Overactive Bladder and Cycling

Is cycling the true cause of my overactive bladder problem? Is there some alternative to medication?

Member Question from justmike

"I think I might be having some overactive bladder issues caused by my bike seat.

For the last year I've been dealing with an overactive bladder issue that seems to be getting worse over the last year.  I'm a 33 year old healthy male.  I put it off for a long time, but having to go frequently was sort of interrupting my work life. 

Finally, I went to the Dr to get it checked out.  He ordered blood work and looked for diabetes, prostate problems, etc.  He didn't really find anything.  All the tests came back fine and he started me on Vesicare.  The drug makes things much better, but it's still rather annoying.  I've been on the medication about four months now.

A few weeks ago I went on vacation and lost my medication in a luggage snafu.  The first two days without it were unpleasant, but three days into my vacation it was like my bladder issues just went away.  I was fine, without the medication. 

Now that I'm back home, things are back to normal. 

The only difference I can think of is that during vacation I didn't have access to a bike.  It was a 8 day complete break from cycling. 

I'm currently using an ISM Adamo Road, which is actually supposed to be good for this type of thing, I thought.  I can't really stop riding, but I'm thinking I may need to try a different saddle.  Thoughts?" 

Answer from Andrew Getzin, MD
MemberAMSSM 

I  am sorry to hear that you are having overactive bladder issues.  It is not uncommon to have genitourinary symptoms caused by prolonged contact with the bike seat.  These symptoms can include numbness and tingling, erectile dysfunction, hematuria (blood in the urine), overactive bladder, and even a transitory decrease in sperm production.

Urine is produced when the blood is filtered by the kidneys.  The byproduct enters the bladder via a long tube from each kidney called the ureter.  The role of the bladder is to store urine until it reaches a level of sufficient filling which then stimulates the detrussor (the bladder muscle).  Contraction of the detrussor muscle expels the fluid from the bladder as urine.  Unfortunately, in some individuals, the detrussor muscle contracts prior to bladder filling.  Consequently, the individual experiences frequent urination, an urgency to urinate, and sometimes leakage of urine.

The first thing to determine is whether or not the increased urination is from biking and not from something else in life.  Were you taking a diuretic such as the caffeine in coffee that you were not taking while on vacation or since you got back?  Perhaps you were liberal with alcoholic beverages on vacation which dehydrated you.  You could also simply drink more fluids when home.

If in fact you do truly have an overactive bladder, there are several things that can help.  First, if you are wearing tri shorts to cycle, please consider wearing bike shorts which typically have a more padded chamois.  Second, physical therapy can often be helpful to teach you how to appropriately relax the muscles around the floor of the pelvis and bladder.  One of the physical therapists that I work with does an excellent job using ultrasound to give patients visual feedback.  Third, you might want to consider modifying the amount of liquids you consume while training.  In my experience, most athletes drink way more than they really need.  Fourth, it is important to gradually increase your saddle time to allow the perineum to adapt to the pressure.

I am a little apprehensive about the use of Vesicare (generic name solifenacin).  It is an anticholinergic medication that can help to relax the detrussor muscle.  Common side effects include dry mouth, constipation, and a decrease in sweating.  The sweat glands are under cholinergic control and if you block them from functioning you can be at risk of overheating during exercise.

The ISM Adamo Road saddle is a reasonable choice.  The shape of the saddle is supposed to spread the pressure across the floor of the perineum (the floor of the pelvis)  and relieve the pressure on the main blood vessels in the perineum, the pudendal arteries.  I consulted with Nick Lehecka, one of my training partners and co-owner of the Finger Lakes Running & Triathlon Company, www.flrtc.com. According to Nick, in a tri position, the body weight is no longer on the ischial tuberosities (the sit bones) as in a road or mountain bike position, but on the pubic rami (bones that sit to the side of the prostate) and soft tissues. While the ISM saddle will decrease or even eliminate pressure on the soft tissue area and prevent or eliminate numbness, it is still a saddle and not a seat and may be causing pressure on the pelvic floor muscles. In addition, the width of the pubic rami vary between different individuals. 

Some people are better off on a single nose saddle like the Fizik Arione, but only if they can ride on the nose of it shifting their weight to one of the pubic rami and staying there.  Only a small number of people should be on a single nose saddle for triathlon, because many riders need to tilt their pelvis back to relieve pressure and are unable to sit in one position on the aerobars for a long time.  The ISM Century is a softer model that may decrease pressure on the pelvic floor muscles. There are narrower options (the Cobb V-Flow Max saddle, ISM Podium, ISM Break Away and soon to be released ISM Time Trial saddles), but a narrower saddle will potentially place more pressure on your pelvic floor.  I would advise trying different saddles to see which is the best one for you.  Finally, we only have a few points of interface between our body and the bike, so please ensure that your bike fit as a whole is appropriate for you.

If your symptoms persist despite some of my suggestions, I would suggest the next step is to see a physician who is experienced with working with cyclists/triathletes.  Best of luck and have a great upcoming tri season.

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Andrew Getzin, MD
All-American USA triathlon 2008, 2009, 2010
Cayuga Medical Center Sports Medicine and Athletic Performance
Ithaca, NY 14850
www.cayugamed.org/sportsmedicine