The management of urinary retention in the elderly female can present a challenging conundrum for primary care physicians, geriatricians, and urologists. It is often difficult to diagnose due to concomitant comorbidities and potential cognitive impairments. Evaluation should include a comprehensive history and physical examination, post-void residual, and urinalysis with consideration given to urodynamic testing in select patients. Management varies from conservative to invasive and should be tailored to the individual patient. Primary goals of care include symptom reduction, prevention of urinary tract infection, and upper tract deterioration. This presents an up-to-date review of the presentation, diagnosis, and management options available for elderly women with urinary retention.