Urinary incontinence (UI), the involuntary loss of urine, has a significant psychological, social, and economic impact on quality of life. While not an inevitable part of aging, UI is much more prevalent in older adults and particularly so in those who require assistance with activities of daily living. Patients may be reluctant to discuss UI given the associated stigma and should be asked about it during medical visits. Evaluation begins with a detailed history of the nature, severity, and burden of UI. Maintaining continence requires a complex interaction of cholinergic, adrenergic, and somatic control. A careful, directed physical exam that focuses on the abdomen, urogenital area, perineal skin, mobility, strength, reflexes, and sensation should be performed. An initial evaluation should include a urinalysis and, if renal function or polyuria is expected, blood tests for creatinine, blood urea nitrogen, glucose, and calcium. Major types of UI include urgency, stress, mixed (stress and urgency combined), and overflow UI. Absorbent products can be a useful adjunct to formal health care for helping manage leakage. Treatment modalities for UI include behavioral strategies, medication treatment, and minimally invasive procedures and surgical approaches. Older adults can have symptomatic improvements, or even cure, for this important clinical problem.