Post Prostatectomy Incontinence: When can I start bicycling again?

Hello fellow riders and PC survivors - hope this thread is still alive (I have read and greatly-appreciate all previous posts!)... 63 years, I am 6 months post N-SRP... (not sure % of nerve-sparing?)... daily mountain bike rider normally... have not been on bike in 6 months... still dealing with some incontinence (improved substantially since catheter removal - but progress is incremental). Want desperately to ride again - but still feel "pain" or "tenderness" along perineum (bike seat area) when pressure applied, and along urethra track after doing 3-4 sets of kegels daily... just bought new ERGON SMC Sport Gel Saddle (specific size and design to remove direct pressure on perineum) but still hesitant to ride due to pain/tenderness. I am remaining active with hiking, stationary recumbent bike, TRX/X-fit workouts - but NEED to bike!
*Any experience/advice from anyone who has been down this path?
*I also just started trying red light therapy (Infrared and near-IR) on perineum area - anyone tried/had success with/ or was cautioned against red light for this area?
Thanks much and best to all!!!

I returned to cycling three months after surgery. Mountain, gravel, time trial (triathlons), indoor trainer (Zwift), and standard road biking with long climbs (1-2 hours of climbing). I never had pain in the perineum. I have used saddles with a center cut-out for the past twenty five years. I started with 15 minutes indoors; when that went OK I progressively increased riding time by 15-20 minutes 3 times a week. A professional bike fit to ensure the saddle is not too high is essential IMO. Knees should remained flexed by about 15 degrees with the pedal at its lowest point.

Thanks for the quick reply @trusam1 - much appreciated! Super-helpful with your progressive-return plan! I am thinking similarly. Glad to hear your return to cycling has been a success! I am a 35+-year mt biker and coach/instructor (not riding has had significant impact on me - mostly for the mental health benefits...). Bikes are custom-fit and seats are A-1 [I also have a pretty cool device for my seats that allows for angle change - depending on terrain (climb-descend-trail)] - to take pressure off and provide support (I have no stake in the product - but, now that I think about it, it could help men with these issues?): it's called an "Aenomaly Switchgrade" (can't post link - but it will come up on google I'm sure).
Anyways, I am hoping this feeling of "tenderness" or whatever it is goes away. I have been riding NordicTrack recumbent with "bench" style seat for 20-45 minutes without a problem for the past 3 months. I will likely start trying short, easy terrain rides in the next few weeks and see how it goes. Thank you again!

@mtb63, you might also be interested in these related discussions:
- Cycling after radical prostatectomy (RP)? Increase risk of recurrence?
https://connect.mayoclinic.org/discussion/cycling-after-rp/
- Hill-walking/hiking after prostatectomy
https://connect.mayoclinic.org/discussion/hill-walkinghiking-after-prostatectomy/
Keep up the kegels👍 https://connect.mayoclinic.org/group/prostate-cancer/?search=kegel#discussion-listview

Have you talked about the tenderness in the perineum with your surgeon or with a physical therapist?

I'm late to this thread but thought I'd add my story anyway. Always been an avid cyclist, including competitive mountain biking. I had my 3 month follow up on 5/29/25 and had started cycling about a week before. Used my mountain bike for more cushion and did short distance in neighborhood. Mostly smooth, with little grade. For my first 2-3 months of recovery after surgery on 2/25/25 I did a lot of walking with a weight vest. I felt okay on the bike. A little bit of pain and tenderness showed up after my first couple of rides. I rode several more times and talked to my surgeon at my 3 month appt. He was not concerned about the small amount of pain. He also did not think I'd be setting my healing back by cycling. Gave me the green light.
I returned home and began cycling on my road bike. Less cushion, more leg extension. I had lowered my seat on the mountain bike, but not on my road bike. The combination of more extension and a little more jarring ride over less than optimal surfaces increased the pain and tenderness a little. But I'm already doing an average of 15 miles per ride.
Conclusion: I know that while some of my most delicate surgical results, like the anastomosis of the urethra to the bladder, have healed well, there is still anatomic adjustment happening. From what I've read, the bladder may return to an optimal position within a year. My surgeon did not think my ED would resolve because he 'went wide' to contain the tumors in my prostate. Therefore, I'm going to ride normally and try to increase my fitness level. I intend to return to mountain biking on trails this month also.
I'll post an update to my story here at the end of the summer. Or maybe sooner, if I have unexpected results to report.
For now, I'm excited to have an undetectable PSA and a good pathology report after surgery. I return to living life with a much more positive outlook about my health.

I am a former cyclist (road and ultra) and also had RARP
Besides the surgical healing, my big concern is incontinence. Three times I have tried to start riding a simple recumbent exercise bike and following very short workouts, each time I experienced setback to my incontinence ( marked increase in leakage, prior to each time I could sleep through the night, stay dry and be fairly dry in the mornings etc. However each time I tried biking it was like I went back to my second week following the surgery

like you, I am very happy that my PSA is next to 0 I am definitely healing and the incontinence is getting better heavy lifting and bike riding however set me back each time I try

FYI RARP Jan 2025 (I am 71)

I was on the bike 4.5 weeks post RP. I am an avid mountain biker and got back to it asap. I naturally leaked at that point and threw a pad in. Then just quit the pad due to rubbing and leaked into my chamois pad after 2 months. At the point I had some control and just didn't worry about it as modern chamois is designed to absorb moisture. I am hell bent on this disease having as little impact on what life I have left and just don't worry about the small stuff. I continued as a sports official after RP and wore a pad for about a week and ditched it once again due to rubbing. We wear black shorts and I could leak and be the only guy in the stadium that knew it. Would even smile sometimes. I did check with a couple of partners that knew my situation to ensure I didn't smell like Pee. No on all accounts. I would also encourage you to take your life back and live your passions to the fullest. Also suggest you if you haven't already, to get your bike saddle fitted to you. Go to a LBS and get fitted. The right saddle won't put pressure on you urethra.

this is a little off topic but maybe not.
maybe 30 years ago I was doing long distance road biking and tris. I was having some tenderness and numbness and I looked into bike saddles. There was a cool test where males were tested for oxygen flow and saddles were compared, the differences between saddles was amazing to me ( 20% to 80% depending) no nose, split nose

check out https://pubmed.ncbi.nlm.nih.gov/12074400/ and https://www.europeanurology.com/article/S0302-2838(01)00028-8/abstract this might be important post RP

It depends upon what kind of bike you have. I could ride my greenway bike but not my road bike. Good luck.

I have one that is split and the other that came out of the box fitted. Elevates by sitting on the sit bones instead of the perineal area. I think there is definite merit to getting fitted. Mountain bike and road bike.