A full history and physical examination in the office by a board-certified colon and rectal surgeon is the first significant step towards determining the cause of obstructed defecation and/or fecal incontinence. Based on the office visit, further studies, including anal ultrasound, anal manometry, pudendal nerve terminal motor latency, defecography, dynamic MRI and/ or colonoscopy, may be ordered. These studies will help the physician determine the causes of obstructed defecation and fecal incontinence and therefore what the optimal treatment plan may be. It is not unusual for there to be more than one contributing cause to pelvic floor dysfunction. This is also true for fecal incontinence.