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. © 2011 The International Urogynecological Association.