It looks like she has visible hemorrhoidal tissue with multiple skin tags or a partial mucosal prolapse with a throbosed external hemorrhoid
If there is pain at a single swelling seen in the picture it might be a thrombosed external hemorrhoid
If not she might be suffering from chronic fissure in ano.
Next Steps
she needs a physical exam by a surgeon and plan for surgery if needed depending on p.r findings
Health Tips
take plenty of fluids
diet changes with high fiber foods
use oint Smuth for local applic and pain relief
sitzbath regularly