Based on the history and the photo, this is suggestive of a recurrent anal fissure with associated external hemorrhoidal skin tags/external hemorrhoids. The pain and bleeding occurring during passage of hard stools are more typical of an anal fissure. However, a definitive diagnosis requires an in-person anorectal examination.
Advice:
* Avoid constipation by maintaining a high-fiber diet, adequate fluid intake, and using a stool softener if required.
* Take warm sitz baths for 10–15 minutes, 2–3 times daily and after bowel movements.
* Avoid straining and prolonged sitting on the toilet.
* You may benefit from topical fissure therapy, after evaluation by a surgeon.
* Please consult a General Surgeon/Colorectal Surgeon for examination, as recurrent fissures or symptomatic hemorrhoids may require further treatment.
Next Steps
Seek urgent medical attention if you develop severe pain, increasing swelling, pus discharge, fever, or heavy bleeding.