Ageing affects the lower urinary tract and is a recognised risk factor for voiding dysfunction and urinary incontinence. The reported prevalence of urinary incontinence in community dwelling older persons ranges from 10% to 40% and up to 70% in residents in aged care residential facilities. Lower urinary tract symptoms and urinary incontinence have been associated with worsening quality of life and morbidity including increased risk of falls, urinary tract infections, urinary retention, renal deterioration and skin irritation. This chapter utilises case examples to illustrate the complexities and principles of continence management in the older patient. The importance of multidisciplinary input and the roles of conservative therapy, optimisation of continence appliances, drug use in the elderly and perioperative care are discussed in the context of common presentations.