Women are impacted twice as likely as men by urgency urinary incontinence (UUI) with nearly one-third of women suffering from UUI in their lifetime. The etiology of UUI is complex, but evidence suggests that shifts in the normal urinary microbiome may play a role in UUI. We aim to understand whether women with UUI have different urinary bacterial loads compared to women without UUI and whether this is correlated with severity of UUI symptoms. Our prospective cohort study compares urinary microbiome in women with and without UUI. This study provides evidence that women with UUI have significantly higher urinary bacterial load, but the higher bacterial load was associated with less severe symptoms. Larger bacterial load in women with UUI symptoms may represent a mix of both pathogenic and commensal bacteria and that symptom severity is dependent on proportion between these two types of bacteria rather than the overall abundance.