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The idea that involuntary contraction of the internal anal sphincter is the primary mechanism of continence and that the external anal sphincter supports continence only by voluntary contraction is outdated. Other mechanisms have come to the forefront, and they have significantly changed viewpoints on the mechanisms of continence and incontinence. For instance, involuntary contractions of the external anal sphincter, the puborectal muscle, and the sphincter of O\u2019Beirne have been proven to play a role in fecal continence. Also, retrograde propagating cyclic motor patterns in the sigmoid and rectum promote retrograde transit to prevent the continuous flow of content into the anal canal. With this review, we aim to give an overview of primary and secondary mechanisms controlling fecal continence and evaluate the strength of evidence.<\/jats:p>","DOI":"10.1152\/ajpgi.00313.2021","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T22:10:46Z","timestamp":1666735846000},"page":"G1-G9","update-policy":"https:\/\/doi.org\/10.1152\/aps-crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Novel insights into physiological mechanisms underlying fecal continence"],"prefix":"10.1152","volume":"324","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3094-1090","authenticated-orcid":false,"given":"Monika","family":"Trzpis","sequence":"first","affiliation":[{"name":"Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center, Groningen, The 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