Friday, January 24, 2014

Bicycle Saddle Sore Turned Out to be a Pressure Ulcer

In May 2010 I was commuting 38 miles per day, and also mixing in some high-intensity efforts. I wore the same pair of shorts both ways, to and from work. At one point I started feeling a “saddle sore” but ignored it as I had done many times in the past, assuming it would go away. After several weeks, I finally took a look with a mirror and was shocked to find a cavity almost an inch long, ¼ inch wide, and about ⅛ inch deep, ugly red color at the bottom, off to one side of my crotch. I looked things up and decided it was a pressure ulcer, also known as a bedsore, at least Stage II, probably Stage III.

I stayed off the bike for about a week and it healed over some. It broke open again after a small amount of riding. Then I tried waiting several weeks, but the healing was again short lived. There was very little pain: this contributed to my original negligence and made it easy to re-injure myself. Surprisingly, the wound never got infected. I went to see a physician, a “wound specialist”, and he did not have much to help. I don’t think he had seen my problem before. The dressings that he would normally use would probably not be suitable in the crotch area. He suggested an anti-fungal powder named Zeasorb-AF (I find that baby powder works better at keeping things dry), waiting several weeks, and then resume riding at 15 minutes per day.

The rest of the summer I took things very easy: riding on alternate days, using Chamois Butt’r, standing up every few minutes, and wearing two pairs of padded shorts. I think the two pairs of shorts idea was the most help. It is also a good idea when commuting, since you can put the clean pair on first when going home.

Along the way, I have received lots of suggestions about what to do: different saddles, creams, shorts, bike fit etc. It’s difficult to empirically test such suggestions since failure means several months of recovery time.

In November the wound looked mostly healed but I took things easy for the winter. I changed to Brooks saddles which seemed to help. (See Sheldon Brown’s procedure for breaking them in.) In May of 2011 I started interval training again, getting ready for the Mt. Washington Hill Climb, but I rode just 12 days and generally not two days in a row. On May 30 I did a 1.5 hour hard effort, and when I was done the wound had torn open again. Very disappointing.

I saw the wound specialist again on June 3, 2011. He said the scar is 60-80% as strong as the original skin. There is no way to “toughen up” skin that has healed. Plastic surgery would make a bigger wound, will have stitching on both sides of the graft, and will probably be weaker than the original wound.

I tried various saddles. I found that wearing two pairs of padded bike shorts really helped. Over the summer of 2011, things seemed to be getting better while limiting riding to about 3 times per week. The spot was still tender to the touch.

On Apr 30, 2012, after about an hour of intense riding, the wound opened up again, about ¼ inch long. I took time off.

By Spring 2013, the wound was mostly healed, but still tender to moderate finger pressure. I trained carefully and was able to do the Mt. Washington Hill Climb. All in all, the wound took 3 years to heal. It never got noticeably infected.

Edit: In Spring 2014, the wound opened up twice, even while treating it pretty carefully. I am limiting riding to twice a week.

I have found very little information about pressure ulcers and cycling--nothing in the ultra-distance cycling sites that I have looked at. I suspect that skin gets weaker as we age, and it might be much less likely to happen in younger people. (I was 60 years old when this started.)

Lessons for dealing with pressure ulcers in the crotch:
  • Don’t ignore crotch trouble
  • Use a mirror frequently to look at the area (pain is not a reliable measure)
  • Take time off if bruising appears
  • Keep shorts clean, take them off right away. Replace them when the pads get old.
  • Chamois Buttr probably helps.
  • Use double shorts, especially for commuting (swap them for the ride home)
  • The Pearl Izumi short liners with an orange pad are the best I have found
  • Hard efforts like intervals cause extra stress
  • Stand up frequently, especially on long rides
  • Take days off
  • A pressure ulcer will heal, but it could take 2-3 years
  • NEW 2016: stick Dr. Scholl's Callus Cushions over the tender spot. Helps a lot.