Meet Sarah

Photo courtesy of Brett Rothmeyer

Name: Sarah

Age: 30

Location: Austin, TX

Primary type of riding: Gravel racing, road

Riding specialty: Endurance, climbing

Years of riding experience: 7

When did symptoms start: February 2019

What did initial symptoms feel like: UTI-like symptoms

If known, presumed causes of pudendal neuralgia: Unknown-I am still undergoing my workup. Endometriosis is a possibility.

Amount of time off the bike since injury: I have taken two 15-20 day stretches off the bike while getting a workup

Symptoms: Early symptoms: UTI-like symptoms (urinary urgency, frequency, urethral burning)

Current symptoms: Vaginal and urethral burning pain typically following activity. Sometimes this also feels like the start

of a UTI.

Treatment: Bilateral pudendal nerve block, pelvic floor PT, icing and ibuprofen as needed, vaginal baclofen/lidocaine suppository as needed

Recovery Status: I am recovering and undergoing a work-up currently.

Are you riding again: I am recovering from a COVID-19 infection so I am not allowed to ride yet. I will try to get on the bike when I can and if my pain levels allow.

Personal note: This has been a long and frustrating road. I initially went to a Urologist with my symptoms because they felt like recurrent UTI symptoms but my urinalysis tests were clean. I got diagnosed with over-active bladder syndrome (OAB) and was put on a medicine to help reduce bladder spasms. I was able to race one gravel season during this time and got through it by taking Azo before and during endurance races. This helped some, but eventually my symptoms got worse and I got put on a second medication for OAB. While on the dual medication therapy, I increased my training volume to ~16-18 hours per week and then my symptoms got worse. My Urologist told me she thought I had interstitial cystitis. I got lidocaine injected into my bladder for temporary relief but it did not do anything to help. This was when I started to look elsewhere for help and someone suggested that I might have PN. I got a bilateral nerve block and it helped my pain, confirming that I have PN. I was able to start riding again but the pain eventually came back. I am now in pelvic floor PT with a PN specialist and am pursuing both a Gastroenterology (GI) workup and an endometriosis workup to see what the root cause of my PN is. My GI doctor is concerned that I may have an endometriosis implant wrapping around my rectum and I am concerned that there may be implants near the pudendal nerve. I am going to try to keep riding through the work-up if I can.

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