“…In acquired cases of IPP, constipation, diarrhea, fistulas, and anal fissures have been hypothesized to play a role, as has the mechanical irritation caused by wiping after defecation (1,4). In our patients a past history of constipation, a condition not uncommon among young children, was present in six cases and an anal fissure was present in three cases, associated in two patients with constipation and as an isolated finding in one patient.…”