<p>Two mechanisms underlie the development of fecal incontinence (FI), which poses a significant autonomic burden among individuals with neurological disease: neurogenic FI, in which neural lesions innervate the bowel/sphincter, and functional FI, without such lesions but occurring secondarily to cognitive decline and/or immobility. Both neurogenic FI and functional FI hinder a person’s toiletings. Neurogenic FI is further divided into two mechanisms: overflow FI due to neurogenic constipation, which is common in older individuals, and sphincter FI caused by neurogenic sphincter weakness due to a lesion in the sacral Onuf’s nucleus or its periphery, which is rare among older individuals. This paper reviews (i) autonomic (bowel) and somatic (sphincter) innervation and how to assess them, (ii) geriatric brain diseases and cognitive/gait functions relevant to toileting and how to assess them, and (iii) the management of patients with FI. The current treatments for FI not only maximize patients’ quality of life but they also help patients avoid gastrointestinal emergencies, as FI is commonly associated with severe constipation. Collaborations between neurologists and gastroenterologists are recommended to achieve the optimal outcomes for individuals with FI.</p>