Abstract Objective To assess the long‐term effectiveness of app‐based treatment for female stress, urgency or mixed urinary incontinence (UI) compared with care‐as‐usual in primary care. Design A pragmatic, randomised controlled, superiority trial. Setting Primary care in the Netherlands from 2015 to 2018, follow up at 12 months. Population Women with two or more UI episodes per week and access to mobile apps, wanting treatment. A total of 262 women were randomised equally to app or care‐as‐usual; 89 (68%) and 83 (63%) attended 1 year follow up. Interventions The standalone app included conservative management for UI with motivation aids (e.g. reminders). Care‐as‐usual was delivered according to the Dutch GP guideline for UI. Main outcome measures Effectiveness assessed by the change in symptom severity score (ICIQ‐UI‐SF) and the change in quality of life (ICIQ‐LUTSqol) with linear regression on an intention‐to‐treat basis. Results Clinically relevant improvement of UI severity for both app (−2.17 ± 2.81) and care‐as‐usual (−3.43 ± 3.6) groups, with a non‐significant mean difference of 0.903 (−0.66 to 1.871). Conclusion App‐based treatment is a viable alternative to care‐as‐usual for UI in primary care in terms of effectiveness after 1 year. Tweetable abstract App‐based treatment for female urinary incontinence is a viable alternative to care‐as‐usual after 12 months.