Meet Andrew
Mostly Symptom-Free
Riding Normally
MTB
Riding Type
Technical singletrack
Riding Speciality
UTI-like symptoms and pelvic pain
Primary Symptoms
Stress and anxiety
Likely Cause of PN
How it Started
My initial big flare up happened in April 2022, but in hindsight my symptoms had started earlier. It seemed like I had a massive UTI with frequent/urgent/painful urination, up all night with no sleep. I went to the urgent care clinic and tested negative for an infection and told to get to a urologist. This happened again 2 weeks later before I could get to the urologist. There I was told that I had hypertonic (cramped) pelvic floor muscles and to go to a pelvic PT, decrease my stress and stay off my bicycle for a few weeks. Luckily I had a planned week off from work and I started on all that.
But, when I returned to work, the pain level immediately went up to an incredible level, completely debilitating, sleepless nights shivering in pain. After suffering through the week and trying unsuccessfully to work, I decided to go on short-term disability for 6 weeks. It was a very dark time.
Symptoms
Along with the intense urinary symptoms, I experienced deep pelvic pain, sexual pain and dysfunction, constipation, and pain with sitting. During the worst periods, the pain was overwhelming and all-consuming. Later, when symptoms flared again, I also developed intense sit bone pain and could only tolerate sitting on a heating pad.
Causes
At the time, the fact that I was a cyclist came up often, but I never had pain while riding or immediately afterward, which made everything confusing. I heard and read horror stories about people never being able to ride again and that this was sometimes called “cyclist syndrome.”
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What eventually became clear is that cycling wasn't causing this - stress and anxiety were the actual contributors. Over the years - and especially the six months before my flare - stress had been steadily building. I was dealing with raising teenagers, various health concerns, my father’s alcoholism, costly home repairs, fear of neglected dental work, career uncertainty, and interviewing for a new job. I’m a civil/environmental engineer and consultant, and the responsibilities were stacking up.​ I was essentially a ticking time bomb and didn’t realize it.
What Helped
Although practitioners mentioned the psychological component, I was focused almost entirely on physical fixes at first. I went on pain medications, received six injections in my perineum, attended pelvic PT appointments, and stretched religiously. In early 2023 I felt a little better, so I decided to dig into the psychological side of things. That's when I learned about the mind-body connection, which changed everything for me.​
Mind-Body Insights
During this time, I discovered the concept of mind-body pain (also called TMS, tension myoneural syndrome). I learned that pelvic pain/dysfunction and pudendal neuralgia is similar to back pain, headaches, irritable bowel syndrome and many other conditions where chronic pain/symptoms can develop from a heightened nervous system and repressed emotions.
I think most people understand that there is a connection between emotions and acute physical reactions (blushing when embarrassed, butterflies when nervous, headache when stressed, etc.) but it’s a radical idea that chronic pain can be from our emotions. I read books from Dr John Sarno (The Mind Body Connection, 1991), Alan Gordon (The Way Out, 2021) and Dr Schubiner (Unlearn Your Pain, 2010), consumed dozens and dozens of podcasts and YouTube videos and started working with a mind-body pain coach. All of these helped me understand that my pain was real but it did not originate from a structural issue that needed to be fixed or heal. The mind-body pain coach taught me how to regulate my nervous system through deep breathing, meditation, day-to-day anxiety reduction practices and a technique called somatic tracking.​​​ On my 50th birthday, my wife got me to try yoga and now I’m hooked. It’s helped so much with teaching me peace and calmness in my body and mind.
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Recently I started working with a different mind-body stress coach that helped me understand that my lingering symptom was tied to a lack of purpose, changing identities and not facing other challenging emotions. Her approach was from a much higher level than the chronic pain or my immediate emotions. She helped me with a job change (left the company I was with for 28 years) and coached me to getting back on my bike in September.
Current Status
Today, I consider myself largely recovered. I have only minor sitting pain left, usually tied to stress or certain physical triggers.
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I am riding my mountain bike again, multiple days in a row on technical singletrack. I no longer fear pain. Riding feels enjoyable again rather than something I’m anxious about. Any remaining sit bone sensitivity is independent of cycling, and I’m confident that as I continue addressing other personal and emotional factors, recovery will continue.
Personal Note
Being off the bike challenged my identity in ways I wasn’t prepared for. Cycling was my exercise, my social outlet, and how I cleared my head. I rode with my wife and teenage sons, made close friends through cycling, and did big solo rides to reset mentally. My garage is filled with bikes and my house with bike artwork - riding wasn’t just something I did, it was part of who I was.​ It was also difficult explaining to people why I wasn’t riding when there was no crash or obvious injury.
Around the same time, I had stopped coaching soccer after doing it for 12 years as my sons aged out. Losing both cycling and coaching at once left me feeling lost and adrift. I wasn’t working, I was in constant pain, and I struggled to understand what was happening to my body. It was one of the most difficult periods of my life.
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I’m incredibly thankful for my wife and a few close people who supported me through that time. I’m also grateful to Scott, Scott, Matt, and Fisher from this site for answering my questions, reassuring me that recovery was possible, and offering support when I needed it most.
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Looking back now, I can see how much this journey reshaped how I understand stress, identity, and health. While I wouldn’t wish the experience on anyone, I’m grateful for what it taught me about listening to my body and staying connected to my emotions.
Connect
Listen to podcasts featuring Andrew:​