Continence is the controlled elimination of rectal contents. Problems with continence related to injury of the internal anal sphincter sometimes can be repaired. At the initial assessment, the cause of sphincter injury is determined. Any history of inflammatory bowel disease, malignancy, and irradiation is elicited. Preoperative assessment focuses on sphincter function, innervation, and the tissue to be used for repair. Sphincter repair involves division, mobilization, and suture re-approximation of the anterior internal sphincter/scar with a smaller diameter. For some patients, sphincter repair is not appropriate. Alternative operations in such cases include anal encirclement, posterior repair, artificial sphincter, muscle substitution, and fecal diversion.