In patients with urinary incontinence secondary to neurogenic detrusor overactivity (NDO) and/or low compliance, treatment is aimed primarily at reducing detrusor pressure and avoiding urinary tract complications. Muscarinic receptor antagonists (MRA) are the main oral drug treatment to control NDO and achieve urinary continence. Despite their clinical and urodynamic efficacy, side effects and a patient’s expectations may influence treatment choice. Indeed, one of the most undesirable MRA adverse events is urinary retention. Although beta3 adrenergics have no negative effects on the voiding phase, their benefits on NDO are still unclear. Alpha-blockers can be considered to favor micturition, reducing bladder outlet resistance. Bladder emptying methods should be reserved for highly selected patients because of the risk of kidney damage. When urinary incontinence cannot be cured, social continence must always be ensured, preferably, by using external appliances to avoid the risk of skin maceration and bedsores. Behavioral and lifestyle interventions can help to promote continence and obviate bladder overdistension which may compromise the ability to void. Pelvic floor muscle training (PFMT) may be indicated when perineal sensation and voluntary contractions are partially preserved. Further studies are needed to determine the efficacy of conservative electrical stimulations in neurogenic lower urinary tract dysfunction.