At a glance
Most people with anal fissures have one — typically at the posterior midline (the back of the anus). Having more than one fissure simultaneously is less common but does occur. In most cases, it is not a cause for alarm, but certain patterns of multiple fissures may prompt further investigation.
This guide explains what multiple fissures may indicate, when they are straightforward, and when they warrant further assessment.
Typical patterns
Single posterior fissure
The most common presentation. A tear at the back of the anus, usually related to constipation, hard stools, or straining.
Anterior and posterior fissures
Having fissures at both the back and front of the anus is seen, particularly in women — especially after childbirth. The anterior position may be more vulnerable due to anatomical differences. This pattern is usually managed the same way as a single fissure.
Multiple fissures in atypical positions
Fissures that are not at the standard midline positions (posterior or anterior) — for example, lateral fissures, or multiple fissures around the circumference — may prompt your clinician to consider whether an underlying condition is contributing.
When investigation is warranted
Multiple fissures may prompt further assessment when:
- They are in unusual positions (not the standard posterior or anterior midline)
- They are accompanied by other symptoms — chronic diarrhoea, weight loss, abdominal pain, fatigue
- They do not respond to standard treatment
- There are other perianal findings — skin tags, abscesses, or fistulas alongside the fissures
- The presentation is atypical for the patient’s age or history
Conditions that may be investigated
- Crohn’s disease: can cause multiple, atypical fissures as part of perianal disease
- Infections: certain infections can cause perianal ulceration or fissuring
- Sexually transmitted infections: in some cases, perianal lesions may be related
- Dermatological conditions: skin conditions affecting the perianal area
Investigation does not mean something serious has been found — it means the pattern warrants a closer look to ensure appropriate treatment.
Treatment
Conservative management
For multiple fissures at typical positions, treatment is the same as for a single fissure:
- Stool softening through diet, hydration, and softeners
- Sitz baths after bowel movements
- Topical sphincter relaxants if prescribed
- Avoiding straining
If an underlying condition is found
Treatment shifts to include management of the underlying condition alongside fissure care. For example, Crohn’s-related fissures require medical management of the Crohn’s disease itself.
The practical message
Having more than one fissure is concerning but manageable. If both fissures are in typical positions and respond to standard treatment, the management is straightforward. If the pattern is atypical, investigation is a responsible next step — not a cause for panic, but a reason to ensure nothing is being missed.