Aims To understand mechanisms underlying overactive bladder (OAB) and voiding dysfunction (VD) in neurologically normal women. Methods: Review of MEDLINE from (1982) to (2011) using defined search terms, and manual analysis. Only articles published in English were included. Results: One in five women report moderate to severe lower urinary tract symptoms (LUTS). Whilst VD is more common in men, women report a higher rate of storage symptoms or post-micturition symptoms. Post-void residual (PVR) volume measurements are vital in the assessment of women with LUTS and patients with VD without stress incontinence (SUI) are likely to have an elevated PVR (82%). Bladder outlet obstruction (BOO) also causes VD in women and can be alleviated by surgery or alpha-blocker therapy, although OAB symptoms typically remain. Surgical repair for SUI can result in temporary VD in the minority of patients, highlighting the complex interplay that is emerging in the urethral bladder functioning complex in women. Conclusions: Women with impaired bladder emptying present with a wide range of LUTS, and PVR measurement is essential for diagnosis. OAB and VD can clearly coexist and accurate diagnosis of underlying pathophysiology is required. Recommendations for clinical practice and research are provided including: investigation of VD in women with OAB; evaluation of PVR values to determine appropriate therapy and identification of BOO. There is clearly a need for further research into the impact of alpha-blockers in women with VD as well as an evaluation of PVR changes in women with OAB before and after antimuscarinic therapy. Neurourol. Urodynam. 31: 422-428, 2012. (C) 2012 Wiley Periodicals, Inc.