Fecal incontinence (FI) in men is common yet data on gender differences in clinical features, physiology and treatment is scarce. Our aim was to provide insights into FI in males compared to females. Prospectively collected data from 73 men and 596 women with FI in a tertiary referral centre was analysed. Anorectal physiology, clinical characteristics and outcome of instrumented biofeedback (BF) was recorded. 31 men with FI proceeded to BF and were matched with 62 age-matched women with FI who underwent BF. Men with FI had higher resting, squeeze and cough anal sphincter pressures (P<0.001) and were more able to hold a sustained squeeze compared to women (p=0.04). Men with FI had higher rectal pressure and less inadequate rectal pressure on strain, and higher sensory thresholds (p<0.05). Men, but not women, with isolated soiling had higher anal resting and squeeze pressures compared to those with overt FI (p<0.05). Men were less likely to undergo BF when offered compared to women. Baseline symptom severity did not differ between the groups. In men, the absence of an organic cause for the FI and the presence of overt FI, but not isolated soiling, were correlated with improvement in patient satisfaction. The outcomes of 50% reduction in FI episodes, symptom and quality of life scores after BF all significantly improved in men similarly to women. We conclude that men, compared to women, with FI have unique clinical features and physiology and are less likely to have investigations and treatment despite successful outcome with BF.