Fecal incontinence is a common problem, particularly for the elderly, that can have a number of negative social and medical consequences. Correct diagnosis will show its cause in many cases. Basic diagnosis calls for anamnesis, digital examination, and proctoscopy. Special diagnostic tools include anorectal manometry, endosonography, and EMG of the external anal sphincter muscle. Using correct algorithms, the degree of incontinence can be reduced or the continence even restored. Conservative treatment involves hygiene, medical therapy, and personal training such as pelvic floor exercises, biofeedback, and electrostimulation. The surgical options range from repair operations such as sphincteroplasty to sacral nerve stimulation, dynamic graciloplasty, and implantation of an artificial sphincter. Which treatment to select — conservative or radical — depends on the pathophysiology of the disturbance and the patient’s cognitive state and possible comorbidities.