In deep anal occlusion complete continence can nearly always be obtained by means of a perineal or sacroperineal operation. On the other hand, the results after reconstruction in case of high recto-anal agenesis are still doubtful. Placing the neorectum inside the junction of the levator ani muscles by the sacro-abdomino-perineal approach has improved the continence function. Manometric studies have shown that the organ of continence has to learn its function first, which may take months or even years. In cases of congenital motor or sensory defects, or iatrogenic lesions, at least partial normalization can be brought about by specific reconstructive operations.