Cycling Saddle Sores

June 18, 2009

Recreational cycling has an ugly underside that is not often talked about,  saddle sores.  The proper term for a saddle sore is a boil.  There are many types of boils, each with a separate cause.  The most typical causes are from some sort of infection or foreign material that finds its way into your skin.  The result is a lump or lumps of red, inflamed skin that are very sensitive and often make for an extremely uncomfortable ride.  Saddle sores have some special cycling specific issues that are not often discussed.  The major concerns are prevention and treatment with my suggestions for both below.

Prevention

The first step in dealing with saddle sores is to prevent them from developing in the first place.  Because the risk of infection increases when skin is rubbed raw the first step of prevention is to eliminate chafing and rubbing.  The tripod of prevention rests on (1) saddle choice, (2) the chamois, and (3) hygiene and cleaning.

1. Saddle choice
Choosing a bike seat that compliments your anatomy goes a long way.  Each person has a slightly unique shape to their underside, which makes no one saddle the right saddle.  However, many people find Fizik saddles to be very comfortable.  Fizik has several models with different shapes and profiles to suit most people’s needs.  I like the flat, narrow Arione CX, but I have also ridden and enjoy the flexible, scouped shell and medium width Aliante.  Both saddles have a fairly flexible shell, but the former has firmer paddign while the latter is much thicker and softer.  Many riders like the Specialized Body Geometry saddles and Selle Italia Flite models.  A small, but faithful following, which includes Lance Armstrong, swear by Selle San Marco’s Concour.  A good saddle should not rub anywhere and focus pressure on the sit bones.  The process can of finding a good saddle can sometimes be difficult, but most local bike shops are willing to offer demo rides, accept returns, and work on an exchange processes to help find a saddle that meets your needs.

2. The Chamois
Once you find a good saddle the right chamois and chamois prep will add an extra layer of prevention.  All true bicycle shorts have a pad (i.e., chamois) sewn in to help cushion your ride.  These pads come in many different shapes, sizes and materials.  The main qualities I consider when selecting my own shorts are (a) thickness, (b) how soft or firm the pad is (i.e., density), material, and (c) construction type.  For me the most comfortable pads are thin, have a dense cushion, a 4-way stretch material, and welded seams that are free from threads or any rough edges.  Pads that are thicker tend to bunch and add pressure where it is not wanted.  Stretchy pad materials conform to the body and seat while the welded seams eliminate any rough spots that could potential rub skin raw.

The second part of optimal chamois utilization is chamois preparation.  For individuals who are very prone to chaffing and/or saddle sores preparing the pad and body for a long ride goes a long way in keeping the underside healthy.  The first layer of preparation is applying a cream to the chamois itself.  I have only ever used Assos brand, but there are many others available.  I like the Assos cream because it is water based and therefore washes out and does not stain.  Assos products also contain a mild anti-bacterial agent to help slow the growth of anything foreign that might try and grow in your chamois.  The second layer of preparation is on the skin itself.  I apply a small amount of Bag Balm to further keep the skin protected against chaffing.  Bag Balm is a thick, petroleum based balm that was originally intended to be used on dairy cows to keep their undersides healthy and free from chaffing and sores.  Bag Balm is a very old friend of the recreational cyclist and no cyclist should have a medicine cabinet without Balm Balm in it.

It is important to note that not all cyclists endorse the use of chamois creams.  The argument is that these creams add an element of moisture that may promote the growth of bacteria.  Although this is a reasonable concern it may not be a valid one.  On longer rides moisture will inevitably build up from sweating.  Choosing a cream that includes an anti-bacterial agent will do more to prevent unwanted organisms that attempting to keep the area dry.  In most cases the early addition of moisture will do more to prevent saddle sores than it will to promote bacteria growth.

3. Hygiene and Cleaning
The final leg of prevention centers around keeping your clothes and skin clean.  Bacteria thrive in warm, wet, and dark places.  Therefore it is important to keep your clothes and skin dry and rinsed to eliminate any unwanted organisms.  Worn shorts should be air dried, rinsed and dried, or best washed and dried after and between uses.  The most cautious route is to simply wash and air dry clothes between every use. I also use Assos’s active wear cleanser when cleaning my clothes.  The product claims it preserves the anti-bacterial treatments applied to active wear clothing, contains a mild anti-bacterial agent, and increases the lifespan of clothes.  Whether or not those claims are true is hard to say, but the detergent is not very expensive and certainly has the potential for some valuable benefits.

Skin should also be thoroughly cleaned and dried following a long ride.  In cases where access to showers is not available alcohol wipes are a effective and painful way to clean up bacteria from your underside.  After a shower, thorough cleaning, and drying of the area individuals at high risk may also wan to apply acne cream, which contains benzoyl peroxide, to kill any bacteria that may have found their way under the skin.  However, be careful when using benzoyl peroxide because it will bleach clothing, chamois or anything else it comes in contact with.

Treatment
Saddles sores can most often be treated at home.  But, in some cases they can escalate to where you should seek out medical consultation.   If the sore(s) persist longer than 2 weeks or you develop a fever or chills you should see a medical professional.  In most cases saddle sores are not very serious, but dealing with infections carries some risk and should be accompanied with the appropriate amount of caution.  If a very large saddle sores develops the first step of treatment is getting off your bike.  No riding or sitting on a bicycle seat until the sores clear up.  Continued aggravation can lead to worse problems and may require the sores to be lanced and in some cases will also require stitches.   Lancing and stitches will obviously lead to a lot of time off the bike and a little voluntary time resting now is much better than a lot of forced rest later.

Sores should not be squeezed, scratched or poked.  Agitating the sore can push the infection deeper into the tissure or into surrounding skin making the situation worse, not better.  According to Web MD the recommended course of action is, “(a) washing and rinsing the area a couple times a day, (b) applying a hot compress will help bring the infection to the surface and drain and (c)  once the sore opens keep it covered with a bandage to prevent the infection from spreading to surrounding tissue.”  Ed Burke, author of Serious Cycling, has similar recommendations, but suggests using a drawing salve in place of a hot compress.  Although an Ichthammol drawing salve is hard to find, they are available on the internet (e.g., here or Amazon), relatively inexpensive, and do work and are often more convenient than holding a hot compress to your saddle perch region a couple times a day.

Following all the aforementioned precautions will go a long way, but some people are still extremely susceptible to developing saddle sores.  One reason for persistent saddle sores despite all the precautions may be poor bicycle fit.  Consulting with a fit specialist will help determine any issues with your bike fit that may be contributing to saddle sores.  You may also have special biomechanical issues that require special considerations and fitting expertise beyond what a typical local bike shop can offer.  In these cases a 3d bike fit or consultation with a physio-therapist, osteopath, chiropractor or other expert will be necessary.  Regardless of the cause once saddle sores develop the next step is treatment.  Hopefully the above suggestions and information will help avoid any unwanted saddle sores.  It is not a problem often talked about, but certainly getting a little information can go a long way.