Core tip: Fecal incontinence is frequent, under-reported, and lacks a perfect treatment solution. Fecal control is not equivalent to normal sphincter muscles. Other factors such (e.g., stool consistency, rectal reservoir function and elasticity are equally important. Incontinence is rather a symptom than a diagnosis, representing the common final pathway of various etiologies. Measurement of fecal incontinence remains subjective and based on patient reporting. Successful incontinence management combines a thorough understanding of contributing factors, workup and interpretation of individual results, tailoring of individual treatment plan. New technologies are abundant but not indicated for all patients, and objective results often less strong than advertised.