When I saw the patient, she was continent at flatus and stool, and her main complaint was proc­talgia, a severe continuous dull pain that was slightly diminished in the prone position and exac­erbated by defecations. A discharging perianal wound was noted; at digital exploration, the pain increased upon digital pressure. At anal manome­try, resting tone was reduced and the rectal sensi­tivity threshold was increased, with the patient reporting pain at small-volume inflation of the rec­tal balloon. Her bowel habit was normal and she did not complain of abdominal pain. However, to exclude Crohn’s disease, we performed a colonoscopy. Both the large bowel and the termi­nal ileum had a normal appearance and the biop­sies were negative. At anal ultrasound, carried out with a rotating probe (she had never undergone this examination before), a distal defect of the internal sphincter was seen, together with a low intersphincteric abscess. A psychological consul­tation was carried out based on the known relation­ship between stress, immunodeficiency, and anal sepsis, indicating the need for a holistic approach in these cases. However, the patient exhibited only low degrees of anxiety and there had been no stressful event prior to disease onset. The only slightly questionable finding was the strong attach­ment of the mother, who was constantly present and seemed to be much more anxious than her daughter.