Inflammation of the Ischial space

Short version
It’s very painful, try not to let it happen to you!

Long version - A Cautionary Tale!
I got a new bike (Enigma Etape) at the start of June this year, in the past I have never been too fussy about saddles so I was happy to stick with the stock saddle. I set the position up to basically match my existing bike and initially all was good – except that after about half an hour of riding I would get an acute pain where both sit bones contacted the saddle BUT everything else was very comfortable. The pain would subside during the ride and was completely gone as soon as I got off the bike. I just assumed I was getting used to a new saddle and the sharp pain would stop after a few rides.

During June I rode about 450 miles, apart from the (tolerable) sit bone pain it was trouble free plus the long term pain in both thumbs I suffered on the old bike completely disappeared. Early in July I went out for a 50 miler, effort wise it was a hard, fast ride but nothing too out of the ordinary and well within the distances and effort levels I was used to riding. All was good on the ride but within a few hours of getting home I was in extreme pain and ended up going to bed for want of being able to do anything else.

During July I had a lot of pain – location wise it was in the area of my back passage and felt like it went up inside for several inches and/or a painful (internal) lump was present in that area. Some days were better than others and it felt like things were gradually getting better. Being on the bike was one of the most comfortable things I could do so on better days I continued to ride clocking up over 500 miles including a 100 mile ride. That was probably a mistake!

Apart from the sit bone pain cycling was comfortable so I wasn’t attributing it as the cause of the problem. For lack of any other ideas, plus the difficulty in getting a face to face appointment with a doctor and despite the fact that I had never had them before I was assuming it was a sudden onset of haemorrhoids and was treating it as such. As July progressed, the bike became gradually more uncomfortable but the off bike pain continued to sort of get better albeit very slowly. Towards the end of the month, I decided to swap the saddle on the Etape with the San Marco Rolls from my old bike. This removed the acute sit bone pain but was of no immediate help with the off bike pain.

At the start of August, I decided to take a week off the bike in the hope that the pain would disappear. The week turned into more or less a month during which time things got a lot better but not 100% back to normal. I went for a couple of short rides late in August which felt good at the time but left me in pain by the evening and for a couple of days afterwards.

Another week off the bike followed during which time I managed to get a face to face appointment with a doctor. After discussing the issue with her and following a physical examination she diagnosed it as inflammation of the Ischial space. i.e. the area around the sit bones. This fully explained all of the symptoms including why being on the bike was not painful.

As of now the symptoms are 99% gone and I am slowly starting to ride the bike again – I did 25 miles yesterday and have no issues today. I am hopefully going out again on Monday for a slightly longer ride. My target for the remainder of the season is to get back to 35 – 40 miles as a normal distance say 3 times a week, I’m also planning to get an appointment with a bike fitter to see if there is a better option saddle wise than my old Rolls and to look at my overall position.

Anyway, the point of this long post is really to say if anyone else gets saddle pain and associated symptoms like I had, I would strongly advise taking a break from the bike ASAP and getting to the bottom of the problem(!) before you end up with virtually no riding for six weeks. Aside from the lack of cycling and messing up my 2021 Mt Sufferladria this has been a big impact on family life over the last 10 weeks!

If anyone has had a similar issues in the past or other related knowledge I would be interested to hear of your experiences and how you resolved it long term.

Thanks for reading!