Hi Ocularsinistra,
My understanding is that internal hems bleed, but are not painful, and external ones can be painful but don't usually bleed.
The bleeding sounds like a fissure to me, but I'm not a doctor. I think you should see a proper CRS, because I'm not sure a regular doctor could diagnose a fissure, even with an anuscope.
And I don't think the sigmoidoscopy would show a fissure. I know I specially asked them to look for a fissure when I had my colonoscopy, and they did not see it.
Signs of a fissure:
- BMs painful, sometimes like passing broken glass or gravel.
- Sometimes painful spasms, or a feeling of burning pain starting 30 mins- 1 hour after a BM and sometimes lasting several hours.
- A skin tag (called a sentinel pile) on the outside of the anus at the site of the fissure. Do a web image search for sentinel pile. Preferably NOT when you are at work or in a public place
- sometimes there is blood, but often there is not any blood.
It's great that you have controlled the pain and bleeding to some extent using stool softeners. You can also work on your diet, getting the right amount of fibre (enough but not too much), and drinking lots and lots of water. But if you have a fissure, the CRS can prescribe medicines that will help you heal faster.
Also, as you've probably read here, you can try sitz baths, or take whole-body baths to relax the anus and help heal it. Heat therapy in general is very good for fissures. Just don't overdo the heat, because it can irritate the area. A nice warmth is best.
Good luck and let us know how you get on.