Is it normal to have more than one fissure?

Having a single fissure is most common, typically at the posterior midline (the back). A second fissure at the anterior midline (the front) is also seen and may be more common in women, particularly after childbirth. Multiple fissures in unusual positions may prompt investigation for underlying conditions.

Do multiple fissures mean something more serious?

Not necessarily. Having two fissures at typical locations is not unusual. However, multiple fissures — especially in atypical positions (lateral, or off the midline) — can sometimes be associated with conditions like Crohn's disease, infections, or other inflammatory processes. Your clinician will assess whether further investigation is appropriate.

Are multiple fissures treated differently?

The basic treatment approach is the same — stool softening, sitz baths, and topical treatments. However, if the pattern suggests an underlying condition, investigation and treatment of that condition becomes part of the management plan.

Can multiple fissures heal at the same time?

Yes. If the underlying causes are addressed (soft stools, reduced straining, sphincter relaxation), multiple fissures can heal alongside each other. The healing timeline may be similar to a single fissure, though some people describe a slightly longer process.

Multiple anal fissures at the same time

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.