Fecal incontinence is a physical and social disability that can profoundly impact a person’s quality of life. Unfortunately, the degree of its widespread impact is unknown. It is thought that the true incidence is vastly under-reported. Early reports cite rates of 2% of all comers in the USA, but more recent studies cite rates of ~11%–15.2% in patients over 65 years and up to ~20%–46% in institutionalized patients (1,2). Fecal incontinence is broadly defined as the involuntary loss of rectal contents (solid or liquid stool as well as flatus) through the anus. Though there are potential health consequences of fecal incontinence such as urinary tract infections and decubitus ulcers, the most costly consequence is the effect it has on quality of life. Many patients suffer significant shame and dramatically alter their lifestyles due to fear of inadvertent fecal soilage. A large study of over 5000 women demonstrated that, among women who suffer from fecal incontinence, 40% suffer severe symptoms impacting their quality of life, and less than a third of these women seek medical care for their bowel leakage (3,4). In this chapter, we will explore the etiology, anatomy, work-up, and treatment options of patients who suffer from fecal incontinence.