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Urinary incontinence affects between 13 and 17 million men and women in the United States, with an annual cost exceeding $26 billion. Overactive urinary bladder can be both neurologic (hyperreflexia) and nonneurologic (detrusor instability). The spontaneous involuntary detrusor contractions that occur with the overactive bladder often lead to urinary incontinence. Symptoms vary from patient to patient, with urgency, increased frequency, and urinary urge incontinence being the most bothersome complaints. Multiple components and interactions of the nervous system are required for appropriate storage and evacuation function of the bladder to occur normally. Thorough history taking and physical examination along with appropriate urodynamic testing are necessary for obtaining an accurate diagnosis and treatment planning. The quality of life for many patients with overactive bladder and the resulting incontinence can be dismal. Fortunately, most of these patients can be treated successfully.