Name: Kate
Age: 33
Location: California
Primary type of riding: Road, gravel
Riding specialty: Climbing, endurance
Years of riding experience: 10+
When did symptoms start: Winter 2017
What did initial symptoms feel like: Pinching sensation in labia while seated on a bike
If known, presumed causes of pudendal neuralgia: Likely a combination of poor fit (sitting on the saddle crooked and too far back, which meant I was sitting on soft tissue & muscle instead of bony structures) as well as inadequate stress/anxiety management.
Amount of time off the bike since injury: 2.5 years
Symptoms:
- General burning sensation of vulva (feels like the start of a UTI)
- Stabbing, sharp pain on labia minora
- Issues wearing tight clothing and underwear
- Strong, intense pain when bladder is partially full or full (sense of urgency to urinate)
Treatment:
- Physical therapy focusing on:
> Dry needling with neuromodulation
> Manual therapy like nerve gliding & muscular releases
>Address muscular imbalances & issues with muscle tone (in this case, a high
tone/overly tight pelvic floor)
- Lifestyle changes
>Stress & anxiety reduction including calming of the nervous system reactivity and
relaxation of pelvic floor
> Breathing techniques - belly breathing to lengthen pelvic floor & slow down nervous
system
> Prioritization of sleep
- Medication
> Gabapentin (100mg-200mg) used very sparingly only on bad days (2-3 days per
month)
- Home care
>Pelvic wand use focusing on the obturator internus & other pelvic floor muscles
> External massage of abdominals, hips, pelvis
> Pelvic stabilization exercises
> Meditation with focus on relaxing pelvic floor
> Stretching
Recovery Status: Majority of daily symptoms have been reduced or eliminated. Still working through the recovery process by means of monthly PT appointments and weekly home care. Still experiencing some bad days alongside many, many good days.
Are you riding again: No, not yet. The fear of reinjury is too high and I am still working through the mental & emotional side of recovery. It may come with time, but I’m not putting any pressure on myself to get back on the bike, as much as I miss it. Living symptom and pain free is too important for me right now.