Fecal incontinence is a multifactorial disorder that is often poorly understood and treated primarily by practicing physicians. Fecal impaction with overflow incontinence can be identified by patient history and physical examination and can be appropriately treated. For the remaining patients, diarrhea is a common aggravating factor that is frequently modulated by dietary changes, antidiarrheal agents, and occasionally by bile salt binders. When patients do not respond to conservative therapy, diagnostic studies to evaluate anorectal continence mechanisms are very helpful. Available therapies include biofeedback and pelvic floor retraining, surgery, and in the future, sacral nerve stimulation in carefully selected patients.