Q. I see bright red blood whenever I pass hard stools. Is anal fissure the cause?

Hi doctor,

I see blood in the stool or sometimes on the surface of the stool or in toilet paper, which is on and off. I do not have pain any longer, but I guess you can say I have a mild burning after passing significant fecal matter. I was wondering if anal fissures could repeat themselves whenever you pass thick stools. Everything started two years back when I had iron deficiency and other vitamin deficiencies. Passing stool while using iron supplements was a complete nightmare like my bum was burning like hell. And eventually, I started to see bright red blood on the toilet. When I went to the doctor, he said I had fissures. If I am having diarrhea or loose stools, I do not see any blood, though.

Once I dropped iron supplements, the pain seemed to go away, but whenever I pass a thick and solid stool, I see bright red blood on toilet paper or the stool's surface, with a minimal amount, though. I still have an itchy pain, but it is not stronger as I had two years back. That pain was unbearable. After stopping taking the supplements, the blood thing was on and off. I was seeing it two to three months later.

Now I started retaking iron supplements (I lack Ferritin, but my other levels are standard). They are not making me constipated, unlike my first iron supplements, but today, I passed thick, quite long stools, and I saw a small amount of bright red blood in toilet paper and on the surface of my stool.

So my question is, can anal fissures repeat themselves like that whenever I pass a hard one? Can they persist over the years by repeating themselves? If I go to the doctor, can he or she still see my anal fissures even if the symptoms are on and off?