Bladder Diary

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Bladder Diary Instructions

 

A diary can give your therapist an excellent picture of your bladder functions, habits and patterns. At first, the diary is used as an evaluation tool. Later, it will be used to measure your progress on bladder retraining or leakage episodes.
Your log will be more accurate if you fill it out as you go through the day. It can be very difficult to remember at the end of the day exactly what happened in the morning. Please do the bladder diary on one weekend day and two work days, for 3 days total.

The more details you can provide, the better!

  • Column 1 – Time of Day
    • Each log is a 24 hour period.
  • Column 2 – If you are on your period, check this box
  • Column 3 – Type & Amount of Fluid & Food Intake
    • Record the type and amount of fluid you drank
    • Record the type and amount of food you ate
    • Record when you woke up for the day and the hour you went to sleep
  • Column 4 – Did you have a urinary urge/ was an urge present? 
    • 0- none at all = No Sensation of urine in bladder at all
    • 1- mild = Sensation of some urine but no desire to void
    • 2- mod = could not wait more than 1 hour
    • 3- strong = could not wait more than 30 minutes
    • 4- urgent = could not wait more than 5 minutes
  • Column 5 – Amount Voided (Urinated):
    • Record the amount voided
    • You can record in seconds by counting “one – one thousand”
    • Recording in ounces is best practice for the most accurate data
  • Column 6 – Amount of Leakage
    • Record the amount of urine loss at the time it occurred.
      • S- SMALL= drop or two of urine
        M- MEDIUM= wet underwear
        L- LARGE= wet outerwear or floor
  • Column 7 – Activity with Leakage & # of pads used
    • Describe the activity associated with the leakage, i.e. coughed, heard running water, sneezed, bent over, lifted something or had a strong urge.
    • If you used a pad, write down the size of the pad, i.e. panty liner, regular, overnight

COMMENTS: (at the bottom of the log table) special problems and new or changes in medication are recorded here.

Log Table

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