by Arnie Baker, MD
Sores of the buttocks and groin area are a common occupational hazard for the bicycle rider. Many causes can be avoided. Specific treatment is available if saddle sores do develop.
Crotchitis is dermatitis: irritation or inflammation of the crotch. Redness, itching, and pain are problems in this area. Discussions about genital numbness and bicycle-seat discomfort follow.
Classic Saddle Sores
Classic saddle sores are inflamed and/or infected hair follicles (folliculitits, furuncles, and carbuncles) and glands (sweat and sebaceous).
- Pressure and jarring
- Friction and shearing forces
Saddle Sore Theory
There are two prevalent theories as to the origin of classic saddle sores.
The first has to do with infection and blocked glands. Bacteria get into glands and cause saddle sores. Therefore, treatment is directed at reducing the level of skin bacteria and preventing pore blockage.
The second theory has to do with (a) pressure and jarring and (b) friction and shearing forces. According to this theory, increased saddle pressure (which often arises through increased miles) prevents small blood vessels from bringing blood to the skin and the skin gets less nutrients. This causes a breakdown in the skin’s defenses, pore irritation, and blockage. Trapped bacteria may proliferate. A saddle sore develops.
Predictably, saddle sore incidence increases with increasing volume. Saddle sores are also more common after long easy rides: when riders do not push down hard on the pedals, they sit heavier on the saddle.
Riders who always get saddle sores on the same cheek may find that their leg on that side is shorter. The buttock of a shorter leg gets more bumping and bruising.
Other Types of Saddle Soreness
Dermatitis / Crotchitis
Skin inflammation of the crotch, is a topic unto itself, discussed in detail below.
Ischial Tuberosity Pain
This is pain in the area of the pelvic bones that bear your weight on the bicycle seat. The ischial tuberosities are the “sitting bones.”
Pain in this area occasionally progresses to bursitis, tuberositis, or ulceration.
Chafing of the inside of the upper leg is common in cyclists. It occurs because of friction caused by the repeated rubbing of the inside of the thigh during the up and down motion of the pedal stroke.
Many cyclists note that the inside of their shorts pill and wear with friction. When this happens to your inner thighs, redness and discomfort are the results. Dampness of cycling shorts related to sweat production and the lack of breathability of the shorts’ material may make the problem worse.
The mucous membranes are delicate and sensitive. They do not have the protective hardness of skin. Many seats, positions, and riding styles expose these tissues to pressure, jarring, friction, and shearing.
Chafing near the urethra can cause urinary tract symptoms and infection.
Skin that is missing its topmost surface layers and denuded is ulcerated. This is sometimes an extreme result of chafing or pressure.
Dilated veins near the anus. Active hemorrhoids external to the sphincter of the anus may contain blood clots and be painful. Folds of hemorrhoidal tissue may trap moisture and be itchy.
Although generally not thought to be caused by cycling, sitting on a saddle may increase discomfort or irritation.
Relatively Rare Problems
- Subcutaneous nodules: These are a specific type of lump found in high-volume male cyclists near the scrotum, sometimes called “extra testicles.”
- Tailbone abscess: A genetic predisposition to a blocked pilonidal sinus may be aggravated by cycling and become infected. Surgical treatment is often advised.
Many cases of crotchitis are related to a combination of factors. In addition to the causes of classic saddle sores outlined above, the following worsen crotchitis:
- Warmth and moisture
- Hygiene and irritants
- Yeast overgrowth
- Vaginal infections
- Medical problems, including dermatitis
Warmth and Moisture
Warmth and moisture aggravate most cases of crotchitis.
Warmth also increases skin friction and predictably worsens friction and shearing related saddle soreness.
Avoid traveling to races or rides in your car already wearing your bike shorts. Change into bike shorts when you arrive. Use bike shorts with a breathable, moisture-wicking crotch. Change out of moist or wet bicycling shorts as soon as possible after riding. Wear loose-fitting shorts or a skirt. Wear breathable fabrics and cotton underwear. Avoid tight-fitting non-breathing underwear, or wear no underwear. Pantyhose is an enemy of the crotch.
Allow ventilation to cool and dry the area. Avoid sitting on non-breathing surfaces such as plastic and leather. Use a car seat cover with air holes if your car has vinyl or leather seats.
Baby powder may help keep you dry. It also reduces friction and shearing forces.
Hygiene and Irritants
Stool is a powerful irritant. Clean yourself properly.
Overzealous hygiene can be just as much of a problem as lack of hygiene. When you are irritated, wiping and rubbing can cause chafing and further irritation. Since this area always has some bacteria, and since irritated skin is prone to worsen and become infected, overzealous wiping must be avoided.
Avoid wiping affected areas with rough toilet tissue.
Wipe from front to back. Women: Do not carry bacteria toward your vagina and urethra. Not only will this worsen crotchitis, but urinary tract infections and vaginal infections may result as well.
Avoid local irritants such as harsh soaps.
If crotchitis extends to areas you need to wipe to keep clean, consider using softer-quality bathroom tissue, facial tissue, or gentle medicated over-the-counter products such as Tucks.
Moistened toilet paper or plain water are also alternatives. Clean, and then pat—not wipe—dry.
Many products may cause skin allergies.
Riders may be allergic to certain laundry products.
Some riders use perfumed or chemically treated products such as sprays, sanitary napkins, or lubricating oils to which they may be allergic.
To help with saddle sores near the crotch, riders may use tapes or pads to which they may have a tape allergy. This worsens saddle sores into saddle sores plus crotchitis.
If you suspect a laundry product allergy, try a fragrance-free laundry detergent, use a double-rinse cycle, and if you use a dryer fabric softener, make it fragrance-free.
Yeast overgrowth is commonly called jock itch or crotch rot. Warmth, moisture, and friction, discussed above, are the principle causes.
Over-the-counter antifungal creams and powders may help reduce yeast overgrowth.
Occasionally irritated skin can also be helped by over-the-counter cortisone cream, although cortisone sometimes worsens yeast overgrowth. Long-term use of cortisone creams thins the skin and is a bad idea.
The extra moisture related to a vaginal infection may worsen crotchitis. Treating the cause of the underlying vaginal discharge may help improve crotchitis.
Occasionally infections such as herpes cause crotch irritation. In turn, crotch irritation can also promote or exacerbate herpes outbreaks in people who harbor the virus.
Infected or otherwise blocked sweat or other glands may develop into crotchitis if friction worsens these conditions.
Riders with skin conditions such as psoriasis or other eczemas may have flare-ups in this area related to friction and other general factors listed above.
Occasionally other medical problems such as lactose intolerance or pinworms are the cause.
Prevention of Saddle Soreness
The best treatment is prevention.
Some general measures will help almost all causes of saddle soreness.
Some treatments may improve some cases but may make other cases worse. It may therefore be important to determine the cause of your saddle soreness.
Pressure and Jarring
A more comfortable ride reduces the causes of most saddle soreness. Even without specific saddle soreness problems, the hints below provide a more enjoyable ride.
Frame and fork.
Construction methods and materials may allow for more or less comfort. Comfort is often sacrificed for responsiveness or cost. Butted tubes are more comfortable than straight-gage tubes. Relaxed, shallow touring seat-tube angles are more comfortable than those of steep-angled time trial bikes. Straight-bladed forks tend to transmit road forces more directly than raked forks.
Tightly-tensioned spokes give a harsher ride.
Use wheels with a 3-cross spoking pattern. The trend of modern wheels to be radially laced may marginally reduce wind resistance. However, these stiffer wheels do not have give.
Avoid narrow, high-pressure tires. Unless you are time trialing, a wider tire with about 100 psi is more comfortable.
If you are 150 pounds, although you can certainly ride 19 mm 200-psi tires, you will be much more comfortable on 23 or 25 mm tires inflated to 100 psi.
Use a seatpost with an offset seat clamp. Binding the saddle directly above the seatpost is not as comfortable as the traditional offset clamp.
It may take a few tries to find a saddle shape that fits your anatomy.
Use seats that provide enough padding or support and spread the support over as wide an area as is compatible with your anatomy.
A cutout center section may reduce or eliminate pressure and irritation on the centerline of the crotch.
Terry saddles work well for many riders, especially women.
Severe cases may require drastic measures—cutting or paring your seat may be necessary to keep riding.
Whether it be more padding on the saddle, a neoprene saddle cover, or gel shorts, padding helps reduce jarring.
Do not confuse cushy with support. Those big wooly saddles do not usually work for longer rides.
Padding elsewhere also helps. Handlebar tape and glove padding makes your upper body more comfortable, allows you to ride more relaxed. This translates to reduced tension and pressure on your rear end.
Do not suddenly and drastically increase your weekly mileage.
Friction and Shearing Forces
Friction can be minimized by using an emollient skin preparation, such as Vaseline, or an anti-yeast cream. Avoid pore-blocking emollients on the scrotum or vulva.
A seat cover or pad fitted over your saddle, or two pairs of cycling shorts may reduce friction and shearing forces and function in the same way as a sock in a shoe.
However, if crotchitis is related to warmth and moisture, Vaseline or doubling up on your shorts may make things worse.
Most bicycles are sized for men, making the top tube stem length too long for most women even if the frame fits otherwise. This puts extra pressure on the crotch. Make sure your bicycle position is not too stretched out.
A slight nose-down position may help, especially for time trial events or criteriums when you are in an aerodynamic position and putting a lot of pressure on the crotch.
A minority of women prefer a nose-up position so that the saddle presses more on the pubic bone and less on the soft tissues around the vagina.
Vary your position.
Move around frequently; get off that saddle when you can.
Stand up on your pedals to relieve crotch friction and pressure.
When climbing, stand up periodically.
When descending, put weight on your pedals and get off your crotch. This allows moving air to cool and dry your crotch while you relieve pressure.
If you are riding tandem, be sure to take frequent crotch breaks by getting out of the saddle at stop signs and stoplights and by standing out of the saddle with your partner at least every 15 minutes.
Keep yourself dry.
Modern synthetics wick away moisture and are softer on the skin than traditional leather chamois. Do not continue to wear wet sweat-drenched shorts after riding. Change into loose shorts that allow air to circulate. After bathing, allow your crotch to dry completely before putting on tight-fitting shorts or cycling shorts. Powder in your shorts can prevent chafing that may lead to irritation and infected blocked glands (although powder may be linked to some cervical problems in women). •
Keep yourself clean.
Have a hot bath after rides. Hot-water soaks increase blood circulation to the crotch, allowing faster recuperation.
Always wear clean cycling shorts. Avoid wearing the same shorts two days in a row without laundering. Soiled shorts not only have more bacteria, they do not breathe as well as freshly laundered ones.
Avoid cycling shorts that are pilled or with seams in areas that either rub the inside thigh or upon which pressure is placed.
Avoid shaving above the short line to the groin. This often results in “red spots,” caused by irritation and infection.
- Apply all the preventative measures described above.
- Modify your training. You do not have to stop cycling but you may need to back off. It is not the time to increase mileage. A couple of years ago when I had some bad saddle sores, I modified my routine. Tuesday was hill sprints, Wednesday long hill climbing, and Thursday hill intervals—all done out of the saddle and off my sores.
- Soak in a comfortably hot bathtub three times a day for 15 minutes. Hot-water soaks increase blood circulation to the inflamed area, allowing more of the body’s healing factors access to the area.
- For classic saddle sores or ischial tuberosity pain, pad your skin with padded tape or moleskin. You may want to reduce the tackiness of moleskin by first applying it to something other than your skin. Leave some tack so that it will still stick, but not so much that it pulls your skin and hair off when you remove it later.
- Another possibility is to take a couple of Band-Aids or a layer of moleskin and cut out a small hole for the sore—effectively padding around the sore and taking pressure off the sore itself.
- The extra padding of a second pair of shorts worn over the first may help reduce jarring or friction related saddle sores. However, two pairs of shorts may worsen dermatitis/crotchitis.
- A padded seat cover may help.
- A different seat may help.
- Suspension may help. Rear-end suspension or beamed seat tubes reduce saddle pressure.
- A modification of seat position—nose up or down, forward or back, up or down—may help.
- An emollient, such as Vaseline, may help friction-related problems. Use emollients such as Vaseline or Bag Balm on the buttocks. Avoid pore-blocking emollients, such as Vaseline and Bag Balm in the gland-rich areas of the scrotum or vulva.
- Try Bag Balm, originally a veterinary product. The active ingredient, 8-hydroxyquinoline in petrolatum, increases the thickness of the skin.
- Topical cortisone, antifungal and antibacterial creams may occasionally help. Long-term use is not recommended.
- Shimming the shoe of the shorter leg may help if saddle sores are related to leg length discrepancy.
Medical and Surgical Treatment
- Eczema may require prescription cortisone creams.
- If hemorrhoids may it difficult to sit down, minor surgery may be necessary.
- If the area around the sore is infected, it may require surgical drainage or antibiotics.
- Uninfected sores that remain as painful, swollen, hard lumps can occasionally be treated with a cortisone injection.
- Occasionally surgery may be required to remove chronic cysts.