A 22-year-old woman with longstanding constipation has severe ano-rectal pain on defecation. Rectal examination is impossible due to pain and spasm

[Kathryn]

#july2020mccqe1

A 22-year-old woman with longstanding constipation has severe ano-rectal pain on defecation. Rectal examination is impossible due to pain and spasm. What is the most likely diagnosis?
(A) Anal hematoma
(B) Anal fissure
(C) Anal abscess
(D) Protalgia fugax
(E) Hemorrhoids