The most likely cause of anal twitching pain, consider spastic pain in the perianal sphincter, and the most likely conditions in which this spastic pain occurs are acute attacks of anal fissures. When an anal fissure occurs, the anal sphincter spasms and this twitch-like pain occurs. Consider perianal abscesses or fistulas. When perianal abscesses and fistulas occur, the pus stimulates the anal sphincter to spasm, which can lead to radiating pain in the anus. To diagnose perianal abscess and fistula, it is necessary to do perianal ultrasound, or local palpation of the anus for the presence of such red and swollen masses and hard nodules like cords. In addition, inflammatory bowel diseases such as proctitis, colitis, and sinusitis can be considered to cause anal pain. In addition, gynecological diseases such as pelvic inflammatory disease, pelvic effusion, and endometriosis can also cause anal twitch-like pain.