A posterior sagittal anorectoplasty (Pena Procedure) was performed on a 27 year old female with congenital imperforate anus and arectoperineal fistula. The patient underwent anoplasty at birth but developed complete incontinence after subsequent vaginal childbirth. This video highlights the technical aspects of the procedure, which is rarely performed on adults. Pre- and postoperative defecograms demonstrate anatomic and physiologic correction. An 18-month postoperative patient interview is included.