A 6-year-old child, who was continent of stool for 2 years,…

A 6-year-old child, who was continent of stool for 2 years, is now having 3-5 incontinent episodes daily. Mom reports the stool to be diarrhea consistency. Occasionally he will sit on the toilet but defecation is very painful and the BM’s are small in size and ribbon like. What is your preliminary diagnosis for his fecal incontinence?