Hi and welcome to Healthcaremagic. Thank you for your query. I am Dr. Rommstein and I will try to help you as much as I can. The cause is probably stone in main bile duct and it then causes liver to swell due to bile accumulation proximal to the obstruction. She must do ERCP to extract stones or surgery i this is unsuccessful. It should not be delayed. There are sevral possible causes and in most cases it is benign and caused by anal fissure, hemorrhoids or polyps. During straining and hard stool passing, anal mucosa is irritated and damaged and may bleed easily. You should use stool softeneres, sitz baths and change dietary habits. If there wont be improvement, you should see proctologist to verify exact diagnosis. In some cases, colonoscopy is required as well. I hope I have answered you query. If you have any further questions you can contact us. Kindly regards. Wish you a good health.