I am sorry to hear that you are one of the people with the severe inner
rectal pain. I had this problem so I know it well. I felt like I was passing shards of glass.
It took me a bit to figure out a way to pretty much prevent it. When it first started I was afraid to take too much Loperimide for fear of getting constipated. However, what I eventually discovered was that I had to keep the stools firm, not hard like a rock, but quite firm, solid.