Your symptoms are most consistent with chronic constipation associated with an anal fissure, possibly with a functional defecation disorder. The fact that you sometimes need to strain even when the stool is soft suggests that the problem may not be simply a lack of fibre or water.
Since this has been recurring for 4–5 years, I would recommend an in-person examination by a gastroenterologist/colorectal surgeon, including abdominal and anorectal examination. Depending on the findings, evaluation for causes such as pelvic-floor dysfunction, IBS-C, hypothyroidism, coeliac disease or other less common conditions may be considered.
The fresh-red bleeding after very hard stools is commonly seen with an anal fissure or piles, but recurrent rectal bleeding should not automatically be attributed to piles/fissure without examination.
Treatment usually involves maintaining consistently soft stools for several weeks to months, rather than taking medicines only when constipation becomes severe. A gradual return to normal physical activity is also advisable. You do not need to unnecessarily avoid eggs, chicken, paneer or other foods unless a particular food clearly triggers your symptoms.
Please seek urgent medical attention if you develop significant or persistent bleeding, black stools, unexplained weight loss, severe abdominal pain/distension, vomiting, fever, anemia, or a major change in bowel habits.
With the correct diagnosis and a structured long-term bowel regimen, this is usually manageable.”
NICE guidance also emphasizes assessment for underlying causes when constipation is persistent/intractable rather than repeatedly treating symptoms alone.
Next Steps
* Gastroenterology/colorectal consultation.
* Anorectal examination to confirm fissure vs hemorrhoids and assess sphincter/pelvic-floor function.
* Review medications/diet and bowel habits.
* Consider targeted blood tests (e.g., CBC,
TSH,
calcium, glucose; coeliac testing when appropriate) based on clinical assessment.
* Establish a long-term stool-softening regimen rather than intermittent treatment.
* Gradually restart exercise and avoid excessive dietary restriction.