Anorectal Problems
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þ Rectal Spasm
 - can occur from hemorrhoids, fissures, other problems
 - treatment options include local NTG paste, though anecdotal reports of
   hypotension and near-syncope
 - botulinus toxin being investigated

þ Supralevator abscess
 - may not be palpable on rectal; causes fever and pain, though.

þ Fissures
 - 80% posterior midline, 20% anterior midline, rarely elsewhere
 - inject lido at 9 and 3 o'clock and then do anoscopy
 - if elsewhere, refer for further evaluation