Regardless of age, mobility, mentation, or institutionalization, incontinence is never normal. By attenuating physiologic reserve, aging increases the likelihood of becoming incontinent in the setting of additional physiologic, pharmacologic, or pathologic insults. Because many of these problems lie outside the urinary tract, so too must the diagnostic and therapeutic focus. Such a strategy, however, coupled with a multifactorial, creative, persistent, and optimistic approach, increases the chances of a successful outcome and generally rewards patient and physician alike.