It is the goal of this review to discuss the increasingly common problem of anorectal motility disorders and their potential surgical management. Perhaps the most important goal in patients with anorectal motility disorders is to categorize them accurately into etiologic groups. The reason is that approaches to medical and surgical therapy are highly dependent on accurate categorization of these patients with motility disorders. This review is written from the perspective of a surgical practice which sees a high volume of patients with anorectal motility disorders and has a very logical, nearly algorithmic approach to the evaluation and management of these patients. The review is not exhaustive, nor does it include all possible alternatives. It is meant to be a relatively practical guide to physicians and surgeons who deal with patients with anorectal motility disorders and is based on the experience of surgeons and gastroenterologists who see large numbers of these patients.