The assessment of female urinary incontinence aims to evaluate the severity of the patient's condition and its impact on her quality of life. The initial evaluation should include investigation of the patient's symptoms, the compilation of a frequency/volume chart, physical examination and urinalysis. Concurrent confounding conditions should be addressed. For effective treatment, it is necessary to differentiate between urge incontinence secondary to detrusor instability and stress incontinence due to sphincter weakness. Symptom assessment alone, performed clinically or by questionnaire, is diagnostically inaccurate and urodynamic diagnosis is necessary before invasive treatment. Self-reporting of symptom severity does correlate reasonably with objective measures of fluid loss, although standardised methods for the quantification of incontinence should be developed to allow comparisons between patients and the monitoring of disease progression and outcome. Symptom severity does not correspond to patients' perception of the effect of the condition on quality of life and this is an important factor in identifying what treatment is appropriate.