My story is very long and slightly complicated due to several issues in my life overlapping which I believe undeniably led to confusion with a diagnosis. I am (now) a 53 year old man who has been involved in competitive cycling since I was around 25 years old. I have raced all distances up to 100 miles almost exclusively in time trials (think triathlon position on the bike) as well as many many long distance rides, up to 300km (yes, in 1 day).
When I turned 50 in 2016 I left the police and started a new job, I joined the police at 40 but had decided it wasn’t for me, I was becoming disinterested and had a pretty stressful final 2 years in the job and began suffering from extreme anxiety and, in my view, very mild depression (the relevance of this will be explained later). What was certain was that I was not the same person I was 30 years before. For my 50th I was bought a new saddle, a brand I had never used before but had wanted for a while and began using it out on the road in March 2017, by now my racing interests had declined and I was just riding for fitness and pleasure, I was doing monthly 200km rides (8 to 9 hours in the saddle with occasional breaks) and commuting an hour or so to work and back. In May 2018 after one 200km ride I felt discomfort in my perineum, I stayed off the bike for a few days but it persisted. As with many men in their 50s with this symptom you immediately think of your prostate so I had this checked out (PSA and digital examination) and there was nothing untoward. At the same time I developed excruciating pain in my rectum. I was treated for hemorrhoids but that made no difference at all.
I went on holiday to Italy in July and was cycling a few hours a day there but it was getting close to the point where I thought the only way to get rid of the pain was to stop cycling. By now I had some warning signs with my symptoms, an extremely sensitive tip of my penis and bizarrely I was getting an erection when I got off the bike, something was seriously wrong.
Through some internet searching I chanced upon a medical paper which centred on a triathlete who had similar symptoms and he had been fixed with the help of Active Release Techniques so I set about searching for someone in the UK qualified in this. I had no luck so believing there was something going on in my pelvis I contacted a local physiotherapist and asked if she treated men which she did.
She suggested that I had hypertonic pelvic floor muscles and gave me relaxation exercises and 2 stretches to do but, in typical competitive male fashion I overdid the exercises and make things worse, by now I was exasperated and the pain was affecting my mental health, I truly believed I would never cycle again. Through August and September 2018 I continued with her but after asking about progression with treatment I was left with the view that there wasn’t really any. What I really wanted was for someone to get hands on with my pelvic floor muscles but it seemed like a strange thing to actually ask for.
I was by now convinced I had a pudendal nerve issue, my GP had prescribed amitriptyline which did alleviate the symptoms and I was sent for an MRI scan but this didn’t show anything.
I started seeing another physio was trained in ART but he was again concentrating on mobility and stretching. I am still grateful for him for the work he did with me as I still use the stretches he taught me to this day but the underlying problem wasn’t going away.
Somehow I then chanced upon Gerard at Kings Heath Physiotherapy clinic, I really cannot remember how this came about but what a revelation he turned out to be. On my first visit I explained everything which I have written above and that I had been using an internal wand device and he was the first person to get hands on with my pelvic floor muscles. Trust me when I say that by this stage any semblance of embarrassment regarding this was well and truly behind me, I just wanted to be pain free and back on my bike. This was in early 2019 and by now after being totally off the bike between the end of August and the end of October I had just started to cycle again, indoors only and for just a few hours a week.
I had also realised that I had got into the habit of “clenching” my glutes a lot, I suddenly realised this one day at work, it had become a habit much in the same way which people clench their teeth or hunch their shoulders, no wonder I was in so much pain. This, in my mind started when I was in the police, it was my subconscious way of dealing with the stress I was putting myself under and it just took a while before my muscles reached breaking point. So, after a 5 or 6 sessions of treatment at the clinic, instruction on how to effectively use my Therawand and using the breathing techniques things started to improve. The pain in my rectum eased and eventually disappeared completely but the symptoms of pudendal nerve irritation persisted, tbh, they still do but ever so slowly this is easing, I often think this will never go away completely but the 2 main points are, I am relatively pain free and I am back cycling regularly, over this winter up to 12 hours a week. I completed a 5 hour ride back in October 2019 with no lasting effects.
So, if you made it this far (if it hasn’t been edited down) the message is this. If you’re in a similar situation as mine, don’t give up, believe in the treatment, something as simple as breathing in a certain way ‘can’ be effective.
I will be forever grateful for the way I was treated by Gerard, so much compassion and encouragement which I will never forget.