Hi. Thanks for your query. Noted the history and understood your concerns. Blood with stools in an young adult can be due to the following reasons: Hemorrhoids commonly called as piles. Fissure in ano, a condition wherein you get a small tear at the anal verge while passing hard stool. Rarely polyp, Large rectal ulcers or so on. Since you have pain and something projecting, the cause can be either of the two or a combination of both. I would advise you the following in such a situation: Per-rectal digital examination and ano-proctoscopy by a General Surgeon to confirm the cause. Sitz bath in a tub with warm water. Laxatives to keep stool soft. Further management as per the cause thus found which may need a surgery is there are large piles.