Taiko, a 53-year-old Japanese woman presents with an 18-month history of intermittent faecal incontinence. She has approximately three accidents/week. Physical activity often precipitates an episode, and she wears absorbent pads. Due to embarrassment, she has curtailed her social and professional activities. There is no history of rectal surgery and no neurologic symptoms. She has three dependent children: all uncomplicated vaginal deliveries. Taiko developed significant menopausal symptoms and has been on hormone replacement therapy for the last year. She has had a gradual increase in her weight to a current body mass index of 30 kgs/m2. She smokes 10-15 cigarettes a day.