OBJECTIVE: The purpose of this guideline is to provide recommendations regarding long-term management for women with obstetric anal sphincter injuries (OASIs) and to describe the role of dedicated clinics. This guideline also presents key components and new algorithms for counselling and shared decision-making regarding subsequent mode of delivery post-OASIs.
TARGET POPULATION: Women who have had prior obstetric anal sphincter injuries (OASIs).
BENEFITS, HARMS, AND COSTS: Timely access to appropriate care is essential to reducing the significant burden of stigma, emotional distress, and financial hardship associated with complications from obstetric anal sphincter injuries (OASIs). Dedicated follow-up clinics and access to pelvic health physiotherapy play a critical role in recovery and long-term outcomes. These services must be accessible to all women, regardless of geographic location. Women should receive clear and comprehensive information about the potential benefits of referral to specialized centers, including the possibility of better long-term prognosis when managed in these settings. Such knowledge is vital for informed decision-making around future care, including mode of delivery after an OASI. Given the current scarcity of specialized services in regional and remote areas, there is a pressing need to improve equitable access across all geographic settings. Innovative models of care, such as telehealth and local provider training, should be expanded to reduce disparities in outcomes; access to these essential referrals and services should not limited by economic barriers. As with any other medically indicated referral, the costs associated with travel, treatment, and follow-up should be covered to guarantee that all women, regardless of circumstance, can access the care they need.
EVIDENCE: Published studies were retrieved by searching PubMed, Ovid, MEDLINE, Embase, SCOPUS, and Cochrane Library databases from September 1, 2014 to July 1, 2025 using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIs, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to adult females and English- or French-language materials.
VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations).
INTENDED AUDIENCE: Obstetricians, urogynaecologists, family physicians, midwives, pelvic health physiotherapists, radiologists, colorectal surgeons, gastroenterologists, nurses, and learners.
SOCIAL MEDIA ABSTRACT: Updated Canadian guideline on long-term management of women with obstetric anal sphincter injuries (OASIs) with new algorithms for counselling regarding subsequent mode of delivery.
SUMMARY STATEMENTS: RECOMMENDATIONS.