Patient in dorsal and lithotomy position. At 12 to 6 o´clock there is a big, livid node that the patient describes as spontaneously arised and extremely painful. This is an anal venous thrombosis. The most common cause for an anal venous thrombosis is chronic constipation, that due to long pressing leads to pressure increase in the anal veins and therefore to a thrombosis. The therapy for such a large finding consists of indexing of the finding and subsequent clearing out of the coagulum.