Background & Aims: The epidemiology of fecal incontinence (FI) is incompletely understood. We report the pre- valence, clinical spectrum, health care- seeking behavior, and quality of life (QOL) in community women with FI. Methods: A questionnaire was mailed to an age- stratified random sample of 5300 Olmsted County, Minnesota, women identified by the Rochester Epidemiology Project. Symptom severity was assessed by a validated scale, and impact on QOL was evaluated for subjects who had any FI during the past year. The prevalence of FI was calculated with direct age adjustment to the 2000 US white female population. Results: Altogether, 2800 of 5300 women (53% ) responded to the survey. The overall age- adjusted prevalence of FI in the past year was 12.1 per 100 (95% confidence interval, 11.0- 13.1). The prevalence increased with age from 7 (third decade) to 22 (sixth decade) per 100 and was steady thereafter. Symptoms were mild (45% ), moderate (50% ), or severe (5% ), and symptom severity was related to the impact of FI on QOL and physician- consulting behavior. Moderate to severe impact on < 1 domain of QOL was reported by 6% with mild, 35% with moderate, and 82% with severe symptoms, whereas 5% with mild, 10% with moderate, and 48% with severe FI had consulted a physician for FI in the past year. Conclusions: More than 1 of 10 adult women in the population have FI; almost 1 of 15 have moderate to severe FI. FI significantly impacts QOL and prompts health care utilization predominantly in women with moderate to severe symptoms. Background & Aims: The epidemiology of fecal incontinence (FI) is incompletely understood. We report the pre- valence, clinical spectrum, health care-seeking behavior, and quality of life (QOL) in community women with FI. Methods: A questionnaire was Mailed to an age-stratified random sample of 5300 Olmsted County, Minnesota, women identified by the Rochester Epidemiology Project. Symptom severity was assessed by a validated scale, and impact on QOL was evaluated for subjects who had any FI during the past year. The prevalence of FI was calculated with direct age adjustment to the 2000 US white female population. Results: Altogether, 2800 of 5300 women (53%) responded to the survey. The overall age-adjusted prevalence of FI in the past year was 12.1 per 100 (95% confidence interval, 11.0-13.1). The prevalence increased with age from 7 (third decade) to 22 (6 decade) per 100 and was steady thereafter. Symptoms were mild (45%), moderate severe (5%), and symptom seve rity was related to the impact of FI on QOL and physician-consulting behavior. Moderate to severe impact on <1 domain of QOL was reported by 6% with mild, 35% with moderate, and 82% with severe symptoms, while 5% with mild, 10% with moderate, and 48% with severe FI had consulted a physician for FI in the past year. Conclusions: More than 1 of 10 adult women in the population have FI; almost 1 of 15 have moderate to severe FI. FI significantly impacts QOL and prompts health care utilization predominantly in women with moderate to severe symptoms.