Anorectal pain is most often secondary to; Anal fissure, Perirectal abscess and/or fistula, Thrombosed hemorrhoid, Anal canal neoplasms, Perianal skin infection, Dermatologic conditions. Proctalgia fugax results from levator spasm and may present without any other anorectal findings. Physical examination is critical in evaluating patients with anorectal pain. If a patient is too tender to examine