The prevalence of urinary incontinence and other lower urinary tract symptoms (LUTS) increases in association with increasing age. This effect is more noticeable in men after the seventh decade of life and, in women, postmenopausally. However, the changes in the lower urinary tract, peripheral nervous system and central nervous system that underpin this observation are both multifactorial and inadequately understood; much debate exists regarding whether these observed changes are pathological or are a part of the 'normal' ageing process; with both health professionals and older people often holding the view that incontinence is an expected part of normal ageing. Here we aim to summarize the current level of knowledge regarding the physiological and hormonal changes that take place during the ageing process and discuss whether the occurrence of urinary incontinence or other LUTS in later life better reflect part of the 'normal' ageing process or the presence of unaddressed pathology.