Question: Dear Dr. I am male 47. I have constipation from childhood and do lots of straining during bowel. I had first episode of fissure / piles and anal bleeding in 2001. Which got ok after a while. Again in 2007 I had severe painless bleeding during motion and this time my Dr did colonoscopy. Two tiny non malignant polyps were removed (biopsy was done). Rest was ok. Post that I had anal bleeding very rarely that is once or twice a year mostly due to straining. However in 2014 I again had an episode of intermittent painless bleeding for a period of 15-20 days. I did sitz bath and applied anovate cream and it got ok after a while. Now after about one year in last 15 days again I'm facing same symptom. Intermittently in 3-4 days I suddenly have an urge of bowel and I pass blood (fresh, red). It's not always and even in a day twice I'll pass the motion ok but usually in the evening I'll have an urge and pass blood then. It's painless but after passing blood the anus itches and have a wobbly feeling for some time. I am worried whether it's still piles/fissure or something more serious. There's no other changes in appetite or otherwise. No pain etc. Please advise.

So are you saying that it has to be diagnosed for internal piles which is a possibility and if internal piles is not there other reasons to be checked thru colonoscopy?