What Caused This Horrible Swelling?

Question: About 2 weeks ago, I got a narrower saddle for my Colnago and positioned it higher to try for a bit of extra power. I noticed significant crotch discomfort, but kept riding in the hope I’d get used to it. Then I developed a swelling half the size of a tennis ball — a large and uncomfortable object to carry between one’s legs! It was diagnosed as a perineal hematoma and I’m off the bike until it goes away. What happened? How can I keep it from recurring? — Robert B.

Coach Fred Matheny Replies: It sounds like two factors were at work. First, you raised the saddle too high. When you do that, your hips tend to rock as you pedal, and the rocking strums your soft tissue over the saddle. “Strum” is the term Andy Pruitt of Boulder Sports Medicine (and a world-reknowned fit expert) uses, and it certainly applies in your case. This isn’t the sort of music you want to hear. It can create the irritation you’re experiencing.

A narrow saddle can make the problem worse. It doesn’t provide enough support for your sit bones, thus placing your weight onto the soft tissue of the perineum. Excessive saddle height magnifies this problem.

Because a bike’s seat tube slants to the rear, the distance from the nose of the saddle to the bottom bracket is shorter than from the rear of the saddle where you ought to be sitting. When your saddle is too high, your body moves forward to lessen the distance to the pedals. As a result, you sit straddling the narrow nose. Add Pruitt’s strumming and you have a recipe for disaster.

You should lower your saddle. Even better, get a pro bike fit to find out exactly where it should be. Also, look into a more supportive saddle. Being stylish doesn’t matter if you can’t ride. Maybe an older model would help, or even an all-leather saddle from Brooks or Selle Anatomica that conforms to your sit bones (the SA makes a sort of “hammock” for each one).

Be sure to read up, too, on bike fit and saddle comfort. We have some great eBooks in our Bookstore. And we have some saddle comfort videos in the Health section of the site, as well.