Saddle Sores

A saddle sore is the irritation of the skin at the buttocks, groin, or thighs which results from sitting on a bicycle seat. This local skin injury is caused by a combination of friction, moisture, and pressure. Saddle sores are categorized as:

Chafing - the most common. A superficial skin rash from the constant chaffing of your shorts/saddle.

Bruising - a more severe injury of the tissue with bleeding into the subcutaneous (below the skin) layer.

A tender subcutaneous nodule - The result of a deeper infection which results from bacteria accessing the subcutaneous tissue via the base of a hair follicle or a sebaceous gland. The pressure injury to the follicle or sebaceous gland allows this to happen.

In this article De. Enad nicely summarizes the progression: "..the friction of thighs rubbing together, clothing, or the bicycle seat can irritate the skin and cause a sore to occur. Moisture, like sweat, can contribute to increased friction and cause the natural bacteria in your groin area to come in contact with the sores. Bacteria often increases inflammation, redness, pain, and a longer healing time. Last, but not least, is that the pressure of your body on the seat can cause saddle sores if you aren't using the correct texture and size of equipment for your body."

The initial discomfort is a simple skin irritation, but it decreases the skin's resistance to infection and the bacteria (which are always present on the skin of the buttocks) then take advantage of the opportunity.

Strategies for decreasing the risk of saddle sores focus on a) decreasing the initial tissue injury and b) minimizing potential for further bacterial infection. Let's look at preventative measures first.

Clothing/Equipment.

Perhaps a smoother chamois. For recreational riders or mountain bikers, shorts with a one-piece liner or a liner carefully chosen for flat seams. It may take experimenting with shorts brands or chamois types to find the model that works best. Women often do better with shorts designed specifically for their anatomy and that have a liner with no center seam.
The saddle. Excessively wide saddles rub your inner thighs. Narrow saddles don't provide enough support for your sit bones -- your weight is then shifted to the surrounding soft tissue which can quickly become bruised and irritated. Thickly padded saddles are another problem as they can press upward between your sit bones, causing uncomfortable numbing pressure. The best choice for any individual rider can only be found through trial and error.
On multiday rides consider adding a second pair of bike shorts. It feels bulky but it does work. The second pair of shorts adds additional padding as well as allowing the shorts to slip against each other rather than a single pair chaffing the skin directly.

Riding routine

Get out of your sweaty shorts as soon as possible after a ride. Shower or clean up with soap and water. Dry well and put on loose-fitting clothing which will allow your skin to dry. The dry skin will be much less susceptible to a bacterial infection in any injured tissue..
Wash your bike shorts after every ride. They are a great place for bacteria to hibernate between rides. And if you were sweating heavily, it gets rid of any salt crystals that might aggravate tissue abrasion on your next ride.
Stand more frequently. It will take a conscious effort at first to remember, but it will take pressure off the ischial tuberosities (sit bones) where they contact the saddle. Get in the habit of standing for 15-20 seconds every five to ten minutes using natural opportunities such as short hills, rough pavement or accelerating from stop signs.
Or make regular changes in your position on the saddle. Try sitting a bit further back on the climbs so your sit bones get maximum support from the wider area of the saddle taking pressure off your perineum. Any shift in position will give pressure points a break.
Gradually increase (versus a rapid ramp up) the length of training rides. This will help acclimate the skin and tissue in the buttock area to more time in the saddle.

The bike.

Consider getting a bike fit.
Or a few simple adjustments on your own. If your seat is too high, as an example, your hips will rock to a greater degree on each pedal stroke, increasing in the risk of skin abrasion.
Occasionally a rider will complain of unilateral (one side) abrasions or saddle sores. This could indicate a leg length discrepancy. If it's several millimeters or more, it could help to use a shim under the short legs cleat). Another solution I have heard (anecdote coming) is a slight reorientation of the nose of the saddle to one side or another.

Topical agents. Creams and ointments decrease friction as well as providing a barrier to prevent bacteria from invading injured tissues.
- Skin barrier/friction reduction. Damp shorts will adhere to the skin and aggravate focused areas of irritation. These products keep damp shorts from adhering as well as providing a moisture barrier. Moisture (sweat), even without the added insult of physical pressure injury, decreases the effectiveness of the skin as a barrier to bacterial infection.
  All these products have their proponents. For example, Pete Penseyres, the legendary two-time Race Across America winner and a former world-record holder is a believer in Bag Balm. If anyone should have the experience to make a recommendation, it would be someone who has spend hundreds of hours in the saddle and ridden 3,000-plus miles in eight days.
  A light coating of inexpensive petroleum jelly will do the job as well as a commercial product (Chamois BUTT'r or Bag Balm) but in the end it comes down to personal preference. Applying to the skin before putting on your shorts works much better than trying to smear it directly on the chamois.
- Antibacterial products. These cut down the concentration of skin bacteria and less bacteria equals less opportunity for an infection. My favorite is OTC Neosporin Ointment. The product warnings list "possible skin allergy" so if you try it, be sensitive to the possibility that a rash not responding to simple measures could be from the neosporin.
  A friend who races swears by Noxzema. It provides a lubricant/barrier effect as well as providing a mild anti bacterial benefit.
  I've read recommendations to use Preparation H Medicated Wipes with aloe and witch hazel immediately after a ride. It cleans the area and kills skin bacteria.
What do I do? First I spend a bit more on my bike shorts. If you prorate the cost, it is just a few pennies more per mile. I only use a lubricant cream early in the season or when I am going on a multiday tour. It's easier to take preventative action than put up with the annoyance of a saddle sore knowing I'm going to have to get on the bike. Having tried almost every possible combination of butt butters and cremes, I've had the best success starting with a base layer of neosporin to the sit bone (ischial tuberosity) area where I experience most of my saddle sores. My theory is that it cuts down on the skin bacterial which aggravate even minor irritations. I follow this with a coat of either Bag Balm or Chamois Butter to provide the lubricant/moisture barrier. Even riding 4 or 5 times a week, that has kept me saddle sore free for several years.

Treatment if you get a saddle sore
- Medicate it. You might opt for an over-the-counter acne gel containing 10% benzoyl peroxide. A topical antibacterial ointment such as Neosporin or the topical prescription Emgel (erythromycin) should shorten the period of inflammation. If things progress, you may need a course of oral antibiotics.
  Hydrocortisone cream can be added to a topical antibiotic. It may help lessen the duration of inflammation.
- Rest it. Take some time off the bike to help it heal. It's far better to lose three days up front than a week or more after infection sets in. If you continue to ride on an open sore it may eventually form a cyst that requires surgery.
  Sometimes you can't take time off - you may be on a tour or at a cycling camp. If so, in addition to regular care keeping the area clean and using a topical antibiotic ointment, these suggestions could help.
  - Change your shorts or saddle. Your problem is most likely isolated to one small area -- a boil or abrasion. Changing your saddle and/or shorts can reduce pressure directly on the sore and lessen pain.
  - Use a heavier skin lubricant. Apply extra lube or switch to a more viscous one. Many long-distance riders swear by Bag Balm, which was originally made for sore cow udders but is now available in most pharmacies.
  - Numb it. OTC pain reducers and anti-inflammatories, such as ibuprofen, can help. Pro team physicians will use topical anesthetics to allow riders to continue in competition. But this is not recommended for recreational riders as removing the pain warning can let you ride yourself into greater damage.
  - Preparation H ointment works on saddle sores. It shrinks swollen tissue and provides local pain relief. Apply it five minutes before adding a layer of chamois cream and putting on your shorts. You can also use it after rides to dull discomfort.
  - Get a donut. In the foot-care section of drug stores, you'll find donut-shaped foam pads in several diameters. They're made for corns but can help you ride more comfortably with a saddle sore, too. Simply place it with the sore in the center cutout to relieve direct pressure. The adhesive backing will keep it in place.
All questions and suggestions are appreciated and will be answered.

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Saddle Sores

Treatment if you get a saddle sore