OBJECTIVES To demonstrate the contribution of problems associated with an overactive bladder; namely continence, urgency and frequency, on health related quality of life and utility. METHODS Patients treated by an academic urology unit in the UK were sent a self-completed survey that included the EQ5D and SF36 and urology disease-specific questions. Potentially confounding factors were controlled using multivariate linear regression analysis. The survey was undertaken with the Health Outcomes Data Repository (HODaR) framework, a large representative dataset linking clinical data to routine QoL and utility survey responses. RESULTS In a routine survey without reminders, 609 surveys were retuned (28% response rate). The mean age of respondents was 65 years (SD 15.5) and 68% were male. Sixty percent of valid responses reported some degree of incontinence. Of these, 60% reported stress incontinence; 85% had urinary frequency problems and 91% had urgency. Among the generally continent: 12% reported stress incontinence; 60% reported frequency problems and 54% reported urgency. Controlling for age, gender and body mass index (BMI), incontinence was associated with a reduction in the EQ5Dindex (-0.11; SE 0.026, p<0.001) and SF36 scores across all domains (max: physical role -14.51 (SE 3.92; p<0.001)). Under similar analytic conditions in continent respondents, urgency significantly reduced social and mental-role functioning (-8.55; p=0.069 & -14.51; p=0.080, respectively) whilst frequency reduced the energy domain (-9.09; p<0.05). Among the incontinent, urgency reduced social functioning by -17.61 (p<0.05), and the mental domain by -11.58 (p<0.05) whilst frequency again reduced the energy domain by -9.07 (p<0.05). CONCLUSIONS Incontinence has a detrimental impact on quality of life comparable with diseases and conditions traditionally regarded as being more serious. Urinary urgency reduces social functioning and mental well-being, whilst increased urinary frequency increases tiredness.