Yes Specific testing for diarrhea Yes Continue treatment Satisfactory? Yes Continue treatment Int J Colorectal Dis (2012) 27:931–937 wise. Attempts to repair, strengthen or replace the anal sphincter are not logical in the presence of a concomitant functional disorder. Four (10%) of the patients with a large sphincter defect, which means that they have an indication for surgery, had an RC ≤100 ml. Patients with an RC of less than 100 ml are at risk for FI and patients with an RC of less than 60 ml are all incontinent, even in the presence of normal sphincter pres- sures [24]. In the absence of proctitis, pouches and previous anorectal surgery, IBS is the cause of a relatively low RC. 935 Therefore, RC measurement is important to exclude IBS with a small RC in patients with FI before surgical intervention. Some patients have a dyssynergic pelvic floor and therefore have a disturbed coordination of their sphincters. These patients are unable to contract their pelvic floors when faeces arrive and some patients consequently become faecally incon- tinent. In 17 patients (8%), we found a non-relaxing pelvic floor, both on clinical examination and anorectal manometry. Anal manometry can be used to confirm the finding of a hypertonic pelvic floor with clinical examination. Clinical Faecal incontinence Diarrhea No High fibre diet, bulking agents Satisfactory? No Biofeedback Anal endosonography Defect of sphincter? Motivated for other treatments? No No No Yes Anorectal manometry Yes Sphincter repair Yes Anorectal manometry No Satisfactory? Eligible for sphincter repair? No Sacral nerve stimulation/ Rectal cleansing/ Gracilis plasty/ Artificial bowel sphincter Consider colostomy No Satisfactory? Fig. 1 Flow chart of evaluation of patients with faecal incontinence