Abstract Objectives To assess the prevalence of anal incontinence (AI) two years after diagnosis of obstetric anal sphincter rupture (OASR), relate the degree of AI to self-reported quality-of-life and identify possible risk factors for AI in this population. Design A cross-sectional study. Setting County of Västerbotten, Sweden. Population All women diagnosed with OASR following vaginal delivery according to the medical records. Methods Questionnaires targeting faecal incontinence and quality-of-life were sent to the women. A reminder was sent after one month. Continuous and categorical data were analysed using Pearson Chi-square and analysis of variance. Main Outcome measures Presence of AI >2 years after the diagnosis of OASR, and health-related quality-of-life (HRQoL). Results Of the cohort of women with OASR, 29.4 % suffered from severe or very severe AI >2 years after delivery. Level of AI was associated with reduced HRQoL, pain, fatigue, anxiety, negative body image, urinary incontinence, embarrassment, and dyspareunia. Induction of labour and BMI > 25 kg/m2 were identified as factors associated with less risk for AI after OASR. Conclusions The results presented clearly stress the need to improve techniques for the repair of OASR as well as careful follow-up of all women with this diagnosis. Psychological consequences and symptoms from the pelvic floor other than AI should be sought and attended.