My Story. 2 years of suffering. Asking your opinion

[webslave]

Yes, there is a physiologic reason: the stool is expanding the rectum upwards and retracting the prolapse, as well as providing pressure on the potentially hypertonic pelvic floor. So eat a high-fiber diet that results in large, soft, bulky stools that pass through the colon easily and expand the rectum nicely.

[jimmy80]

Ok. And why after the stool passing the burning starts? Because the prolapse come back? Is it possible to replicate the pressure on the hypertonic pelvic floor to ease the symptoms?

Hence I guess if the prolapse will be surgically (or with other methods) retracted I could potentially resolve.

But my doubt is that my symptoms started in 2016. In 2017 I was visited by two proctologists that didn't find anything.

Only in 2018 another proctologist diagnosed first grade hemorrhoids + excessive excursion of the perianal area during straining.

Then in 2019 the colonoscopy found nonspecific sigmoiditis and hemorrhoidal congestion.

Then in 2020 another proctologist found the rectal mucosal prolapse + hemorrhoidal congestion.

The same proctologist visited me again in 2022 and 2023 and confirmed both the times that the rectal mucosal prolapse and hemorrhoidal congestion still persist and suggest surgery to fix it.

Now. My biggest doubt is: if the prolapse + hemorrhoidal congestion is the main trigger that induce CPPS, why in 2017 wasn't found? My biggest fear is to undergo surgery, with all the pain which implies, only to discover in the end that it wasn't the reason, it was useless and I'm still on square one.

Any thoughts?

[webslave]

Bad hemorrhoids and a rectal prolapse are persistent (chronic) problems that should yield to surgical intervention, removing the likely cause of your symptoms and allowing you to recover over time. In your shoes, I would research the best surgeon in your area who is skilled in this sort of surgery, and then allow the problems to be repaired. I would opt for the perineal approach surgery. You are looking at a recurrence rate of only 16%, and since your prolapse seems to be mild, probably an even lower possible recurrence rate, meaning the surgery is a good option for you.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096348/

If your pelvic pain persists after this (unlikely in my view), you can tackle it separately, knowing it is only UCPPS and not having the added complications of a prolapse and congested hemorrhoids to confuse the picture.

[jimmy80]

Ok. Maybe I’ll consider a less invasive procedure like banding.

But how about in 2017 the fact two proctologist didn’t find prolapse and hemorrhoids neither? That’s my conundrum.

[webslave]

You've seen 4 different proctologists? Things change over time. Find one that has a good reputation (check reviews if possible) and if he confirms a prolapse and congested hemorrhoids, have them fixed. Get the obvious problems eliminated. That's a start.