Fecal incontinence (FI) is a distressing condition affecting a great number of patients. Itsetiology is often multifactorial and cannot always be determined despite anorectal physi-ology testing or anal sphincter imaging. Severity scores combined with quality-of-lifescores are useful to evaluate and compare treatment outcomes. Medical treatment toregulate bowel transit is helpful but other medications, such as topical perianal agents orantidepressants, have failed to demonstrate any efficacy. Biofeedback is widely used evenif its superiority over simple conservative treatment is not apparent in systematic reviews.A variety of injectable sphincter bulking agents have been proposed with modest results.The major advance in the treatment of FI is the advent of sacral nerve stimulation (sacralneuromodulation) supported by a growing body of solid evidence for short and midtermefficacy. Indications for sacral nerve stimulation are expanding continuously and in manycenters include patients with sphincter defects. This has raised a debate around the placeof sphincterplasty in the treatment of FI especially as long term follow-up studies showsignificantly declining success rates after 5-10 years. More complex reconstructive proce-dures, such as dynamic graciloplasty and artificial bowel sphincters are still valid optionsfor severe FI with non-negligible morbidity but good outcomes in expert centers andmotivated patients. This paper reviews the current status of the above-mentioned and othertreatment options for FI.