sommer; Klotz; Cremer; Engelmann. “Cycling and Penile Oxygen Pressure.” European Urology. 41.139-143. (2002)
Trofaier, Marie-Louise; Schneidinger, Cora; Marschalek, Julian; Hanzal, Engelbert; Umek, Wolfgang. “Pelvic floor symptoms in female cyclists and possible remedies: a narrative review.” Int Urogynecol J. 27,513-519. (2016) doi:10.1007/s00192-015-2803-9
