Meet Sarah
Managing Symptoms
Riding with Adjustments
Gravel & Road Racing
Riding Type
Endurance, climbing
Riding Speciality
Pelvic and urinary burning with activity
Primary Symptoms
Endometriosis (PN-like symptoms, not PN)
Likely Cause of PN
How it Started
My symptoms began in February 2019 and initially felt like a recurrent UTI - urinary urgency, frequency, and urethral burning. There wasn’t a clear trigger, and at the time I didn’t associate the symptoms with riding. I continued cycling while trying to understand what was going on.
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I first went to a urologist because the symptoms felt urinary, but my urinalysis tests were clean. I was diagnosed with overactive bladder syndrome and started on medication to reduce bladder spasms. I was able to continue riding and even race a gravel season during this time, managing symptoms as best I could. As time went on and my training volume increased, the symptoms worsened, which led me back into the medical system to keep searching for answers.
Symptoms
My early symptoms felt very much like a UTI, including urinary urgency, frequency, and urethral burning. These symptoms were persistent and frustrating, especially because testing repeatedly showed no infection.
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Over time, the symptoms changed. I began experiencing vaginal and urethral burning pain, most often following activity. At times, this pain felt like the early stages of a UTI returning. While the symptoms weren’t always constant, flare-ups became more noticeable and harder to manage, particularly as training volume increased.
Causes
At first, the cause of my symptoms was unclear. Because they felt urinary, I was treated for overactive bladder syndrome and later told I might have interstitial cystitis. When symptoms persisted and worsened, pudendal neuralgia was also considered, especially after a bilateral pudendal nerve block temporarily helped my pain.
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Over time, it became clear that my symptoms were not caused by cycling itself. Instead, further evaluation showed that pelvic floor dysfunction was playing a significant role. During pelvic floor physical therapy, my therapist was able to reproduce the pain I experienced on the bike through internal trigger point release.
Eventually, I pursued further medical workups, including gastroenterology and gynecology evaluations.
In January 2021, I underwent surgery for suspected endometriosis. During surgery, endometriosis was confirmed and excised. I had likely been experiencing symptoms related to endometriosis since my teenage years, and years of pain led to chronic guarding, which contributed to a hypertonic pelvic floor.
What Helped
I tried several treatments as I worked through different diagnoses. I had a bilateral pudendal nerve block, which provided some relief, though much of that improvement also came from being off the bike. I also used icing and ibuprofen as needed to help manage symptoms.
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Pelvic floor physical therapy became an important part of my care. Along with PT, medication adjustments helped support symptom management. I initially used vaginal baclofen/lidocaine suppositories as needed, and later switched to valium suppositories to help the pelvic floor muscles release.
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Using these treatments before rides led to some improvement in symptoms and allowed me to continue riding while working through the larger medical picture.
Current Status
My road back to normal cycling has been long and frustrating, but ultimately fairly successful. I’ve been able to return to training 10–12 hours per week and even racing on gravel.
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I still experience flare-ups at times, especially following harder efforts, and occasionally need to reduce ride duration or adjust the type of riding I’m doing. However, my symptoms are now explainable and manageable, which has made a significant difference in how I approach both riding and recovery.
Healthcare Learnings
One of the hardest parts of this experience was navigating the medical system while my symptoms didn’t fit neatly into a single diagnosis. Because my pain initially felt urinary, I spent years cycling through urology visits, medications, and treatments that didn’t fully explain what was happening. Along the way, I received multiple diagnoses - overactive bladder syndrome, interstitial cystitis, and later pudendal neuralgia - each of which explained part of my experience, but not the whole picture.
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What I learned is how important it is to keep advocating for yourself, especially when treatments aren’t working or symptoms don’t fully make sense. Changing providers, asking new questions, and being willing to revisit assumptions ultimately led me to answers I wouldn’t have reached otherwise. Endometriosis wasn’t confirmed until surgery, and pelvic floor dysfunction only became clear after working closely with a skilled physical therapist. None of this was obvious early on, and it took time, persistence, and multiple perspectives to connect the dots.
Personal Note
If my road through pain, incorrect diagnoses, different therapies, and constant ups and downs has taught me anything, it is this: always advocate for yourself, never settle for less than the quality of life you want, and remember that recovery is not linear.