Inclusion Criteria:

1. Female patients with a history of obstetric anal sphincter injury and are:

   a) At least 6 weeks postpartum

2. Either able to speak, read and write in English, or has a professional interpreter present at the time of appointment.

3. Capable of understanding and signing the informed consent form after full discussion of the investigations and its risks and benefits.

4. Able and willing to complete the St Mark's Score, ICIQ-UI SF and other trial related questionnaires, comply with scheduled clinic visits and manometry studies.

Exclusion Criteria:

1. Existing anal pain precluding anorectal examination
2. Neurological conditions such as stroke, multiple sclerosis, spinal cord injury or Parkinson's disease
3. Age <18 years old
4. Currently pregnant -