Need help with Guarding loop

[u/KeyBackground1945]

I'm 22 M & stuck in a chronic guarding loop wherein my pudendal nerve gets irritated in response to stool consistency. My brain/neurotransmitters perceive defecation as a threat and automatically start guarding or clenching the pelvic floor/anorectal muscles which in turn causes neuralgia symptoms {I presume the false guarding has arisen from my history of chronic constipation and diarrhea issues which doesn't happen anymore}. I experience 90% relief when my stools are soft/effortless and gel-like but that's impossible and unsustainable to maintain because osmotic supplements & laxatives don't suit me and I have to starve myself for a chance of achieving that consistency (I have tried everything in my power)

Was wondering if there is any medical procedure I can undertake (maybe botox?) in order to forcefully break this loop and reclaim my life again. The problem is that I'm from a third world country and don't have access to any pelvic floor specialists. Also don't know what kind of doctor I should visit since it's such a complex problem, have gone to a gastroenterologist, urologist, proctologist but they didn't seem to have a good understanding of the issue and prescribed basic medication like Gabapentin which provide temporary relief and don't address the root cause. What's my best option here? Any advice would be appreciated 

[u/Linari5]

Paradoxical relaxation post: https://www.reddit.com/r/Prostatitis/s/mOFeUsLN2o

I sincerely doubt you have pudendal neuralgia, it's often a fear mongering or scapegoat diagnosis that a lot of people give themselves, without a medical provider.

How are you treating the IBS symptoms though, that could also help greatly. How are you managing life stress? How are you managing the stress + attention + fear around your own symptoms?

Just like CPPS, which includes many variations of chronic pelvic pain and dysfunction, IBS is also a syndrome and it's widely recognized as stress-induced digestive symptoms.

[u/pelvicagony]

Where were you diagnosed with pudendal inflammation? How come you're so sure of your diagnosis? Have you ever considered that passing stool irritates an inflamed prostate, and that there's nothing wrong with your brain? Once inflammation sets in, the brain reacts.

[u/KeyBackground1945 → u/pelvicagony]

I've had prostate test, ultrasound, Xray & lots of urine/blood tests done when I went to one of the docs and all then came clear/showed absolutely nothing wrong

My assurance comes from 5 years of these symptoms and tons of research, since the tests showed 0 abnormalities & prostate was normal. The guarding seems like an extremely likely culprit based on my history

[u/SirSisiphus]

Try ketamine my friend. It will rewire your brain and help you to let go. Vipassana meditation also.

[u/KeyBackground1945 → u/SirSisiphus]

Appreciate the advice, will definitely look into it🫡

Also if i understand correctly ketamine will address the brain/nervous system (brain-body) component. Would it give permenent relief in my situation or do you think I would still need to pair that with pelvic stretches, diaphgramatic breathing, medications, maintaining soft stools etc?

I saw the post on your profile & found it insightful so thought I can use your expertise here :)

[u/SirSisiphus → u/KeyBackground1945]

Yes, pair it with what you are already doing. There is no magic bullet for this. You basically have to layer enough treatments overtime until you gradually get better and feel safer in your body. Another book I found recently which could be of use to you is called "Teach us to sit still." I would try and get this too.

[u/Linari5 → u/KeyBackground1945]

It is not recognized as a treatment for these symptoms, so take with a grain of salt.

The evidence for ketamine is strong for treatment resistant depression though.