Ask The Coach

Doesn’t everybody wish that they had access to a personal coach for their questions about training and fitness? Johnathan Edwards M.D. Dr. Edwards is a practicing sports doctor and anesthesiologist in Las Vegas, Nevada. He has been a sports doctor for American cyclists as well as in Europe. He is a USA cycling certified level 3 coach and has worked with athletes during the Paris Dakar rally. As a former professional motocross racer and current Cat 2 road racer, he understands the health and training needs of cyclists of all levels.

Dear Coach, I’m asking about a seldom discussed problem in bicycling forums, but it is something that seems to increase as riders hit the later years. Do you have any good information in regards to prostatitis as it relates to bicycling and its causes, treatment, and prevention? Thanks.

Male cyclists and their saddles, an eternal problem even since cowboys started riding horses. Some saddles feel quite right, while others just hurt. A cyclist’ saddle needs to fit like a good pair of shoes that allow you to walk without pain for hours. Thus when you find a good saddle, you keep it. Miguel Indurain was reported to always carry his saddle in hand when traveling so that it would never be lost. It makes sense why he treasured a good saddle because he seldom rose from it.

Male problems associated with cycling are common including sebaceous cysts, saddle sores, urethral problems, hemorrhoids, and erectile dysfunction. But one problem that is not discussed often is prostatitis. Prostatitis is an infection and inflammation of the prostate gland. Fortunately this problem is rare, but when it strikes, it can take you off of the bike for months at a time. In fact one of our magazine editors contracted prostatitis just before he was scheduled to ride the Etape du Jour at the Tour de France. Not only was unable to ride the event, but he was off the bike for almost 4 months.

Prostatitis occurs in cyclists due to the pressure placed on the perineum by the seat while riding. It is an extremely painful condition that requires antibiotics, anti-inflammatory medications and rest. It may rarely require surgery in severe cases.

Who gets prostatitis?
Medical risk factors include a history of frequent urinary tract infections, prolonged pressure on the prostate gland, urethral trauma, previous prostatitis, and a condition called Benign Prostate Hypertrophy (enlarged prostate). Cycling risk factors include improper seat position insufficient padding by the chamois. Prostatitis occurs more frequently in older cyclists, but is has been reported in males in their early 20’s. Improper bike fit / saddle position is the most common cause of prostatitis in cyclists.

What are the early symptoms? Prostatitis in cyclists often presents with urinary tract outflow obstruction ? such as high frequency, dribbling, and incomplete bladder emptying. Dysuria (painful urination) is also a symptom of prostatitis.

Things you can do to prevent prostatitis:
Bike fit, be sure you ride the proper size bicycle and adjust the seat such that it decreases pressure on the perineal area (Johnny Knoxville calls this the ABC).

Finding a good saddle can be a tedious task. A seat that allows comfort and that allows you to take pressure off the perineal area is ideal.

If you are riding and your buttocks are numb, then so is your perineal area (as they are supplied by the same nerves). Learn to ride on your ischial tuberosities (butt bones) by rotating your pelvis back; this may not be possible for everyone, but at least give it a try.

Stand up on the pedals at regular intervals. See an Urologist promptly if you experience any of the symptoms mentioned above. Early treatment and prevention are the keys to avoiding this catastrophe.

And, once you find a seat that is right for you, keep it.

Dr. Edwards

The author would like thank Dr. Michael Verni for his advice preparing this article. He is a practicing Urologist in Las Vegas who loves to rides bicycles.

The information provided in the ASK THE COACH column does not constitute formal medical advice. The information provided on this public web site is provided solely for general interest of the visitors to the site. Information in this column does not constitute medical advice nor establish a doctor-patient relationship with Dr. Johnathan Edwards. Readers of this column should not act upon any information contained in the web site without first seeking medical advice from their personal physician.

If you have your own question about health or training that you would like to ask a coach please send them to [email protected]

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