Background/Purpose: Anorectal incontinence (ARI) is a serious problem in patients operated for congenital anorectal 
malformations (ARM). The aim of this study was to evaluate the various diagnostic tools and therapeutic options for 
patients with ARI after primary repair of ARM. 
Material & Methods: Twenty-two patients (17 males & 5 females) were treated for various degrees of ARI after repair of 
congenital ARM. The initial surgical procedures used for repair of the ARM were: abdominoperineal pull through (n= 12), 
posterior sagittal anorectoplasty (PSARP) (n=8) and perineal approach (n=2). Templeton & Ditesheim fecal continence score was used to quantify the degree of ARI in both pre and post treatment periods. Detailed clinical assessment, radiological investigation and motility studies were used for selection of the treatment modality. 
Results: The ages of the 22 patients ranged from 4 to 19 years. The clinical and imaging studies revealed a sphincteric defect (N=8), anteriorly displaced anus (n=2), laterally displaced anus (n=2), rectal mucosal prolapse (n=3), contracted perineal scar (n=1), anal stenosis (n=1) and no apparent clinical abnormalities (n=5). Conservative treatment (enema program, biofeedback therapy, and self-perineal exercises) was applied initially for all patients. Satisfactory results were noted in 10 patients (45.5 %). Twelve patients (54.5%) required secondary surgical procedures for treatment of ARI after failure of the conservative treatment. These secondary surgical procedures included: relocation of anorectum through posterior sagittal approach (n=4), PSARP & sphincteroplasty (n=3), excision of prolapsed mucosa (n=3), and anoplasty (n=2). Two patients achieved complete continence following surgery, 4 had a significant improvement, 2 showed mild to moderate improvement and 4 had no improvement. The follow-up periods ranged from 6 to 30 months. 
Conclusions: 1. Conservative treatment should be tried initially in the majority of patients of ARI following repair of 
congenital ARM; 2. When properly selected, surgical treatment proved to be a viable option in the management of ARI 
following repair of congenital ARM particularly in patients with mislocated anorectum outside the muscle complex; 3. A less favorable postoperative functional result is expected in cases with significant damage and scarring of the levator and muscle complex.