Abstract Fecal incontinence is a particularly vexing problem leading to a disruption in lifestyle and social embarrassment for those who suffer from it. Prevalence rates may be higher than reported, as patients are often reluctant to seek treatment. Furthermore, the traditional treatments of medical management, biofeedback, and surgical repair of sphincter muscle defects have only a limited utility for some patients. Innovative therapies being developed and tested may contribute substantially to the traditional treatment armamentarium. After reviewing traditional management, this chapter focuses on novel pharmacologic options and new advances in surgical treatment including encirclement procedures such as the artificial bowel sphincter and neuromodulation using sacral nerve stimulation. © 2003 Elsevier Inc. All rights reserved.