Purpose of Review: To review up-to-date management of fecal incontinence in older women, highlighting age-related issues. Recent Findings: Fecal incontinence is highly prevalent in older women. The etiology is multifactorial; however, advanced age itself has been found to be an independent risk factor. Understanding age-related physiologic and anatomic changes and unique challenges in the geriatric population is critical in order to offer effective therapy. Evaluation should start with obtaining a thorough history and physical examination, and diagnostic tests should be reserved for refractory symptoms or specific conditions. Simple conservative approaches can be effective and should be offered without diagnostic testing. More treatment options have recently become available or are currently being investigated in an effort to provide higher long-term efficacy and safety. Summary: Treatment of fecal incontinence in older women can be challenging and often complicated by decreased health and functional status. Management should be individualized based on the patient’s health status, clinical setting (ambulatory versus institutionalized), preference, and goals of therapy.