A prospective randomized trial compared post-anal repair (n = 12), anterior levatorplasty (n = 12) and total pelvic floor repair (TPFR) (n = 12) for women with post-obstetric neuropathic faecal incontinence. Anal manometry and videoproctography were performed before and after operation. At 24 months, the quality of continence after TPFR was significantly better than for the other procedures tested. Anal sphincter pressures were not influenced by any of the operations. Only TPFR lengthened the anal canal, raised the pelvic floor and improved pelvic floor movements. These data suggest that TPFR is the best form of operation on the levator ani for women with neuropathic faecal incontinence.