29 September 2015 ~ 2 Comments

Saddle Sores — Prevention & Treatment with Ointments

This page deals primarily with ointments and medicated powders as it deals with one’s “undercarriage” in cycling. For saddle issues, visit this page.

 

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Cremes for Use Prior or During a Ride

During May of 2011, I  had a small cyst or boil near my sit bone. It was a week before I was going to do the Grand Canyon 600K. A doc looked at it and thought I needed an anti-fungal cream (I think he was just guessing), which I started to apply per his recommendation. I only used that cream for my chamois lube on that ride and didn’t add anything more until the half-way point. Big mistake. The cream was too runny and didn’t stay put. I got some major sores and had to use two pair of shorts to get through to the end. It got me thinking that perhaps the chamois cremes I use are not anti-fungal and I need to change.

There are many cremes out there, aside from the common U.S. selection which is Chamois BUTT’r. Thy include Assos Cream, 2 Toms, DZ Nuts from Dave Zabriskie (U.S. pro racer), Hammer, Okole Stuff, Sportique (European company) etc. Many claim to be natural with little or no “petro” or oil-based products.
But yet according to Andy Pruitt’s Complete Medical Guide for Cyclists, he says (p. 90) “Petroleum-based lubricants have more staying power, especially in wet conditions. I recommend petroleum-based products that contain antibiotics.” Another interested fact is that most marathon open water swimmers use lanolin as a body grease (i.e. those swimming the English Channel and the like). Some of them mix lanolin with petroleum jelly, which is sometimes referred to as channel grease. According to the book Open Water Swimming (p. 65) it says  Lanolin “is a thick, greasy, sticky substance that appears white on the skin and stays on much longer than petroleum jelly.”
Bag Balm would be considered oil based. Chamois BUTT’r is primarily water based, although it has a little bit of lanolin oil (the main ingredient in Lantiseptic) and mineral oil. In 2012 I got a very long e-mail from them regarding this matter. Basically they said their product is designed for the average Joe, who cycles maybe three to five hours. Their product will not stain or rot clothing and is easy to wash out. Here it what they said about anti-fungal and anti-bacterial properties…
“We do not make anti bacterial or anti fungal claims, as it is our understanding that the FDA does not allow those claims to be made by “cosmetic” products…We don’t advertise our products to be “antibacterial or antifungal” (claims made by medications), but you can say they have anti bacterial and anti fungal ingredients.”

Here is an informative article (with photos) referred to me by a cycling customer who practices orthopedic sports medicine. He said regarding folliculitis or inflammation of hair follicles: “Ointments are usually petroleum based, non-water soluble, like Vaseline and Bag Balm. They last longer while riding, may plug hair follicles and predispose people to folliculitis (infected hair follicles and saddle sores). To treat follicultis you need to use a non-petroleum, water soluble cream. Abraded and irritated skin predisposes one to infections including boil and abscess formation. So I learned that Neosporin cream worked better than Neosporin ointment to heal and stay healed from saddle irritation. I apply the cream 2X a day to the affected areas if there is any skin irritation.  Ointment based topicals to use between rides for skin irritation may last longer and lube the skin better, but they do not deal with the underlying problem of bacterial growth within the plugged  the hair follicles.”
Despite his statement about not using petro-based creams, he uses Okole Stuff for longer rides (see below) because it is not very water soluble and lasts long.

As a general rule I apply creme on both my chamois and my skin before the ride. Apply not only to your private parts, but also to your sit bones — anywhere where there might be pressure from the saddle or chafing caused by the repetitious movement of your legs. Sometimes I wonder if what matters most is not what is in the creme, but that the viscosity is thick enough to stay put.

In summary, after several seasons of testing various types of cremes I have settled onto two products: Lantiseptic Skin Protectant (not Skin Cream, which has less lanolin and is not as thick) or Okole Stuff, which I sell on my site eoGEAR. The Lantispetic is designed for treating folks in care centers for incontinence and diaper dermatitis. The Okole Stuff is designed for athletes and is the thickest anti-chafe specific ointment I could find. It comes in a jar, not a tube. It contains lanolin, aloe vera oil, tea tree oil, all of which not only lubricate, but also prevent infections (they claim). With Lantiseptic, since it is SO STICKY, I now carry disposable vinyl gloves, which I use when applying, which helps in clean up.

Dealing with Saddle Sores During a Ride

For use during a ride, I sometimes pack a stick of Body Glide Chamois Glide as it rolls on like deodorant and is quick and easy to apply while in a c-store restroom. Other times I will pack a small container of Okole Stuff in my saddlebag for touch up during long rides.

Let me quote Susan Otcenas (owner of the huge women’s site Team Estrogen, which is now offline, & long distance cyclist) from an e-mail on a cycling forum in 2014 [square brackets are my comments]:

  1. Stop at a grocery store or drug store.
  2. Head directly to the first aid section of the store. Purchase something with a numbing agent in it. [Anything with 20%  Benzocaine.] Some options include Vagisil (5% benzocaine. Vagisil is marketed as a women’s anti-itch product, but let’s face it: if it’s delicate enough for a woman’s genitalia, it’s certainly going to be safe enough on your butt, male OR female. Vagisil has a creamy consistency that will go on easily and wash off your hands quickly.), Preparation H (Pramoxine HCI 1%. Also has glycerin & petroleum jelly, which are a little greasy, but will “protect and lubricate” the affected area.), Orajel (yeah, it’s for toothaches, but it has 20% benzocaine, which will numb that spot right up. And if it’s safe to ingest by mouth, it can’t be too harmful on your @ss, now can it?).
  3. Head to the restroom. Grab two wads of paper towels. Saturate one with water, and leave the other dry. Use the wet wad to thoroughly wipe down the affected areas. Sweat is full of salts that irritate open/chafed skin, so clean the entire area. Pat dry with the dry wad. Now carefully apply whatever you purchased in step 2. Take the time to do it right, covering whatever tender spots you have. Pull up your shorts completely and firmly seat the chamois against your skin. Droopy/loose shorts are just asking for trouble/chafing.
  4. Go ride your bike.  :-)  The numbing agents seem to wear off after 30 minutes or so but by then, maybe something else will hurt more…
  5. Re-apply at controls [aid stations] or as necessary.
  6. Post-ride, consider using something to help you heal faster. Desitin is surprisingly effective. It’s gentle on the skin (it’s diaper rash cream, after all), and it’s designed to reduce inflammation and irritation. After a really rough ride, you many find you need a weekend off to fully heal.
  7. For the NEXT ride, consider taking extra care to lube that spot well, with something like Lantiseptic. Once chafed, certain spots seem to be more prone in the future.

Treatment of Problems After a Ride

I think I have had more saddle sores than flat tires. I have tried many post-ride solutions, but let me share my techniques.

  • If you have open sores, particularly ones that are oozing, I would first (after showering) consider covering the whole area with a topical antiseptic/antimicrobial cleanser like Hibiclens or Betadine Solution. Let it dry and then apply Neosporin Cream. Get the pain relief kind if possible. Since it is hard to apply a bandage to your tush (as I experienced flying back from a DNFed 1200K in Seattle due to saddle sores…), apply a medicated powder over the ointment, so the ointment doesn’t stick to your underclothing. I recommend Anti Monkey Butt (as sold on my site eoGEAR), because it contains Calamine. Ammens Medicated Powder is similar and also does the job.
  • After some seven years of riding, in 2015 I had my first “under-the-skin bacterial infection” saddle sore. This was different that the topical chafing or open sore problems I experienced before. It started with some tiny welts, like acne, eventually developing a bump under the skin. This happened shortly after swapping out saddles. Perhaps I had the post too tall, causing chafing. Or maybe my interacted with the mink oil which I slather on my leather saddles. I went ahead on a 1000K the following week, but on the last day of this long brevet, in order to finish, I had to consume a ton of ibuprofen and wear two pair of shorts. I could feel a big lump near my left sit bone. Afterwards, despite not riding for several days after this event, it didn’t disappear. After seeing my family doctor, he indicated that I had an abscess or pocket of pus and prescribed some antibiotics, along with the use of a warm compress. It eventually went away after about seven to nine days, and I was able to finally get back on the bike. Lately, during the course of my regular training rides, if I discover those strawberry, zit-like welts, I immediately apply acne medication such as Clean & Clear Perso-Gel 10 or Clearasil two to three times a day. These products contain 10% Benzoyl Peroxide, which “works by reducing the amount of acne-causing bacteria and by causing the skin to dry and peel.” I also apply a light coating of Anti Monkey Butt powder to my underclothing, so the ointment doesn’t transfer into the fabric. Another possibility is the use of Betadine Solution (commonly used as an antiseptic prior to surgery), which also dries out the skin and kills bacteria on the surface. I also apply a heating pad to that area two to three times daily as that helps bring to the surface any pus or other “gunk.” The following warning comes with those acne products: “Because excessive drying of the skin may occur, start with one application daily, then gradually increase to two or three times daily if needed… If bothersome dryness or peeling occurs, reduce application.” The problem is that if one has redness or soreness caused by chafing or pressure of the saddle, then the typical solution is to apply an ointment (i.e. Bag Balm, Desitin, zinc oixide etc.) to retain moisture so the skin can heal itself, but moisture, as I see it, can be problematic, as moisture invites bacteria which causes acne or abscess. Consequently, one needs to determine which is the greater problem, superficial skin irritation or bacterial infection, both of which require opposite treatments!
  • If you do not have open sores, but “only” redness or soreness caused by chafing or pressure, then I generally put on a thin layer of Bag Balm, or the more sticky Lantiseptic CaldaZinc Ointment, which contains a lot of zinc oxide and some lanolin too (it is designed for diaper rash, chafing & relieves itching). Top that off with some a medicated powder so it doesn’t stick to your underwear. Reapply a few times a day as needed. Other cyclists have recommended Preparation H or any hemorrhoidal ointment cream with 10-20% Benzocaine — I keep them in my arsenal of creams, and finally used one (in 2017) while in the midst of a 1000K when I was having slight soreness with a newish saddle. Cetaphil is a nice medicated soap/lotion that you might consider.
    On multi-day rides, like a 1000K or 1200K brevet, I usually use the above treatment “just to be sure,” right before going to sleep. Keeping the area slightly moist with an ointment enables the skin to repair itself, so you can start out the next day with a better chance of being comfortable (although ironically, as I said in the prior paragraph, too much moisture become a breeding ground for infections!).

2 Responses to “Saddle Sores — Prevention & Treatment with Ointments”

  1. Bob 30 September 2015 at 4:23 pm Permalink

    Helpful information – thanks. For applying Lantiseptic, I just use wide flexible wooden sticks available in bulk at art supply stores. They are about twice as wide as a popsicle stick and slightly thinner. This keeps my fingers out of the stuff and makes cleanup easier.

  2. Ed 14 October 2015 at 6:08 pm Permalink

    For applying Lantiseptic during intermediate points of a 1200km ride, I put some (a single application) into a small snack baggie and turn it inside out whilst applying it to the arse. Fingers don’t get mucked up.

    I probably should try the Okole Stuff since the smell of Lantiseptic is a touch off putting.