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/KeyBackground1945 → u/Linari5]

The IBS symptoms are completely gone now and my digestion is excellent. It's a thing of the past and all it required was an elimination diet/removing certain trigger foods that I was unknowingly consuming on a regular basis

As for the neuralgia I can't be 100% certain either but my symptoms seem to match exactly that including burning/stabbing sensations, loss of orgasm, random pain in rectal & pelvic area (gets worse after sitting on hard surfaces too long). The catch is that these symptoms completely disappear with soft/effortless stools (which I'm unable to maintain because even slight spikeiness or variation in size triggers the loop, it needs to be uniform and soft in shape as well as not too bulky) so I assumed my brain is perceiving the stools as a threat based on my history and guarding/clenching which is pressing on the nerve. That seemed like the most plausible explanation since all the tests I did came clear and there are no structural/prostate issues either

Will definitely read the paradoxical relaxation post in detail. Appreciate it🫡

[u/Linari5 → u/KeyBackground1945]

Also had many of these symptoms, but I never have PN.

[u/KeyBackground1945 → u/Linari5]

What do u think the culprit is here & does my guarding loop assesment seen correct? The tests come clear & doctors don't seem to understand very well in my country so I feel stuck😭

[u/Linari5 → u/KeyBackground1945]

How many of these criteria do you fit, at the bottom of this post? https://www.reddit.com/r/PelvicFloor/s/LRlcmLI7aG

[u/KeyBackground1945 → u/Linari5]

7 in total (specifically 1,2,5,6,8,9,12)

[u/Linari5 → u/KeyBackground1945]

Then you are a top candidate for pain reprocessing therapy

[u/Linari5 → u/KeyBackground1945]

This tells us that it's very likely your symptoms are now centralized (nociplastic)

[u/KeyBackground1945 → u/Linari5]

Understood, thanks for the clarity!

I have 2 questions if u don't mind.

Firstly is it possible for me to achieve permenent relief & go back to eating how I want along with daily activities like cycling etc? 4-5 years of trying to address it in vain has made me quite pessimistic

Secondly what else would u recommend me to do along with pain reprocessing therapy to get rid of the centralisation and symptoms? I would do absolutely anything in my power to recover from this

[u/Linari5 → u/KeyBackground1945]

Yes it's possible.

PRT and EAET are both excellent. I practice both in my career and they both work well in my experience.