The most severe form of childbirth trauma is a fourth degree laceration which can result in a cloacal like defect. A 39 year old woman was evaluated for severe fecal incontinence (CCF Incontinence Score 20). Fifteen years prior to presentation, she sustained a fourth degree laceration following the delivery of her third child. Immediate repair failed and she was left with a cloacal like defect. Ultrasound revealed a 180 degrees anterior defect. The patient underwent perineal reconstruction of her traumatic cloaca in the prone jacknife position. Pre-operatively she underwent an oral bowel preparation and received intravenous antibiotics. The dissection was carried through the rectovaginal septum and ischiorectal fossae. The anterior rectal wall with the internal sphincter muscles were imbricated and anterior levatorplasty with overlapping external sphincteroplasty were performed. An endorectal flap was advanced to cover the rectal side. The skin was partially closed to allow for drainage. Three months post-operatively the patient had complete healing with resolution of her fecal incontinence. Perineal reconstruction of traumatic cloaca can be successful with good functional outcome.