Introduction and Hypothesis <p>Obstetric anal sphincter injuries (OASI) are the main risk factor for postpartum anal incontinence (AI). All major scientific societies recommend follow-up in a perineal clinic to assess recovery and scarring, treat or prevent symptoms, and give advice about the subsequent mode of delivery.</p> Methods <p>This narrative review was conducted through a systematic search of the relevant literature with the aim of exploring the role of ultrasound in the follow-up of patients with OASI. The databases searched included PubMed, Scopus, and Web of Science, using keywords such as “obstetric anal sphincter injuries,” “anal incontinence,” “endoanal ultrasound,” “perineal pelvic floor ultrasound,” “perineal clinic,” and “mode of delivery.” The search was limited to articles published in English up to December 2024, and included original research articles, reviews, and clinical guidelines. Data extraction was performed independently by two reviewers.</p> Results <p>A pelvic floor ultrasound (PFUS), including the anal sphincter complex, should be performed after vaginal delivery in all women with OASI and those at high risk of obstetric pelvic floor trauma. PFUS plays a key role in assessing the success of primary intrapartum repair. Endoanal ultrasound (EAUS) is considered the gold standard; however, perineal or endovaginal approaches may be used as an alternative to identify sphincter complex abnormalities due to good testing accuracy and to determine which patients require further in-depth assessment with EAUS. The presence and severity of residual defects detected by PFUS are prognostic factors to determine optimal therapeutic management. PFUS is also useful in counseling patients regarding subsequent pregnancies, together with symptom assessment and patient preferences.</p> Conclusions <p>In patients with OASI, PFUS is useful for evaluating primary repair of OASI and guiding therapeutic management and subsequent pregnancies.</p>