Purpose/Hypothesis: The purpose of this study is to describe the prevalence of urinary incontinence (UI) in inpatient rehabilitation facilities (IRFs) and evaluate the impact of UI on patient outcomes. Number of Subjects: 435,547 Medicare beneficiaries admitted to inpatient medical rehabilitation in 2005. Materials/Methods: A retrospective, cohort study was performed using 2005 Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data to report continence status at discharge (continent, continent with device, incontinent), self-care and mobility function at discharge, and discharge to community. Results: Of the patients admitted to IRFs, 24% are incontinent and 44% are continent with a device on admission. UI is most prevalent in stroke (32%) and brain injury patients (31%) but the largest absolute numbers are among orthopedic patients. (n = 27046 incontinent, n = 69953 continent with a device) Continence with a device is most prevalent among spinal cord injury patients. Most patients with UI do not change status from admission to discharge; 62% are still incontinent at discharge. In regression models, for patients with UI, IRF-PAI mobility score was 2.4 points lower at discharge, on average. In addition, patients with UI at discharge were 2.6 points lower on self care, and LOS is 1.9 days longer, on average. Many patients with UI (67%) are discharged to the community but it was less likely than patients without UI. Conclusions: UI is highly prevalent among IRF patients. UI makes a significant contribution to patient outcomes independent of functional status at admission. UI is common in multiple rehabilitation diagnoses including neurologic and orthopedic. UI is related to significantly worse patient mobility and self care outcomes. Clinical Relevance: Physical therapy interventions such as sacral electrical stimulation and pelvic floor muscle exercises, as well as simple behavioral techniques such as timed voiding, can be initiated during the inpatient admission and can benefit many patients with UI. Yet assessment and treatment of UI is rarely given sufficient priority in inpatient physical therapy treatment planning. Because many causes of UI are potentially treatable by physical therapists, these data suggest opportunities for improved patient outcomes. Though treatment strategies for UI may differ by diagnostic group, all patients could potentially be treated with relatively simple interventions if higher priority was given to UI's prevalence and significance.