Puborectalis Muscle Cysts

The puborectalis muscle is part of your pelvic floor and plays a key role in keeping the bowel contents inside the rectum by forming a sling around it. Sometimes, cysts (small, fluid-filled sacs) can develop in or around this muscle. Although these cysts are usually benign (non-cancerous), they can cause discomfort, pain, and affect bowel and pelvic functions.

A puborectalis muscle cyst is a fluid-filled sac that forms in or near the puborectalis muscle, which is part of your pelvic floor. These cysts are usually benign and may form due to several reasons including inflammation, infection, or blockages in glandular tissues. Although they often do not cause symptoms, in some cases, they can lead to discomfort and affect the normal function of the pelvic floor.

---

Pathophysiology

Understanding the pathophysiology helps explain why cysts form and how they affect the body. Let’s break down the key aspects:

Structure of the Puborectalis Muscle

• Location:
  The puborectalis muscle is located in the pelvic floor, wrapping around the rectum. It works with other muscles (such as the levator ani) to support pelvic organs.

• Relationship to Other Structures:
  The muscle forms a sling behind the rectum, which helps maintain continence (the ability to control bowel movements).

Blood Supply

• Main Sources:
  The blood supply to the puborectalis muscle comes from branches of the internal pudendal artery and sometimes the inferior gluteal artery. These small vessels bring oxygen and nutrients that help keep the muscle healthy and assist in healing.

Nerve Supply

• Nervous System Involvement:
  The puborectalis muscle is mainly innervated by nerves from the sacral plexus, including branches of the pudendal nerve. These nerves help control muscle contraction and send pain signals if an injury (or cyst) develops.

Functions

• Maintaining Continence:
  The muscle’s sling-like structure helps keep the rectum closed, preventing accidental leakage of stool.

• Supporting Pelvic Organs:
  By maintaining the position of the rectum, it helps support other pelvic organs.

• Assisting in Defecation:
  When you pass stool, the puborectalis muscle relaxes slightly to allow the rectum to open, and then contracts to help control the process.

---

Types of Puborectalis Muscle Cysts

There are several ways to classify puborectalis muscle cysts based on their characteristics and origin:

1. Simple (Non-Complex) Cysts:
   • These are usually small, well-defined, and filled with clear fluid.
2. Complex Cysts:
   • May have septations (internal walls) or irregular shapes. They sometimes contain debris or have thicker fluid.
3. Congenital Cysts:
   • Present at birth due to developmental anomalies.
4. Acquired Cysts:
   • Develop later in life, possibly due to trauma, infection, or inflammation.
5. Infectious Cysts:
   • Caused by a localized infection that leads to cyst formation.
6. Inflammatory Cysts:
   • Develop as a result of chronic inflammation or irritation in the pelvic floor area.

---

Common Causes of Puborectalis Muscle Cysts

While the exact cause of a cyst in this area can vary, here are 20 potential reasons why they might develop:

1. Congenital Abnormalities:
   • Developmental issues present at birth.
2. Direct Trauma:
   • Injury to the pelvic region.
3. Infections:
   • Bacterial or viral infections that lead to inflammation.
4. Pelvic Inflammatory Disease (PID):
   • Infections of the reproductive organs can extend to nearby muscles.
5. Blockage of Glandular Ducts:
   • Obstruction that causes fluid buildup.
6. Inflammatory Conditions:
   • Chronic inflammation from autoimmune disorders.
7. Post-Surgical Complications:
   • Scar tissue formation after pelvic surgery.
8. Radiation Therapy:
   • Side effects from treatment in the pelvic area.
9. Endometriosis:
   • Tissue similar to the uterine lining growing in the pelvic floor.
10. Abscess Formation:
    • Localized collection of pus from infection.
11. Muscle Overuse or Strain:
    • Repetitive heavy lifting or strenuous activities.
12. Idiopathic Causes:
    • No known cause.
13. Iatrogenic Factors:
    • Complications from medical interventions.
14. Cystic Degeneration of Muscle:
    • Breakdown of muscle tissue forming cyst-like areas.
15. Obstruction from Scar Tissue:
    • Scarring that blocks normal fluid drainage.
16. Hormonal Imbalances:
    • Fluctuations that might affect glandular secretions.
17. Local Vascular Anomalies:
    • Unusual blood vessel formations causing fluid leaks.
18. Pelvic Floor Dysfunction:
    • Abnormal functioning of the pelvic muscles.
19. Prior Inflammatory Episodes:
    • Repeated inflammation leading to cyst formation.
20. Parasitic Infections:
    • Rare infections that result in cystic lesions.

---

Common Symptoms of Puborectalis Muscle Cysts

Not every cyst will cause noticeable symptoms. When symptoms do occur, they might include:

1. Pelvic Pain:
   • Dull or sharp pain in the pelvic region.
2. Lower Back Discomfort:
   • Pain that may radiate to the lower back.
3. Rectal Pressure:
   • A feeling of pressure or fullness in the rectum.
4. Pain During Bowel Movements:
   • Discomfort when passing stool.
5. Difficulty Defecating:
   • Feeling of incomplete evacuation.
6. Urinary Frequency:
   • Needing to urinate more often.
7. Painful Urination:
   • Discomfort when urinating.
8. Pelvic Tightness:
   • A sensation of muscle tension in the pelvic floor.
9. Pain While Sitting:
   • Increased discomfort when seated for long periods.
10. Pain During Intercourse:
    • Discomfort or pain during sexual activity.
11. Swelling in the Pelvic Area:
    • Noticeable enlargement or fullness.
12. Tenderness on Touch:
    • Pain when the area is pressed or palpated.
13. Visible or Palpable Mass:
    • A lump that can sometimes be felt.
14. Muscle Spasms:
    • Involuntary contractions or cramps in the pelvic floor.
15. Numbness or Tingling:
    • Altered sensation in the pelvic or perineal region.
16. Changes in Bowel Habits:
    • Alternating constipation or diarrhea.
17. Lower Limb Discomfort:
    • Pain radiating into the upper thighs or buttocks.
18. Fatigue:
    • General tiredness due to chronic pain.
19. Abdominal Discomfort:
    • A vague sense of discomfort in the lower abdomen.
20. Anxiety or Stress:
    • Emotional distress stemming from chronic discomfort.

---

Diagnostic Tests for Puborectalis Muscle Cysts

To determine if a cyst is present and to understand its nature, healthcare providers may use a combination of diagnostic tests:

1. Digital Rectal Examination (DRE):
   • A manual examination to feel for abnormal masses.
2. Pelvic Ultrasound:
   • Uses sound waves to create images of the pelvic structures.
3. Transperineal Ultrasound:
   • An ultrasound performed through the perineum.
4. Transvaginal Ultrasound:
   • For women, an internal ultrasound to view pelvic organs.
5. Magnetic Resonance Imaging (MRI):
   • Detailed images of soft tissues to define the cyst’s structure.
6. Computed Tomography (CT) Scan:
   • Cross-sectional imaging to view the pelvic region.
7. X-ray:
   • Occasionally used to rule out other conditions.
8. Endoscopic Ultrasound:
   • Combines endoscopy and ultrasound for detailed imaging.
9. Cystoscopy:
   • A scope is used to examine the interior of the bladder and nearby areas.
10. Colonoscopy:
    • To evaluate the colon if symptoms extend to bowel issues.
11. Biopsy:
    • A small tissue sample is taken to rule out malignancy.
12. Blood Tests:
    • Check for signs of infection or inflammation.
13. Urinalysis:
    • To rule out urinary tract infections.
14. Pelvic Floor Evaluation:
    • Assessment by a specialist in pelvic disorders.
15. Defecography:
    • Imaging while the patient defecates to study pelvic floor function.
16. Electromyography (EMG):
    • Tests the electrical activity of pelvic muscles.
17. Manometry:
    • Measures pressure within the rectum.
18. Nerve Conduction Studies:
    • To assess if nerve damage is contributing to symptoms.
19. Positron Emission Tomography (PET) Scan:
    • Used rarely, if there is a concern for unusual metabolic activity.
20. Dynamic Pelvic MRI:
    • Captures images during movement to assess functional issues.

---

Non-Pharmacological Treatments

Many patients benefit from non-drug therapies that help relieve symptoms, reduce inflammation, and improve pelvic function. Here are 30 strategies that can help:

1. Rest:
   • Avoid activities that worsen symptoms.
2. Ice Application:
   • Apply cold packs to reduce swelling and pain.
3. Heat Therapy:
   • After the initial inflammation subsides, warm compresses can relax muscles.
4. Physical Therapy:
   • Tailored exercises to strengthen the pelvic floor.
5. Pelvic Floor Exercises (Kegels):
   • Help improve muscle tone and control.
6. Yoga:
   • Gentle stretching and relaxation poses for pelvic balance.
7. Pilates:
   • Focuses on core stability and pelvic alignment.
8. Stretching Exercises:
   • Target tight muscles to ease tension.
9. Pelvic Massage:
   • Helps relieve muscle spasms and improve circulation.
10. Biofeedback Therapy:
    • Teaches you how to control pelvic muscle contractions.
11. Postural Training:
    • Correcting posture can reduce pelvic strain.
12. Activity Modification:
    • Change daily habits to lessen pelvic stress.
13. Dietary Fiber Increase:
    • A high-fiber diet aids bowel regularity.
14. Hydration:
    • Drinking plenty of water supports overall tissue health.
15. Weight Management:
    • Maintaining a healthy weight reduces pelvic pressure.
16. Stress Reduction Techniques:
    • Practices like meditation or deep breathing can reduce muscle tension.
17. Acupuncture:
    • May help relieve pain and improve circulation.
18. Manual Therapy:
    • Hands-on techniques by a trained therapist to release tension.
19. Core Strengthening Exercises:
    • Support the lower back and pelvic floor.
20. Balance Training:
    • Improve stability to reduce falls or injury.
21. Ergonomic Adjustments:
    • Modify your workstation and home environment.
22. Use of Supportive Cushions:
    • Special seating can relieve pelvic pressure.
23. Regular Walking:
    • Low-impact exercise that promotes circulation.
24. Meditation:
    • Helps manage pain and emotional stress.
25. Avoiding Heavy Lifting:
    • Reduces strain on the pelvic muscles.
26. Progressive Resistance Training:
    • Gradually build strength without overexertion.
27. Transcutaneous Electrical Nerve Stimulation (TENS):
    • Uses mild electrical currents to reduce pain.
28. Relaxation Techniques:
    • Activities that promote overall calm.
29. Regular Follow-Up with a Physiotherapist:
    • Monitor progress and adjust therapy.
30. Education and Self-Care:
    • Learning about your condition empowers better management.

---

Drugs Commonly Used

Medications for puborectalis muscle cysts are chosen based on symptoms, severity, and whether infection or inflammation is present. Always follow your doctor’s advice when taking any medication. Here are 20 drugs that might be used:

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
   • Ibuprofen, naproxen for reducing pain and inflammation.
2. Acetaminophen (Paracetamol):
   • For pain relief.
3. Muscle Relaxants:
   • To ease muscle spasms.
4. Oral Corticosteroids:
   • To reduce severe inflammation.
5. Topical NSAIDs:
   • Creams or gels applied directly to the area.
6. Antibiotics:
   • If an infection is suspected.
7. Opioid Analgesics:
   • For severe pain (short-term use only).
8. Antispasmodic Medications:
   • To reduce muscle spasms.
9. COX-2 Inhibitors:
   • A type of NSAID with fewer gastrointestinal side effects.
10. Tramadol:
    • A mild opioid pain reliever.
11. Diclofenac:
    • Another NSAID option.
12. Celecoxib:
    • A selective COX-2 inhibitor.
13. Topical Analgesics:
    • Such as lidocaine patches.
14. Capsaicin Cream:
    • Reduces pain by desensitizing nerve endings.
15. Steroid Injections:
    • Local injections to relieve inflammation.
16. Gabapentin:
    • For nerve-related pain.
17. Pregabalin:
    • Also used for neuropathic pain.
18. Antidepressants:
    • Low doses can help manage chronic pain.
19. Anxiolytics:
    • If anxiety exacerbates pain symptoms.
20. Vitamin Supplements:
    • To support muscle and nerve health (as advised).

---

Surgical or Invasive Procedures

Surgery is generally reserved for cases where the cyst causes severe symptoms, does not respond to conservative treatment, or if there is any suspicion of complications. Surgical options may include:

1. Cyst Excision:
   • Surgical removal of the cyst.
2. Cyst Drainage (Aspiration):
   • Using a needle to drain the cyst fluid.
3. Laparoscopic Removal:
   • A minimally invasive procedure using small incisions.
4. Open Surgical Removal:
   • Traditional surgery for larger or more complex cysts.
5. Marsupialization:
   • Creating an opening in the cyst to allow continuous drainage.
6. Endoscopic Removal:
   • Using an endoscope to access and remove the cyst.
7. Excisional Biopsy:
   • Removing the cyst for both treatment and diagnostic analysis.
8. Cyst Enucleation:
   • Carefully “shelling out” the cyst from surrounding tissue.
9. Pelvic Floor Reconstruction:
   • If the cyst has caused significant damage to pelvic structures.
10. Surgical Repair of Adjacent Tissues:
    • If the cyst has affected nearby muscles or nerves.

---

Preventive Measures

Preventing puborectalis muscle cysts focuses on maintaining a healthy pelvic floor and reducing risks associated with infection or trauma. Consider these steps:

1. Regular Pelvic Floor Exercises:
   • Strengthen the muscles to improve support.
2. Maintain Good Posture:
   • Reduces unnecessary strain on the pelvic muscles.
3. Avoid Heavy Lifting:
   • Use proper techniques to protect the pelvic floor.
4. Maintain a Healthy Weight:
   • Reduces stress on the pelvic region.
5. Balanced Diet and Hydration:
   • Supports overall tissue health and prevents constipation.
6. Regular Medical Check-Ups:
   • Early detection of any pelvic floor issues.
7. Practice Safe Sex:
   • Reduce the risk of pelvic infections.
8. Warm Up Before Exercise:
   • Prepares muscles for physical activity.
9. Use Protective Gear:
   • In sports or high-risk activities.
10. Stress Management:
    • Reducing stress can prevent muscle tension and related issues.

---

When to See a Doctor

It is important to consult a healthcare professional if you experience any of the following:

• Persistent or Severe Pelvic Pain:
  • Especially if it disrupts your daily activities.
• Changes in Bowel or Urinary Habits:
  • Such as increased urgency, frequency, or pain during elimination.
• Noticeable Mass or Swelling:
  • In the pelvic, perineal, or lower back area.
• Pain During Sexual Intercourse:
  • That does not improve with conservative care.
• Symptoms of Infection:
  • Fever, chills, or redness in the pelvic region.
• Lack of Improvement with Home Care:
  • If non-pharmacological treatments do not ease your symptoms over time.

---

Frequently Asked Questions (FAQs)

1. What is a puborectalis muscle cyst?

It is a fluid-filled sac that forms in or around the puborectalis muscle, which is part of your pelvic floor. These cysts are generally benign and may occur due to infection, inflammation, or other factors.

2. How do puborectalis muscle cysts develop?

They may form from blockages in glandular ducts, infections, trauma, or inflammatory processes in the pelvic area.

3. Are these cysts cancerous?

Most puborectalis muscle cysts are benign (non-cancerous), but any new or growing mass should be evaluated by a doctor.

4. What are the common symptoms?

Symptoms can include pelvic pain, rectal pressure, pain during bowel movements, discomfort while sitting, and sometimes urinary issues.

5. How is the diagnosis made?

Doctors use physical exams, ultrasound, MRI, CT scans, and sometimes a biopsy to diagnose and evaluate the cyst.

6. Can puborectalis cysts affect bowel control?

Yes, if the cyst is large or causes significant inflammation, it may interfere with the normal function of the pelvic floor and affect continence.

7. What non-drug treatments are recommended?

Rest, ice, heat therapy, pelvic floor exercises, physical therapy, and lifestyle modifications are commonly recommended.

8. When are medications used?

Medications such as NSAIDs, muscle relaxants, or antibiotics may be used if there is pain, inflammation, or infection.

9. Is surgery ever required?

Surgery is usually reserved for severe cases or if the cyst causes persistent, debilitating symptoms that do not respond to conservative treatments.

10. How long does recovery typically take?

Recovery depends on the size and cause of the cyst. Mild cases may resolve in a few weeks, while more severe cases might require several months of treatment.

11. Can lifestyle changes help prevent these cysts?

Yes, maintaining a healthy weight, performing pelvic floor exercises, and avoiding heavy strain can help reduce the risk.

12. Are there any risks with surgical removal?

As with any surgery, risks include infection, bleeding, and injury to nearby structures. Your doctor will discuss these risks before the procedure.

13. Can puborectalis muscle cysts recur?

In some cases, especially if underlying issues persist, cysts may recur. Regular follow-ups are important.

14. Is imaging always necessary?

While a physical exam may suggest a cyst, imaging tests like ultrasound or MRI are typically needed to confirm the diagnosis and assess its size and complexity.

15. When should I seek emergency care?

Seek medical help if you develop severe pain, signs of infection (such as fever), or if you experience sudden changes in bowel or bladder function.

---

Conclusion

Puborectalis muscle cysts are fluid-filled sacs that can develop in the pelvic floor, potentially causing discomfort and affecting daily functions like bowel movements and sitting. Understanding their anatomy, causes, and the many treatment options available is essential. From non-pharmacological methods like physical therapy and lifestyle modifications to medications and, in rare cases, surgical intervention, there are many ways to manage these cysts.

 

Authors Information

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

 

References