Although the prevalence of fecal incontinence is greater in women compared with men and in elderly subjects compared with younger subjects, data regarding the influence of age and sex on anorectal performance in continent and incontinent patients are conflicting. The authors, therefore, investigated age-and gender-related changes in anal resting and squeeze pressure as well as in sphincter relaxation after rectal balloon distention in 75 patients with fecal incontinence of different pathogenesis and in 99 continent patients by multichannel anorectal manometry. As a group, incontinent patients usually exhibit lower pressure profiles than do continent patients regardless of age and gender; however, both the resting pressure of the internal anal sphincter and the voluntary contractile pressure of the external anal sphincter are decreased with age, and both are lowered in women compared with men. Sphincter relaxation and perception of gastrointestinal events are not altered in incontinent patients, and they are not different between men and women or between elderly and younger patients.