1st April 2022

A 43-year-old man presents to the GP with a 2 week history of painful defecation

A 43-year-old man presents to the GP with a 2 week history of painful defecation. He eats a very low fibre diet and has a sedentary lifestyle. He has no history of weight loss, tenesmus or change in bowel habit. External inspection of the anus is unremarkable. digital rectal examination is very painful and reveals only a small amount of fresh blood on the glove. 

Given the most likely diagnosis, what is the most likely underlying cause?

Select the SINGLE most appropriate option from the list below. Select ONE option only.