Hi I appreciate your concern pain or bleeding during defecation , protrusion of anal mucosa through anal orifice that may slip back inside or may remain outside Constipation is a known causative factor for hemorrhoids The diagnosis can be ascertained after per rectal examination or proctoscopy In my opinion if you are having such problems please visit your surgeon immediately continue to have dietary fiber and lots of fluids liquid paraffin to avoid constipation and sitz bath twice daily are my advise to you Hope I have answered your query thanks for using health care magic have a nice day