It depends. If it’s been for years and is painless and there has been no change in the bowel motions recently, then it’s likely it’s the piles (or haemorrhoids in scientific jargon).

However, if the bleed is a recent phenomenon, is associated with pain and change in bowel motion, then it may be an indication of a sinister cause such as a tumour. One should get in touch with a gastro physician or a Gastrosurgeon for complete assessment.
Piles can nowadays be treated by minimally invasive technique such as laser or stapler technique that is almost  painless and is wound free.

Yes. This is most likely an anal fistula. The main reason for early treatment is because the fistula turns increasingly complex with time. The recurrent infection makes it develop branches and side branches like a tree. These complex fistula may then become more difficult to treat often leading to failures. Therefore, the results are best when treated early

Fear is very common in anal diseases. One should realise that pain during passage of stool should not be taken lightly. They may be a symptom of a tumor or a colitis (inflammatory bowel disease) that of course will benefit from early diagnosis and treatment. Secondly, certain diseases that cause anal pain  such as anal fissure are simple to treat either medically or surgically. Many procedures can now be performed incurring mild pain and decreased wound. The postoperative dressings are rarely required. Most patients are able to get back to work in 1-2 weeks.

A rectal cancer is nowadays treated first with radiotherapy and chemotherapy. More often than not it shrinks the tumour. If after this therapy the rectal cancer is at least 5 cm away from the point where the anus starts, then the patient may get away without a bag in the tummy (colostomy). This procedure is particularly facilitated with use of technology such as circular staplers snd laparoscopy.

This is most likely a rectal prolapse. This is usually seen in women with some perineal injury or weakness during childbirth. The treatment of this situation can be done through a laparoscopic technique whereby the rectum is fixed back to the bone behind (called sacrum). Post surgery the patient is trained to perform certain pelvic floor exercises to get the strength back.