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Hemorrhoids would be my first guess. Why do you think internal hemorrhoids? Couldn't they be external?
We are not supposed to push hard when we go. Easier said than done.
You could have internal/external hemorrhoids or you might have cuffitis when causes blood sometimes and it shows on the TP. It also can cause anal irritation/itching/burning. I have chronic cuffitis and if I forget to use my suppositories for a while I am quickly reminded with burning pain and hard to pass BM's as everything is swollen up at the bottom of the pouch due to cuffitis. I really hope you just have hemorrhoids or better yet nothing wrong.
If you are needing to push I'd suggest you stop and figure out how to make your bowel movements smoother or more runny. That sounds like weird advice as we strive to get rid of runny poop.
I just hit hit a year after my surgery and I am in the same boat as you I think I'm going to bring this up to my doctor as well I had blood work done the other day and my white blood count was a little high so I'm starting to think this could be what is going on with me
