The rate and pattern of rectal distension affect rectal distensibility, perception, and anal relaxation in health. Because rectal urgency is a prominent symptom in fecal incontinence (FI), we assessed rectal distensibility, contractions, perception, and anal pressures during barostatic distention of a highly compliant polyethylene rectal balloon in 21 healthy, asymptomatic women (age 61 ± 2 years, Mean ± SEM) and 51 women with FI (60 ± 2 years). The rectum was inflated and then deflated between 0 and 200 ml at 25, 50, and 100mL/min; a phase of sustained distention (SD), lasting 1 minute, separated inflation and deflation. The rectum was stiffer during rapid compared to slow rectal distention. This effect was more prominent at a lower volume (50 ml) and was also more pronounced in older subjects and in fecal incontinence. A rectal contractile response was observed not only during inflation, but also during SD and during deflation. During inflation, this contractile response was rate dependent in controls but not in FI. During rectal distention, the duration of perception, but not sensory thresholds was significantly longer in FI. However, the rate of distention did not affect rectal perception (i.e., sensory thresholds or duration of perception) during ramp distentions. Baseline anal pressures and the magnitude of anal relaxation during rectal distention were also reduced in FI. In addition to reduced rectal capacity and compliance, women with FI had an exaggerated rate-dependent reduction in rectal distensibility, lower sensory thresholds, and more prolonged perception, indicative of recto-anal dysfunctions.