Pelvic Floor Problems and Cycling: Symptoms, Causes, & Solutions

Our pelvic floor is involved in so much of our everyday life, yet we ignore it completely until problems start to arise. Those problems seem to show up even earlier when you throw cycling into the mix. We have a fixed connection with our saddle and can have a variety of scenarios present when dealing with pelvic floor issues related to cycling. Correctly understanding what is going on musculoskeletally and neuromuscularly, as well as what the bike fit looks like, tells an important story.

Understanding the Pelvic Floor

Pelvic floor issues, whether related or unrelated to cycling, can show up as anything from urinary incontinence, to painful sex, hip pain, and more. But why?

Our pelvic floor consists of three layers of muscles and plays a role in bowel function, bladder function, sexual function, and support. The lower abdomen (below your belly button) has fascial connections to the second layer of the pelvic floor. These pelvic floor muscles (PFM) can be hypotonic (low tone) and weak, or hypertonic (tight) and weak. If these muscles are tight, loose, or weak, they aren’t behaving properly and can’t support or relax when needed for bowel, bladder, and sexual function.

Common Pelvic Floor Symptoms Cyclists Experience

These problems include, but aren’t limited to:

• Urinary incontinence (leaking urine)

• Dysuria (painful urination)

• Nocturia (waking more than once per night to urinate)

• Urinary urgency and frequency

• Pain with sex, exams, or period products

• Erectile dysfunction

• Constipation

• Fecal incontinence (leaking stool)

  
  

The pelvic floor works in conjunction with the transverse abdominal muscles, diaphragm, and multifidi/erector spinae muscles, which form our “core.” Think of it like a soda can: when everything functions properly together, it modulates pressure. That’s why if you leak urine when you cough, sneeze, laugh, or jump, we know that intra-abdominal pressure isn’t being managed correctly.

Is Cycling Good or Bad for the Pelvic Floor?

Cycling itself isn’t the problem. But it can bring existing pelvic floor dysfunction to the surface or make symptoms worse if things are already off. The saddle setup, how you sit, how long you ride, and the unique shape of your anatomy all play a role.

When there’s tightness, weakness, or poor coordination in the pelvic floor muscles, the fixed connection between your pelvis and the saddle can start to cause issues. Throw in a saddle that doesn’t match your structure, and it’s easy to see how symptoms creep in.

Think of it like wearing high heels on a hike. Now imagine doing that with a sprained ankle. Your shoes weren’t made for the terrain, and your body wasn’t ready for the task. Same idea on the bike. Anatomy and equipment both matter.

Common Cycling-Related Pelvic Floor Issues to Watch For

• Pudendal Neuralgia: Compression to any portion of the pudendal nerve, located in the pelvis, resulting in tight, weak, and painful pelvic floor muscles and surrounding fascia.

• Coccydynia: Tailbone pain that may also include pelvic floor tension, weakness and pain, constipation, gluteal tightness, and difficulty sitting on or off the bike.

• Hip Impingement: Pinching and pain in the front of the hip or groin, often related to tight hip flexors and adductors. Symptoms may radiate into the perineum.

• Lumbosacral Pain: The S2-S4 nerve roots innervate the bowel and bladder. If anything is restricting them, pelvic floor issues can follow. We have connective fascia along the spine that continues down to the coccyx and lies close to the pelvic floor itself.

We need to determine whether these issues stem from bike fit, a cyclist’s baseline anatomy, or both (usually both). A proper bike fit combined with an evaluation and treatment by a pelvic floor physical therapist can optimize your ride.

How to Treat Pelvic Floor Issues

A trained pelvic floor physical therapist will resolve these concerns through various manual therapy techniques, both to the pelvic floor and surrounding structures. This may include dry needling, myofascial release, Theragun, scraping/Graston, cupping, etc. That’s followed by exercises to reactivate muscles that have been underactive.

At the same time, work with your favorite 90+ bike fitter to ensure your equipment is dialed in. Ride, re-evaluate, treat, repeat.

2 Exercises that Support the Pelvic Floor

Pelvic floor work doesn’t have to be intimidating or complicated. A couple of simple movements can go a long way in reconnecting with the core and supporting overall function on and off the bike.

• Diaphragmatic (belly) breathing: Lie on your back, place one hand on your chest and the other on your belly. Breathe so that only the hand on your belly rises and falls. This teaches pressure management and encourages the pelvic floor to move naturally with the breath.

• Happy baby pose: While lying on your back, bring your knees toward your chest and hold the outsides of your feet with your hands. Let your hips relax open. This position gently stretches the pelvic floor and helps release tension through the hips and lower back.

Everyone benefits from these, regardless of pelvic floor condition. They’re simple, effective, and a great place to start.

A happy pelvic floor means a happy bike ride!