This chapter provides an overview of incontinence and lower urinary tract symptoms in normal pressure hydrocephalus (NPH), and covers areas including dementia and incontinence, differential diagnosis, physiology and pathophysiology, symptoms, evaluation, and treatment. The relationship between gait disturbances, dementia, and incontinence has profound importance because of the potential heightened risk of falls. In the central nervous system, there are two main areas involved in the motor control and reciprocal coordination of lower urinary tract function. Our understanding of lower urinary tract dysfunction in NPH is limited by a lack of detailed knowledge of the supraspinal pathways involved in the control of micturition. Urodynamic studies may be the most important investigative procedures performed in patients with significant urinary symptoms and idiopathic NPH (iNPH), as the results will help identify etiologies and guide treatments. Patients may be treatment refractory to standard doses or may require higher than recommended doses or combination therapies.