Ask the Doctor
With Prentice Steffen

Dear Doc;I recently had something strange happen and wanted to get your thoughts. Two days after my last ride I noticed that a golf ball sized "bump" started to grow right where the saddle and the underside of my left cheek come into contact. By late afternoon it had grown significantly in size and I went to the local emergency room. The diagnosis was that a vein (or several) had burst and that I had a fair amount of internal bleeding. The doctor operated on the wound (which was by now quite black and blue) to release some of the pressure and later told me that the damaged veins had sealed

By Prentice Steffen, MD, FAAEM

Dear Doc;
I recently had something strange happen and wanted to get your thoughts. Two days after my last ride I noticed that a golf ball sized “bump” started to grow right where the saddle and the underside of my left cheek come into contact. By late afternoon it had grown significantly in size and I went to the local emergency room. The diagnosis was that a vein (or several) had burst and that I had a fair amount of internal bleeding.

The doctor operated on the wound (which was by now quite black and blue) to release some of the pressure and later told me that the damaged veins had sealed themselves normally due to the pressure.

My question to you is twofold; have you ever heard of this happening to another cyclist, and how do I keep this from happening again? The doctors did not really understand why this had happened to me and suggested that my weight and/or saddle maybe a cause. I use high quality cycling shorts and the saddle is in good shape and has been used for the last three seasons. I have been cycling for ten years now and average about 2000 to 3000 miles a year.

I am 33 years old, 5’10, and weigh about 195. I was not able to do much cycling last year and my weight is about 10 to 15 pounds heavier than I would like. I began cycling early this season and started out slowly doing averaging of about 20 miles a ride. I had logged about 200 miles when this happened. I have not made any large changes to the position if the saddle (height or cant) nor did I crash or stress that area. Any thoughts would be welcome!
Thanks,
Don M

Editor’s Note: This week’s question is answered by Doctor Prentice Steffen, Team Doctor for the Prime Alliance squadDear Don;
You really did have something strange happen to you. It sounds like it was a real bummer… I’m sorry. Puns are absolutely the lowest form of humor, but I often find it difficult to begin my response without a wise crack (oh god, I did it again!).

As is usually the case, a picture would be worth a thousand words but I’m going to assume that you didn’t take one for us. It sounds to me like your emergency physician made a good diagnosis and gave you appropriate treatment. In the almost 20 years that I’ve been involved in the care of cyclists, I’ve not seen your specific problem but I can imagine such a thing happening and bet that you’re not the first cyclist to whom it has happened.

Veins are thin-walled low-pressure blood vessels (as opposed to arteries which are thick-walled high-pressure conduits) and can occasionally rupture with even minimal trauma. You say that you didn’t “stress that area”, but simply riding a bike can be stressful enough.

I’ve seen this in my own emergency medicine practice on various parts of the body where a vein lies just under the surface of the skin and is subjected to what can only be defined as a very minor traumatic episode. Sometimes in older people, who tend to have very thin skin, both the vein and overlying skin are damaged and significant bleeding can result.

I suspect that this was a one-in-a-zillion freak incident and that it will not occur again and that there is no specific cause or prevention strategy that is necessary. Once healed from this recent episode, I recommend that you resume a gradual advancement of your program and leave your equipment as is.

Now, if you have a second similar incident, you should probably see a good general surgeon for further, and more definitive, care. Your question initially made me think of a couple of other problems cyclists tend to get. The first is hemorrhoids which are veins just near the anus that are very close to the skin surface and will occasionally swell and even burst. Your situation doesn’t sound like hemorrhoids because of the location you describe and the fact that they are fairly common and easily diagnosed.

The second thought I had was “saddle sores” which are infected/inflamed sweat glands, oil glands, or hair follicles. Again this doesn’t really sound like your problem and are a whole other topic in themselves.

Best wishes for an uncomplicated recovery and a quick return to action, Prentice


Dr. Prentice Steffen, board certified in both Emergency Medicine and Sports Medicine, is currently serving as team doctor for the Prime Alliance Cycling team. He has served as team doctor for several teams including Mercury, Spago and U.S. Postal. Steffen has also served as medical director and event physician for major races including the Tour Du Pont, New York City Marathon and the Tour de Trump. Steffen also serves as the Sports Medicine section editor for the Journal of Emergency Medicine. Please send your sports-related medical questions to “Ask the Doctor” in care of WebLetters@7Dogs.com. We will forward a selection of questions to one of three physicians currently working with this site.Important Notice:
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