INTRODUCTION AND HYPOTHESIS: The objective of this study was to determine the effect of external anal sphincter repair on fecal incontinence symptoms, quality of life, and anal sphincter squeeze pressures. METHODS: The fecal incontinence symptoms and impact on quality of life, patient satisfaction, and anorectal manometry were assessed pre- and post-operatively. RESULTS: One hundred four women were eligible and 74/104 (71%) returned post-operative questionnaires. Fifty-four of 74 (73%) had pre- and post-operative questionnaires. Twenty-five of 74 (34%) had pre- and post-operative anorectal manometry measures. Mean length of follow-up for participants (n = 54) was 32 +/- 19 months. Modified Manchester Health Questionnaire scores decreased from 47.3 +/- 21.9 to 28.4 +/- 24.3 (p < 0.01) and Fecal Incontinence Severity Index scores from 30.6 +/- 13.0 to 21.6 +/- 15.5 (p < 0.01). Seventy-seven percent of the participants was satisfied. Sphincter squeeze pressures increased from 53.4 +/- 25.0 to 71.8 +/- 29.1 mmHg (p < 0.01). CONCLUSIONS: External anal sphincter repair resulted in sustained improvements in fecal incontinence severity and quality of life along with improved anal sphincter squeeze pressures.