An Obstetrical traumatic cloacal defect can lead to long-term pelvic floor dysfunction if unrecognized or inadequately managed. Cloacal-perineal defects represent a severe sequela, characterized by disruption of the anal sphincter complex, loss of the perineal body, and distal rectovaginal septum[1]. Incidence is 0.003%. These present with fecal incontinence, perineal pain, recurrent urine infections, and sexual dysfunction, significantly affecting quality of life and posing serious psychological and social consequences to the individual.[2,3]
. This case highlights a delayed presentation of an acquired cloacal defect with predominantly liquid fecal incontinence.

This case report describes a 61-year-old P3L3 woman with prior home deliveries and an untreated perineal tear. She presented with ~10–12 years of anal incontinence and fecal incontinence for liquid stool, specifically triggered by intake of green gram sprouts, resulting in 3–4 episodes of loose stools per day and necessitating diaper use. No incontinence for formed/solid stool. Bristol stool score - 6 to 7. Wexner score 12.
Work-up included dietary assessment, stool studies, colonoscopy, and pelvic floor distress inventory. Endo anal ultrasound revealed external sphincter defect from 10- 2  O'clock. Internal sphincter normal. No malignancy/colitis.
Examination revealed absence of rectovaginal mucosa up to 2.5 cm from muco-cutaneous verge, Perineal body absent. No palpable external sphincter anteriorly
 A multimodal management plan was adopted: dietary modification and stool regulation, followed by definitive surgical repair (anal sphincteroplasty, perineal body reconstruction, levatoroplasty) and postoperative pelvic floor rehabilitation with biofeedback.

An inverted-U incision was made on the cloacal margin.
Endopelvic fascia dissected from vaginal mucosa, and internal anal sphincter was identified
The retracted ends of the external anal sphincter were identified.
Levator ani identified
Anal mucosa freshened and sutured with 2-0 vicryl suture
Internal anal sphincter plicated in the midline with 3-0 pds
End-to-end sphincteroplasty with 3-0 pds
Levateroplasty with3-0 pds
The perineal body reconstructed sututring bulbocavernosus and superficial transverse perinei.
Vaginal mucosa and skin was closed.
A perineal body of 3cm was achieved.

 At 12-month follow-up, liquid fecal incontinence reduced from 3-4/day to approximately 5 episodes in a month. Diaper dependence eliminated. The Wexner score improved from 12 preoperatively to 4 postoperatively. Patient-reported outcome (PGI-I) was 1, indicating significant subjective improvement

Obstetric traumatic cloacal defect may present late, often with liquid stool incontinence exacerbated by dietary triggers. This case underscores the importance of identifying specific dietary triggers, along-side addressing structural defects. Optimal outcomes are achieved through a combined approach of anatomical reconstruction, stool consistency management, and pelvic floor rehabilitation. Even in long-standing cases, significant functional recovery and improvement in quality-of-life,  are achievable.

Herand Abcarian, Charles P. Orsay, Russell K. Pearl, Richard L. Nelson, Susan C. Briley. Traumatic cloaca. Dis Colon Rectum 1989; 32:783-7.
Venkatesh KS, Ramanujam P. Surgical treatment of traumatic cloaca. Dis Colon Rectum 1996; 39: 811-6.
Kaiser AM. Cloaca-like deformity with faecal incontinence after severe obstetric injury--technique and functional outcome of ano-vaginal and perineal reconstruction with X-flaps and sphincteroplasty. Colorectal Dis. 2008 Oct;10(8):827-32. doi: 10.1111/j.1463-1318.2007.01440.x. Epub 2008 Jan 16. PMID: 18205849

Continence 19S (2026) 102594
DOI: 10.1016/j.cont.2026.102594