Hi Dr. Hurst. There has been an interesting thread about underwear and chamois cream and would like to know your views. I am particularly concerned about the ingredients in the chamois cream and the sensitive area. Is one type less likely to irritate than the other? Have never used the cream before and feel rather nervous about doing so! Thanks for your help. OldBird
Hi Dr Kim, Ive been getting U.T.I's and thrush a lot recently and it seems that the more I cycle the worse it gets. My GP suggested alkanising my urine by putting sodium bicarb in my hydration pack, or eating a rennie before I go out. And Using canestan cream mixed in with asoss chamois cream every ride to help with the thrush. The question is, is it safe to do this on a regular basis? Is it common for female cyclists to get these problems and is there anything else you can suggest? AA
Survival Guide to Saddle Sores
Many cyclists have first hand experience of this uncomfortable phenomenon! In fact, in one study of amateur long-distance road cyclists over 60% had buttock discomfort and approximately 50% of these had been forced to alter their riding style or temporarily stop cycling as a result of the pain!
Sound all too familiar? Here's a self-help survival guide…
What are Saddle Sores?
“Saddle sores” is a term used to describe the skin problems that can effect the area of skin in contact with the bicycle saddle and includes: ischial tuberosity pain, chafing, folliculitis and skin ulceration. While these disorders can occur independently of each other, it is common for more than one to occur at the same time.
1. Ischial tuberosity pain
The ischial tuberosities are your “sit bones”, the 2 bony prominences on your backside which contact the seat of a chair when sitting. Since a bicycle saddle is designed so that the majority of your body weight is concentrated on these bones when seated, it's not surprising that ischial tuberosity pain can be arise as a result of lots of time in the saddle. Typically, the skin overlying the ischial tuberosities becomes red and tender. If you continue to ride through this pain, the skin can eventually break down and an ulcer may form.
Ischial tuberosity pain is very common. In the study I mentioned in the introduction, over 70% of the saddle-related discomfort was due to ischial tuberosity pain!
2. Chafing
Chafing occurs anywhere where there is constant rubbing against the skin. For male runner's this can be the nipples, for cyclist's it's the groin! The friction caused by constant rubbing results in a red, inflammed abrasion.
Chafing is incredibly common and is believed to occur more frequently in female cyclist's (although there is no evidence showing the frequency is any higher is women than men!).
3. Folliculitis
Folliculitis is an infection of the base of a hair follicle. It looks like a white spot with a hair coming out through the middle. This infectious process occurs most commonly in areas of the body subjected to minor trauma, such as the groin in cyclists. Folliculitis can be painful but usually resolves on it's own. But if the are of infection becomes walled-off it can form a deeper infection and an abscess. Abscesses can become quite large and are incredibily painful!
4. Skin ulceration
Ulcers are small, painful, crater-like lesions in the skin. Since the outer protective layer of the skin is damaged, bacteria can get into the deeper layers of the skin and cause an infection. Ulcers have been reported to occur in up to 10% of cyclists completing a 500-mile week-long ride.
A comfy bottom
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Why do Saddle Sores happen
Sores in the skin happen due to pressure, friction, moisture and temperature. Pressure is caused by your body weight on the relatively small area of the bicycle saddle. This pressure causes compression of the tiny blood vessels supplying the skin and therefore impaired blood supply. Soft tissues are damaged more easily when the blood supply is impaired.
Friction is a result of your movement on the saddle. While tiny amounts of rubbing may seem insignificant when they are repeated with every revolution of the crank they can amount to considerable friction on the skin. Just think, if you ride with a cadence of 80rpm for an hour that's almost 5,000 cranks revs!
And finally, sweating causes a build up of moisture. Particularly when you're wearing tight fitting lycra cycling kit!
Prevention
1. Out of the Saddle
Standing up out of the saddle for regular short periods of time temporarily relieves the skin of pressure and friction. It will also help you build strength for riding out of the saddle, which will improve your cycling fitness!
2. Change Position
Check your bike position is correct. If you have your saddle too high then your hips will rock from side-to-side and you will move around on the saddle more, resulting in more friction and potentially more saddle sores.
3. Change Saddle
Selecting the saddle that is right for you is tricky and generally down to trial and error (although Specialized have recently come up with some nifty ways of gauging which saddle is likely to be best for you!).
4. Gradually Increase Mileage
The body constantly adapts to stresses put on it. If you gradually increase your mileage your body will adapt (possibly by the skin becoming slightly thicker, nobody knows the full answer!) and saddles sores will be less problematic. This is particularly true for ischial tuberosity pain.
5. Dress Sense!
Clean, dry cycling shorts with a chamois help prevent saddle sores. If you're doing ultraendurance events, like Mountain Mayhem, make sure you change into clean shorts as regularly as possible.
6. Chamois Creams
Chamois cream works by reducing friction. There are loads of different chamois creams out there to try! Different brands have different ingredients and some have antimicrobials to try to reduce infection. On the cheapear end of the scale, vaseline applied liberally works the same way and there is no evidence it's use leads to increased rates of infection. The only trouble is it's more difficult to wash out of your shorts! I would be careful about regularly applying anything that has large amounts of antibacterials or antimicrobials, as this may change the balance of normal bacteria in the vagina and may lead to an infection.
Treatment
No matter which one of the four types of saddle sores you have, the treatment is the same.
1. Time Out
Complete time off the bike is the best way to allow saddle sores to heal. Continuing to get your training in on the bike is possible, depending on your pain threshold! Changing your position on your bike or using a different saddle for a while may help or alternatively do some X-training like running or swimming, which will allow things to properly heal.
2. Skin Care
Most importantly, keep the skin clean and dry. If there is mild infection then a cream or ointment containing antibiotics may help but avoid using any alcohol-based creams or preparations containing steroids.
3. See your GP if…
The sores are worsening, especially if they are becoming larger or if the infection seems to be spreading.
Taking the Piss
One study has shown that almost 20% of women who suffered with saddle sores also had symptoms of dysuria (pain when passing urine). This may be due to micro-trauma to structures in this area and these symptoms may feel similar to that of a urine infection. Alternatively, repetitive friction around the opening of the urethra (where you wee out of) has also been shown to predispose women to urine infections (hence the term “honeymoon cystitis”!).
The only way to be certain whether or not there is a urine infection is for a sample to be sent off to the lab for culturing to see if any bugs grow but, as a rule of thumb, if your pain is associated with the urine becoming cloudy or smelly or if you feel unwell with a high temperature then you are more likely to have an infection and you should see your GP.
If you find the friction caused by cycling is resulting in more frequent urine infections then you could try chamois cream to minimise the friction or drink cranberry juice, which changes the acidity of your urine and kills off bacteria. Note: I don't know of any studies on this so these are theoretically useful but not of proven benefit!
TOP TIPS
A change is as good as a rest!
Get into the habit of frequently changing position while you cycle, with regular short periods out of the saddle. It will help your cycling fitness too!
Saddle selection
The right saddle will make a huge difference. Unfortunately, it's trial and error to find a saddle that suits you, but once you've found one then stick with it!
Look after yourself
Always use clean dry shorts (or wherever possible if you're a MTBer!) and if you do end up with saddle sores, some time off the bike and basic skin hygiene can help speed up the healing process.
Chamois cream
Reduces friction, feels slimy but works a treat!
See your GP if…
Sores are becoming worse, increasing in size, or the infection seems to be spreading.
DISCLAIMER: Advice and information is provided via SheCycles.com Clinic on a free of charge basis as a supportive service to women in sport. It should not replace the use of your General Practitioner for medical problems. Copyright 2006 Dr K Hurst
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