The etiology of fecal incontinence is multifactorial and can be broadly divided into traumatic events, neurogenic causes congenital malformations, intestinal causes and others. A more comprehensive list of potential causes of fecal incontinence is listed in Table 18.2 [14–16]. Traumatic damage to the nerves, muscles, and/or blood supply of the rectum and continence mechanism from childbirth, forceps injury, accidental trauma, surgery or radiation may lead to fecal incontinence. Obstetrical injury is the most common cause of fecal incontinence in women and may be the result of injury to nerves and/or muscle that may occur during vaginal delivery, from an episiotomy, a third- or fourth-degree laceration, or an occult injury to the sphincteric complex. This may directly lead to fecal incontinence after delivery or may be a contributing factor to fecal incontinence later in life. Studies have shown that sphincteric defects and/or incompetence may be persistent after a perineal repair despite what was thought to be an adequate repair. Additionally, prolonged compression of the pudendal nerve during delivery may result in permanent nerve injury, which can contribute to both fecal and urinary incontinence [15, 16]. Pelvic radiation, which may compromise rectal compliance through tissue damage and fibrosis, is another form of trauma, leading to fecal incontinence. Similar to bladder physiology, rectal compliance refers to the ability of the rectum to distend while intraluminal pressures remain low. A decrease in rectal compliance can lead to urgency and fecal incontinence [17]. Similarly, a loss of rectal capacity, measured by the amount of material that can be successfully and comfortably stored in the rectum, can lead to fecal incontinence by allowing the rectum to be overwhelmed by severe diarrhea or fecal impaction. The etiology of a patient’s fecal incontinence should be determined in order to discern if the incontinence is reversible or treatable.