The purpose of this study was to develop a substantive theory describing and explaining cognitive, psychosocial, and behavioural aspects of living with urinary incontinence in a nursing home. Using grounded theory methodology, data were obtained from interviews, participant observation, and minutes from meetings of resident advisory councils, and analysed concurrently using the constant comparative method. Three nursing homes located in the metropolitan area of a major American city served as sites for the study. Ethical approval was obtained from the administrator of each facility and institutional review board of a major university. Ten residents served as primary participants, consenting to provide one audiotaped formal interview, subsequent opportunities to observe and discuss their methods of bladder control, and access to their health care records. Another 33 residents from these facilities served as secondary participants, providing opportunities for observation and informal interview when their bladder control needs, issues, or methods were visible to the investigator and seemed relevant to the evolving theory. Data were collected over a period of 17 months. Findings suggest that nursing home residents with actual or potential urinary incontinence engage in a process called managing urinary incontinence. Managing urinary incontinence occurs in the context of believing that it is an inevitable part of ageing and seeking to protect physical, psychological, and social integrity. Managing urinary incontinence is a dynamic process with consequences that are influenced by the degree to which six specific strategies are used with satisfaction by the resident and supported by staff and significant others. Implications for nursing practice and research are discussed.