Ongoing gastrointestinal and perineal pain and no solution in 18+ months

[Maldipancia]

Hello

I'm a 40 year old male, 6'1"/185cm and around 10.5st/67kg. Aside from the below I'm in relatively good health; could exercise a little more, but can also happily walk all day in the mountains close to where I live. I stopped smoking ~1.5 years ago, drink perhaps a little more than is healthy (though far from every day) and appear to have very sensitive skin, probably allergic to dust/pollens etc.

So... there really is way too much to go into to give the entire context here, but I'm finally compelled to write.

Approx 18 months ago I experienced what I now realise were the first symptoms of what may or may not be IBS and related conditions.

Initially it manifested as fever, lots of small trips to urinate, a sometimes painful bladder and urethra, nausea and minor diarrhoea. It passed after a fortnight or so, but then the bladder, abdominal discomfort/pain began to return periodically. I put that first bout down to a possible urinary tract infection and began to forget about it.

Fast forward a few months and, while the fever and nausea had subsided, the intestinal/stomach issues seemed to have become chronic. Barely a day with complete relief, and sometimes quite intense discomfort, also affecting the perineum and post-sexual activity. Memory is kind of bad but at points it was so intense I could do little more than sit/lie down, dose up on ibruprofen and wait for it to pass.

Another couple of months and, when realising this wasn't going anywhere without being treated (I was living between two countries at the time and so hadn't been organised enough to get to a doctor/hospital and, as it had seemed intermittent, kept postponing 'until I'm in one place for a decent chunk of time'.) I finally saw a gastroenterologist, was given some probiotics, and told to report after a period to see how it had gone. Without much change, I was prescribed some antibiotics (which cleared it up, albeit briefly) and sent for what I assume are the standard allergy/intolerance tests. *Everything* was returned negative.

Meanwhile (and, unhelpfully, during the first lockdown) I went to the bathroom and thought I'd prolapsed. A subsequent trip to a proctologist informed me that it wasn't that, but it was 'just skin' which had been pushed out and I was given some gel for anal fissures. I still have the skin flaps protruding, though to a lesser degree.

A later trip to a proctologist for a thrombosed haemorrhoid saw me prescribed something (I forget what now) specifically for that, along with further propbiotics. The haemorrhoid cleared, thankfully, but still there was significant discomfort inside.

I've been prescribed various combinations of pro/antibiotics all year, to varying - though largely minimal - effect. I've had an abdominal ultrasound (nothing unusual found apparently) and more hospital/doctor trips to try and find a solution but, while the pain is admittedly reduced from its peak during the previous winter/spring, the symptoms are never completely relieved.

In short, now, I feel perineal pain, kind of like an inner 'stinging', as though there could be small pins or slits inside around that area. Bowel habits have returned more or less to 'normal', although each movement has consequences, sometimes intensifying the perineal pain, sometime causing and/or relieving uncomfortable gas. Sexual function appears more or less acceptable, but erections can cause perineal pain too and I'm fairly convinced that, when I've had trapped gas they worsen it, though am not completely certain. I've had intermittent, though thankfully not frequent bouts of diarrhoea and constipation that have sometimes seemed to have been related to medication, though I can't confirm that.

I have a *constant* ... I can only describe it as a kind of pulling, straining *tightness* somewhere in my intenstines/stomach, that is almost ever-present, along with the previously described perineal sting that, while not constant, is frequent.

Essentially the whole area seems to be a mess, and never truly relieved from some pain or other.

I'm aware that I've not given precise details of treatments/tests etc but wanted to post this as a starter. I hope to see another gastroenterologist soon but, where I am, it's quite expensive and of course Covid has complicated matters further.

One more, perhaps unrelated item I considered lately - I have a number of small, hard, epididymal cysts that were identified ~20 years ago. A couple more potentially unrelated, but potentially not, things:

I had minor carbon monoxide poisoning just a few months before this all began and quite intense vomiting and diarrhoea a a direct consequence.

I stopped smoking around the same time.

The same week symptoms first appeared, I was with a friend who rides a moped, and was being bounced quite violently up and down on the hard, wooden, rear seat - I remember thinking at the time that it might cause injury, it was so violent.

I think this is enough for now, as this post is quite long. Any help is appreciated, though I obviously acknowledge that without examination it will be necessarily limited.

Thanks,
MdP