I'm not too sure.
I have had occasional bleeding for about 2-3 years with no pain which started on a low carb diet, never any pain at all or discomfort, I called it my perioids :p
Saw a doc about it, he didn't seem too concerned, prescribed me suppositories but I never took them, the bleeding very gradually got worse which looking back I think the spasming started happening aswell because I started getting constipated on occasion, until I started getting pain about 2 months ago with alot more blood and a sentinel pile, I thought it was a hemorhoid until I went to see a crs. Diag 3 hemorhoids 1 fissure.
So really unsure of when it happened.
Posting from phone.