Overactive bladder (OAB) is a complex of symptoms frequently encountered in the primary care setting. Impediments to optimal management of OAB include inaccurate perceptions on the part of patients and primary care providers, e.g., that the symptoms of OAB represent a natural progression of aging and are beyond the scope of treatment or that diagnosis and treatment are specialist concerns. Complicating the physician’s task is the reluctance of many patients to initiate discussion of their OAB symptoms and the fact that patients often develop disruptive coping strategies rather than seek medical treatment, possibly because of a belief that OAB is a normal part of aging rather than an actual medical condition. In most cases, OAB may be managed quite well by the primary care physician who has an understanding of the pathophysiology of OAB. This article reviews normal bladder function and then explores pathophysiologic changes that likely cause the symptoms of OAB.