Trouble when passing stools at nine months old

Patient : I have 9 month old boy,girl twins. My girl has always had trouble when passing stools. She is not constipated as she goes everyday but she screams and cries, goes bright red and has to push really hard. She is on nutrimagen milk due to possible cma. I have cut banana, weetabix and anything else that I think could cause a problem out of her diet. She has pears daily and squash or diluted orange juice to try to help. She has had softener and laxatives, none of which help and occasionally she has a tiny bit of blood.
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