Fecal incontinence due to anal sphincter disruption is a relatively common process affecting 2% of the population. While non imaging modalities have been utilized in the past, the recent development of endoanal ultrasound to evaluate the integrity of the anal sphincter is now becoming more commonly employed. Disruption of the sphincter using endoanal ultrasound techniques is accurately diagnosed in a high percentage of patients. In many instances, endoanal ultrasound has replaced or is used as an adjunct to non imaging techniques. This article discusses the clinical and imaging characteristics of fecal incontinence due to anal sphincter disruption.