Obstetric anal sphincter injuries (OASI) are the main risk factor for the development of postpartum anal incontinence (AI), which can persist over the long term. Almost all gynecological scientific societies of gynecologists recommend a follow-up visit for women sustaining an OASI in a dedicated perineal clinic, with access to anal testing such as ultrasound and anal manometry. The purpose of the follow-up visits is to assess recovery, check for correct scarring of any perineal tear, ask for urinary, anorectal, prolapse, and pain symptoms, assess sexual function, treat or prevent pelvic floor disorders, and provide advice about the most appropriate subsequent mode of delivery (MOD). Endoanal ultrasound (EAUS) should be offered at about 3 months after vaginal delivery to all women with a diagnosed OASI and those presenting high risk of obstetric pelvic floor trauma, which includes women after operative delivery, shoulder dystocia, or macrosomia. EAUS has a key role in the follow-up to assess the success of intrapartum primary repair, considering that under- and overdiagnosis exist, and the presence and severity of sonographic residual tears are prognostic factors for developing AI. If EAUS is not available, transperineal ultrasound (TPUS), which is cheaper and more accessible to gynecologists, could be used as a screening tool to identify sphincter complex abnormalities due to good test accuracy and to select which patients should be referred to an EAUS. Regarding symptoms of pelvic floor disorders or abnormal results in anal testing, women after OASI may benefit from physical therapy, for instance, supervised pelvic floor muscle exercises or manual therapy techniques for treating dyspareunia or other types of vulvovaginal pain. Ultrasound is also useful to advise on eventual subsequent pregnancies. Until the publication of an agreed-upon international OASI guideline, counseling about the MOD after OASIS should be based on symptoms, ultrasound, and anal manometry, together with estimated fetal weight and maternal age. With personalized information about risks, women should be able to autonomously decide the MOD that they would like to have, balancing between the risks associated with cesarean section against the risk of OASI recurrence or development of AI.