Fecal continence and quality of life were evaluated by a questionnaire completed by 33 patients (mean age, 35 years; 25 males, 8 females) who had undergone anorectal reconstruction for a high or intermediate anorectal anomaly between 1946 and 1962. The malformation was classified as high in 30 cases and as intermediate in three. The primary reconstruction was abdominoperineal in 23 patients and direct perineal in 10. Ten patients had undergone secondary sphincter reconstructions. Fecal-continence was assessed by the scoring system described by Holschneider. Thirty-five healthy people with a similar age and sex distribution were used as controls. Only 6 patients (18%), including all three with an intermediate anomaly, had good fecal continence. None had completely normal bowel habits. Eighteen patients (54%) had a fair continence outcome. Seven patients (21%) had complete fecal incontinence. A permanent colostomy had been performed in two patients. Urinary incontinence was reported by 11 patients (33%). Ten patients (30%) had difficulties with sexual functions. Social problems related to defective continence were found in 28 patients (85%). All controls had good fecal continence; 80% had completely normal bowel habits. The authors conclude that most adults with high anorectal malformations who have undergone abdominoperineal or direct perineal repair suffer from severely defective fecal continence and have poor quality of life.