Enterobiasis (Pinworm Infection): This is the most common parasitic infection in the United States, especially in children. The patient's symptom of feeling like worms are coming out of the anus is classic for pinworms, which typically migrate out of the anus at night to lay eggs, causing intense itching.

Anal Fissure or Fistula: These conditions can cause severe pain and discomfort, potentially leading to a sensation that could be misinterpreted as worms moving.
Hemorrhoids: Though not typically described as feeling like worms, severe cases can cause significant discomfort and a sensation of something protruding from the anus.
Pruritus Ani: A condition characterized by intense itching around the anus, which could lead to a mistaken belief that worms are present.

Invasive Colorectal Cancer: Though rare, a mass or lesion in the rectum could potentially cause a sensation that might be described as worms, especially if it involves the anal sphincter or perianal area.
Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause severe rectal symptoms, including pain, itching, and a sensation of something moving, due to inflammation and potential complications like fistulas.
Neurological Disorders: Certain neurological conditions, such as neuropathy or even psychiatric disorders, could lead to misinterpretation of sensations in the anal area.

Schistosomiasis: A parasitic infection that can involve the rectum and cause symptoms like rectal bleeding and pain, but it's rare in areas without recent travel to endemic regions.
Tapeworm Infection: Though less common than pinworms, other types of intestinal parasites like tapeworms could potentially cause similar symptoms, especially if they involve the rectum.
Ectopic Pregnancy in a Rectal or Perianal Location: Extremely rare, but could potentially cause unusual sensations in the anal area due to the abnormal location of the pregnancy.