Intersphincteric abscess: This condition is the most likely diagnosis given the patient's symptoms of chronic anal discharge and the MRI findings showing a tract from 2 o'clock to 6 o'clock about 5 cm away from the anal orifice. Intersphincteric abscesses are characterized by their location between the internal and external anal sphincters, which can lead to the formation of a fistula if not properly treated.

Ischiorectal fistula: Although less likely than an intersphincteric abscess, an ischiorectal fistula could present with similar symptoms. The location described in the MRI could potentially be consistent with a fistula that has formed in the ischiorectal fossa.
Levator ani abscess: This condition involves an abscess formation in the levator ani muscle and could potentially cause chronic discharge if it communicates with the anal canal. However, it is less common and might not as directly explain the specific MRI findings.

Perineal abscess: While less likely given the specific location described in the MRI, a perineal abscess could potentially cause chronic discharge and should not be missed due to the risk of severe infection and potential for necrotizing fasciitis, a life-threatening condition.

Prolapse piles (hemorrhoids): Although prolapsed hemorrhoids can cause discomfort and discharge, they are less likely to be associated with the specific MRI findings of a tract from 2 o'clock to 6 o'clock about 5 cm away from the anal orifice. Hemorrhoids typically do not cause the formation of such tracts or abscesses.
Other rare conditions such as rectal duplication cysts or congenital anomalies could potentially present with similar symptoms but are much less common and would be considered only after ruling out more likely diagnoses.