Objectives: to determine the impact of incontinence on individual patients. To identifythe impact of effective and ineffective health interventions for the management of incontinence on individuals. Design: a multiple case study approach using qualitative and quantitative research methods. Setting: this research was undertaken in two health authorities, one with an established continence advisory service (CAS) that fulfilled 10 of the 11 key features for a continence service (Department of Health 1991), and one without a service that fulfilled three of these features. Participants: a quota sample of subjects whose incontinence had been successfullymanaged and unsuccessfully managed was identified by health professionals (n=28). Main outcome measures: qualitative data — themes related to health professionals,health services, consumer views and continence status. Quantitative data — Self Esteem Scale and Incontinence Impact Questionnaire. Findings: themes from the qualitative data related to the effective and ineffectivemanagement of incontinence are discussed in relation to health professionals and health services, along with suggestions for purchasers and providers. Conclusions: the effective management of incontinence is not simply a matter of thetechnical skills of health professionals. It demands a patient-centred approach that emphasizes the possibility of self-referral, open access to services and services that maintain the patient's privacy and dignity. Such services need to be seen in the light of their appropriateness and acceptability to users.