Constipation with associated fecal incontinence can represent a devastating problem for all who suffer from it, often preventing a person from becoming socially accepted, which in turn can provoke serious psychological sequelae. In this review we focus on the surgical approach to constipation in its role as a contributor to fecal incontinence. In both children and adults constipation is a prevalent problem that mostly can be treated conservatively. Only, a select group requires surgery.