Q: I am a veteran cyclist of racing, triathlons and touring, now just happy to ride. I recently underwent surgery for benign prostatic enlargement (TURP) which was totally successful.
The problem is I have no clear idea as to when to resume cycling. I am aware that the pressure from sitting on a narrow saddle for prolonged periods is considerable, which leads me to my second question and may also be the answer to the first… With a myriad of saddle types on the market, could you recommend any particular type that would ease the pressure the most? I am considering the hole-in-the-middle type such as the SLC Gel Flow by Sella Italia.
A: I’m glad to hear of your successful prostate op, Allen. Normally about the size of a walnut, the prostate gland sits at the very base of your bladder, and encircles the start of the urethra (the tube to the outside).
It contributes nourishing secretions to seminal fluid, making for happy, healthy sperm. Although I say ‘normally’, the gland grows throughout life – by the age of 60, almost half of all men are likely to have some minor symptoms of benign prostatic hyperplasia (ie, enlargement) and this is thought to rise to 90 per cent for men in their 80s.
Symptoms result from pressure on the urethra and irritation of the bladder, so increased frequency of urination and poor, hesitant stream are most common – it’s always worth getting symptoms like these checked out by your GP.
There’s an increased risk of urinary infections due to incomplete bladder emptying too. Such symptoms can respond to medications aimed either at shrinking the prostate or relaxing the urethral muscle, but TURP (trans-urethral resection of the prostate) is best performed when symptoms remain troublesome.
While there are now quite a few alternatives, it’s still a very common procedure (second only to cataract surgery) and is reportedly between 75 and 96 per cent successful at improving symptoms.
The operation (done either under general or spinal anaesthetic) simply involves removing excess tissue under direct visualisation through a scope inserted down the urethra – it’s ‘keyhole’ surgery with no skin cuts. Having said this, you’re likely to feel quite fragile in your perineal area for a while afterwards, and your own consultant will have recommendations as to when you can resume cycling (six weeks is a conservative estimate, but your individual recovery may be sooner).
Although you can’t see a wound, the tissues inside still need time to heal – at least four weeks before any cycling – and passing some blood after the op is usual. Another factor to consider is your ‘PSA’ (prostate-specific antigen) levels, sometimes checked post-operatively. Cycling can artificially raise this marker, so it’s best to wait until after that blood test, if you’re scheduled to have one.
Selecting a prostate-friendly saddle is definitely a good idea, to shift pressure away from the perineum and onto the sit-bones. Any of the Gel Flow series from Sella Italia will do the job (www.chickencycles.co.uk), as will offerings from WTB (www.hotwheels-international.com) and Specialized’s Body Geometry range (www.specialized.com), the Terry Fly Ti (www.terrybicycles.com) and the outlandish but allegedly very effective Selle SMP Strike (www.sellesmp.com).
It’s also worth looking at your bike position to ensure you’re not putting undue pressure on the perineum; stretching too far forwards or too low to your handlebars will tilt your pelvis forwards onto the nose of the saddle, as will having it nose-down. Better to tilt your saddle a couple of degrees nose-up, so that you’re rocked slightly backwards instead.
A search for BPH on Medic8.com will lead you to an excellent, comprehensive review of this common condition.