lot of changes are expected in these 4 years since your MRI, (plus very few pics to comment on them)
IF the pain has increased please get a consultation.
At the age of 27 you need not compulsory use western toilets. But they are good in long run for your back and your knees.
Live a normal life.
Do physiotherapy
Next Steps
Excersice
Lots of fluids daily
Health Tips
Avoid bending forward
Avoid lifting heavy weight