TMBRA - Rider Board

[Anonymous]

Sorry to bring up such a disgusting subject, but I'm in a lot of pain and need some good advice. I've been fighting this problem for a couple of years and one race season. I've tried everything I've read on the internet and still they continue to reappear. I've worn different shorts, used chamois butter and get out of my shorts as soon as the rides over. I've used hydrocortisone and medicated powders and found some relief but I would really like to work on prevention. These are not pimples I'm talking about, their deep, large red swolen areas that don't always return in the same area. In most cases there would be no way to drain them without minor surgery. Are there any prventative measures out there, or am I destined to ride in pain?
Sincerly,
Pain in the Ass

[SamandTracey]

I've had the same problem, sores are kind of like boils. I finally broke down and went to see dermatologist, his opinion was that it could be staph infection, prescribed ointment (mupiricon - sp?) which you apply around the inside of the nose with a swab 5 days a month; he also suggested using antibacterial soap. I still go through all the motions you've been doing (Assos, getting out of shorts ASAP) and following doctor's orders. Still get a little tender sometimes, but no more "sores". I'd say it's 99.9% better!

Tracey

[Guest]

Thanks,
I'll see if I can get a perscription of that. I'm at the point I'll try just about anything.

[The Bike Doc]

Dear Pain in the Ars:

Below is a copy of an article I wrote for Texas Cyclist several years ago regarding saddle sores. You may find the information helpful.

The Bike Doc

by

Paul K. Nolan, M.D.



Back in the Saddle Again: Saddle Sores Prevention and Treatment

Saddle sores can be an uncomfortable deterrent to bicycle riding. They often develop in areas where excessive pressure, chaffing or rubbing occurs between skin and saddle or areas where the skin rubs against itself. They can range from an uncomfortable chaffing to boils or abscesses with surrounding skin infection. Saddle sores can hit seasoned pros and recreational riders alike.

Having been inflicted with these maladies, I've had first rump experience to test treatment and prevention modalities. Their best management is prevention which hinges on a good saddle and appropriate bike shorts. A well made saddle is not excessively wide, provides easy movement of the thighs without chaffing and padding to pressure areas But what about those fanny hugging, anatomy revealing lycra bike shorts?! Having once been a hold out against lycra bike shorts (I didn't want to be seen riding around in a pair of colored underwear) I have discovered the functional benefits of the form fitting material. Saddle sores often can develop in areas where loose fitting clothing can bunch up and rub against the skin. A well made pair of lycra shorts with smooth seams and a moisture absorbing rump pad is well worth the investment in preventing saddle sores.

In our hot and sometimes humid Texas weather additional measures are necessary to prevent the chaffing and rubbing due to sweat build up. An inner pair of form fittings boxer briefs or an unpadded pair of lycra shorts beneath the padded lycra shorts as well as a body powder such as Mexana or Ammens in the groin and rump area helps to absorb moisture and provide a surface that can slide easily between the skin and saddle. This works in the same way as wearing two pair of socks and using foot powder to prevent blisters when wearing athletic shoes for running. Having at least two pair of lycra bike shorts and liner shorts allows the rider to alternate between them so that a pair can always be clean and dry.

What should a rider do if saddle sores develop? If the sores are only areas of chaffing with redness, a brief detour out of the saddle and using the above described shorts combination when back in the saddle again may be all that is necessary. When extra protection is needed such as when a die hard bicyclist like myself cannot get out of the saddle, a small application of a heavy salve such as Corona ointment or Bag Balm (found in your local feed stores) to the chaffed areas covered with an application of body powder and the double shorting can help return the rider to the saddle sooner. However, if there are signs of infection such as spreading redness, local warmth, boil formation or increased swelling, the rider has to get out of the saddle and get to a doctor for further evaluation and treatment. A course of antibiotics may be required for an infection, an incision and drainage may be required for boils or abscesses and mandatory time out of the saddle must be taken. Once these areas have healed a return to the saddle can then be pursued. The rider should avoid returning to long distance bike riding initially, but instead start with short rides and gradually building back up to longer distances to allow the rump to toughen up.

Another saddle sore related problem can result from excessive compression of the perineal nerve which runs just under the bottom of the symphysis pubis, the base of the pelvic bone. This is manifested by numbness in the penile or external vaginal areas thus the oft referred to slang amongst long distance cyclist of the "DDD" or the "Dreaded Dead Dingus". Again the best treatment is prevention. A well made saddle with a padded nose that has been positioned properly is critical. Saddle height should not be set so high that the riders pelvis rocks side to side to maintain peddle contact. The saddle tilt should be parallel to the ground or with the nose angled only slightly downward 1 or 2 degrees from level. Try the saddle in the level position first if it has been ridden with the nose elevated, then if this does not prevent the numbness try lowering the nose slightly. Avoid excessive downward tilting of the saddle nose as this can place too much weight on the rider's hands and cause nerve compression in the wrist leading to pain and numbness in the hand and fingers. Also the afore mentioned padded lycra shorts are helpful in preventing the "DDD.". A check with your bike mechanic or a more experienced rider for saddle adjustment or recommendations may also be helpful. Following these tips can help get you back in the saddle again.

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc

[Guest]

You cannot lose with a BROOKS saddle. Read the reviews!

Also, a small amount of NOXZEMA skin cream applied to base camp and beyond acts like teflon for your butt and buddies. Try it!

[Anonymous]

Thanks for all the great advice. I'll put it to good use.

[Anonymous]

I think a combination of some ill fitting baggy riding shorts and not taking them off soon enough blended with (possibly) some too-tight tighty whiteys and sweat caused an outbreak of saddle sores on my sit bones.

(I guess I don't wear a size 32 underwear anymore. )
Desperate, I tried ichthammol, which helped to soften them up. It's commonly used for boils, but it appears these saddle sores where more akin to pressure sores (bed sores) than a boil.

I am trying a product called 2nd Skin which greatly shrank the inflamed tissue overnight. I am hopeful after a second day/night of treatment I will be back in the saddle again. (You see? You don't have to be a country crooner or a cowboy to say those words! )

http://www.drugstore.com/qxp86351_333181_sespider/2nd_skin/quick_heal.htm

The active ingredient is hyaluronan. There's lots of information on the web about the indications of hyaluronan.

This whole episode will probably make me a boxer man!

[Anonymous]

Here's a link about pressure sores.

http://www.nlm.nih.gov/medlineplus/ency/article/007071.htm

[Anonymous]

Had another outbreak of saddle sores, which were actually underskin pockets of staph infection. I saw a dermatalogist who prescribed a pill antibiotic and a cream antibitoic. The cream antibitoic is to swab the inside of my nose.

I did try the Bike Doc's recommendation (wearing a second pair of lycra shorts, lubricating the area with Bag Balm) but I still got another lump.

I also had a scratch on my thigh at the bottom of the pants leg line that refused to heal.

The doc said staph grows in the groin, armpit and nose. He recommened keeping bottles of waterless hand sanitizer handy and frequently clean the hands with the sanitizer. The doc also said to get som Hibiclens soap and wash the area twice a day with the antiseptic soap.

He also recommended keeping my fingernails trimmed.

In my early posting I claimed the Second Skin treatment helped, but now I think it was more of swabbing the inside of my nose with some OTC triple antibiotic cream.

Hope this helps someone.