<s>[INST] Hi doctor, For the past one month, I am having pain in my anus. It pains while throwing waste and even while sitting. There is a skin flap that has appeared at the end of the anus towards the outer side. There are two flaps one is more white in color and the other is reddish. It is not bleeding however, I am having pain. I am not taking any medication for that as I could not go and see a doctor and thought that it will be cured on its own. It actually started at the time of my period when my stomach got disturbed with hard stools. Please help. [/INST] Hi. The picture (attachment removed to protect patient identity) and the symptoms suggest you have an external pile mass. The pain is due to an underlying fissure, or simply a crack at the anal opening. These usually result from hard stools or constipation. You need to start on dietary measures aimed at making stools soft as well as stool softening medicines. Also, topical medicines to apply at the anal orifice will also help in relieving the acute pain. I hope this helps. </s>