Geriatric patients are defined as being over 70 years of age and are vulnerable due to multimedication and multimorbidity. The typical incontinence type in geriatric patients is the overactive bladder syndrome as a result of anatomical alterations and the influence of conditions which typically occur in the elderly, e.g. diabetes mellitus, vaginal atrophy, constipation, neurological affections and dementia. This multimorbidity leads to multimedication but many pharmaceutical compounds aimed at indications of diseases distant from the urinary tract can also influence the continence situation. This has been proven for cardiac medications, such as alpha-blockers and diuretics, neurological drug therapy and analgesics. Diagnostic investigations in geriatric patients are usually non-invasive and include geriatric assessment to quantify incontinence symptoms but invasive diagnostic tools are required if the primary therapy fails or an operative intervention is planned. Pharmacotherapy considers the special requirements of the very old patient with cognitive impairment and vulnerability due to falls or delirium. In the group of anticholinergic drugs, trospium chloride seems to be the favorite substance to treat this group of patients because this hydrophilic compound is considered to be unable to cross the blood-brain barrier and therefore minimizes the risk of side effects in the central nervous system (CNS).