26th April 2024

A 30-year-old man presents with a 3-month history of severe pain during and following bowel movements, described as a sharp, tearing sensation.

A 30-year-old man presents with a 3-month history of severe pain during and following bowel movements, described as a sharp, tearing sensation. He reports occasional bright red blood on the toilet paper but no alteration in bowel habits. He has been reluctant to defecate due to the pain, which he says lasts for several hours after passing stool. His medical history is unremarkable, and he takes no regular medications. On examination, there is no abdominal tenderness, but a digital rectal examination is extremely painful for the patient.

Investigations:

Stool guaiac test: Positive for occult blood

Which is the most likely diagnosis?