Hi, I have gone through your medical history carefully and understood your concern. Constipation is the key factor in causing you to have pain at the beginning and end of bowel movement. Once you regulate the function of your bowels, you won t have such problems again. The most important thing is not to delay the time of passing the stool once you get the feeling. This will prevent the stool become harder due to increased absorption of water and long staying in your colon . In this way, the first part of stool will be softer and won t cause pain. What you eat also matters. Have more fiber rich foods and increase water intake. Psyllium or prunes fiber supplements can help together with gentle laxatives like senna and lactulose. Hope this helps. Dr. Albana