Patients tend to present with complaints of pas­sage of atus or stool through the vagina. Chronic vaginal infection, foul smelling vaginal discharge, and dyspareunia may also be reported. These symptoms tend to be magnied with loose stool or diarrhea. Fecal incontinence may be experienced, as anal sphincter injuries are uniquely associ­ated with obstetric trauma and other causes of RVF formation. While recognized obstetric anal sphincter injuries have been reported in 4–6% of all vaginal deliveries, it is estimated that occult sphincter injury occurs in up to 28% of patients following a normal vaginal delivery [21, 22]. In a series by Yee and colleagues, anal sphincter injury was noted in 92% of patients undergoing surgical repair for RVF.A thorough history should be elic­ited, focusing on symptoms, bowel habits, quality of life, and possible etiologies for RVF formation. A detailed obstetric history is important, making note of complicated deliveries such as forceps or vacuum assisted delivery or the presence of shoul­der dystocia. Prior anorectal surgery, as well as, a history of malignancy, radiation therapy, and IBD should be investigated.