Pelvic issues caused by spinning and cycling; How to ENJOY your cycling Pain Free.
I read the article below, brought to my attention by one of my gorgeous clients, with great interest.
I would definitely agree with Dr Philippa Kaye – do not ignore pain and definitely numbness or discomfort in your pelvis region during or after cycling is not right.
Dr Kaye expertly explains the possible issues for both women and men and is reassuring that some simple adjustments can help to relieve all pain.
In my opinion there are some definite modifications that can make cycling and spinning much more comfortable.
Always wear padded shorts or padded pants (with no underwear). And buy the ones with the best padding that you can afford.
Make sure these garments fit snuggly – if they are too lose they can cause chaffing (as I found out)
Invest in a specially designed ‘women’s or ‘mens’ saddle. These accommodate our differing anatomy and give the necessary parts, space. Some companies do allow you to try before you buy.
Learn to pedal effectively. Never stamp down and pull up. Instead focus on a smooth push through your thigh and ‘scraping the mud off the bottom of your shoe’ at the bottom of the stroke. This uses the most effective muscles (quadriceps and hamstrings; as opposed the the smaller calf muscles) and improves cycling efficiency. It also prevents ‘bouncing’ in the saddle which puts damaging pressure through your pelvic region.
Build your upper body and core strength to hold your torso strong. This again will prevent that heavy ‘stomping’ through your legs and help develop smoother rotating pedal stroke.
Avoid very uneven and bumpy terrain – cobbles etc when out on the road.
Think twice about standing up on your spinning bike. Do you really need to stand on a bike whilst you are pedalling. I never do.
Spinning Into Incontinence
By Br Philippa Kaye
The patient, in her 50s, wasn’t so much embarrassed as perplexed. She had, in recent moths, began to suffer an inability to hold on when she had the urge to pee. Worse, she’d began to ‘leak’ a bit, almost without realising.
She’d not suffered this kind of problem significantly after the births of her two children, who were now in their early teens. And she’d religiously done her pelvic floor exercises, which help women regain and retain water after being pregnant.
‘It makes no sense – I can’t work out why it is happening now,’ she lamented, adding that a number of her friends had been far worse affected.
It didn’t take long to narrow down the cause. Her problem was at it’s worse when she exercised, and that was pretty much always one thing: spinning.
These intense indoor cycling classes, which usually feature load music and an instructor at he front empathetically urging on the group, have been around for years and have a devoted following.
But now there is also Peloton, a stationary bike with a 22in flat screen attached to the handlebars on which you can take virtual spinning classes at home at any time.
Despite the eyewatering prices, from £1,300 to £1,800 – they sold like hot cakes during the lockdown, although demand had apparently died down now that more of us are heading back to the gym.
My patient now did both, meaning she was on the saddle for a high-energy session at least four times a week. ‘I’d do it more if I had time,’ she admitted. ‘I love it.’ She’d also bought a real bike so she could cycle with her kids on the school run and to the shops.
Had she noticed any numbness or discomfort ‘down there’ I asked? ‘Yes, but I thought it was normal to be a bit saddle sore,’ she said. So you can imagine her disappointment when I told her that no it wasn’t normal, and her newfound obsession may be contributing to her incontinence.
It’s long been suspected that cycling can cause men all sorts of problems with their urinary and genital organs – the genitourinary system. One recent study found an increased rate of prostate cancer in men who cycled more than eight hours a week, although it’s not totally clear why.
One theory is that the saddle exerts pressure on the perineum – the area between the testicles and the anus – which can, in turn, irritate the prostate, which is just below the bladder. It’s been suggested this could be linked to erectile dysfunction and urinary incontinence, however research has found that these problems – which are common in middle aged men – are seen just as often in those who do other sports.
What’s less well known it that too much time in the saddle can trigger a range of problems in women.
Whilst there aren’t official figures, Facebook groups for Peloton and spinning are packed with of posts from female enthusiasts with similar stories to my patient.
Many report alarming , swelling after a rigorous class, or going totally numb then suffering pins and needles. Unexpected leaks, even in women without children who’d never had problems before, was another common theme.
A study of more than 300 female triathletes, who cycle a lot as part of their sport, reported that one in three suffered incontinence and pelvic pain. Experts have also found female cyclists can suffer decreased vaginal and labial sensitivity, and a higher rate of urinary tract infections.
The reason? Men are able to move their genitals out of the way when they cycle, but women can’t. And while having low handlebars may make you feel faster, leaning forward to hold them increases the internal pressure exerted by the saddle which then engages the pelvic floor – the hammock of muscle that sits at the base of the pelvis and supports the bladder, uterus and rectum. However, if your pelvic floor is weak, this pressure can cause leaks.
Other triggers include strenuous exercises such as running and jumping but also coughing, sneezing or even just laughing. We call this stress incontinence.
An overactive or overworked pelvic floor can cause incontinence by exerting pressure on the bladder, and the nerves that supply it, which leads to the sudden urge to go. A sudden change in position can prompt the sensation of urgency for example, during a spinning class when you move from sitting in the saddle to standing up on the pedals. You can also have a mix of both types of incontinence, and both might be worse after the menopause – the loss of oestrogen can lead to the tissues of the pelvic floor and genitourinary system weakening.
This isn’t to say don’t cycle, as I told my patient. Building activity into normal life, including about 30 minutes of moderately intense exercise 5 days a week, is linked to an endless list of health benefits. But if genital discomfort and incontinence become an issue, some adjustments need to be made.
Getting you saddle and hand bars adjusted professionally at a bike shop is key, to ensure they’re comfortable. Look into padded cycling shorts, too – these have to be worn without underwear as your knickers can literally end up in twists, exacerbating the situation.
There are also a range of saddles that can better accommodate the female anatomy.
If sores or chafing are a problem, a smear of an anti-chafing cram over the labia, groin and inner thighs can do the trick. Experts also advise standing up every ten minutes or so while cycling, just to relive the pressure on your perineum. This might occur naturally if you are muting on urban roads, but you might have to remind yourself when on a static bike.
Urinary incontinence which affects 40% of women at some point in their lives, shouldn’t ever be dismissed.
It’s one of my missions as a GP to make sure it’s not accepted as a normal consequence of pregnancy, childbirth or the menopause.
Sadly NHS provision can be patchy. Patients, even when they do seek help, can end up on long waiting lists. According to a recent report on the Pelvic Floor Society – a body made up of bladder and bowel specialists – some incontinence sufferers wait over a decade even for a diagnosis.
If incontinence is impacting everyday life, GPs should be able to offer advice or refer patients to a continence clinic, and specialist physiotherapists can recommend exercises aimed at giving sufferers better bladder control.
It’s also important to remember that any new pelvic pain should be investigated, to rule out anything sinister.
So if cycling is causing you problems, a few simpler adjustments to the bike and your riding style can be all that’s needed to get you back, comfortably in the saddle.
The Mail on Sunday – January 23rd 2022