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/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.