Two possibilities are most often considered when there is a fleshy ball at the anal opening and it is more painful, one is thrombosed external hemorrhoids and the other is perianal abscess. Thrombosed external hemorrhoids are a relatively common clinical condition, mostly a mass at the anal opening but not large, which may bleed inside the external hemorrhoid after drinking alcohol, eating spicy and irritating foods, suddenly becoming larger and more dark purple in color, and more painful. Treatment can be conservative through internal medicine, such as warm water baths, applying hemorrhoid cream, oral painkillers, avoiding sedentary, avoiding dry stools; or through surgery, performing thrombosed external hemorrhoid debridement, post-operative treatment is the same as internal conservative treatment. Perianal abscess is an infection of the perianal skin or sinusitis that is not well controlled and forms an abscess, which manifests as a mass at the anal opening, the skin is generally red and swollen, and the pain is more intense, so surgery is recommended.