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: Daily symptoms have almost been fully eliminated. I would consider myself recovered from PN.
Are you riding again: Yes