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Your Daily Bladder Diary

This diary will help you and your health care team figure out the causes of your bladder control trouble. The "sample" line shows you how to use the diary.

Your name: ________________________________________________
Date: _____________________

 Time  Drinks  Trips to the
 Bathroom
 Accidental
 Leaks
 Did you feel
 a strong
 urge to go?
 What were you
 doing at the
 time?
  What kind? How much? How many times? How much urine? (circle one) How much? (circle one) Circle one Sneezing, exercising
having sex, lifting, etc.
 Sample Coffee 2 cups A cell with two checkmarks demonstrates how the user is to record two trips to the bathroom. Three circles appear side by side in each cell in this column.  The circles are labeled, from left to right, Three circles appear side by side in each cell in this column.  The circles are labeled, from left to right, The words Running
 6–7 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 7–8 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 8–9 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 9–10 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 10–11 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 11–12 noon       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 12–1 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 1–2 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 2–3 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 3–4 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 4–5 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 5–6 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 6–7 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  

Use this sheet as a master for making copies that you can use as a bladder diary for as many days as you need.

 Time  Drinks  Trips to the
 Bathroom
 Accidental
 Leaks
 Did you feel
 a strong
 urge to go?
 What were you
 doing at the
 time?
  What kind? How much? How many times? How much urine? (circle one) How much? (circle one) Circle one Sneezing, exercising
having sex, lifting, etc.
 Sample  soda 2 cans A cell with two checkmarks demonstrates how the user is to record two trips to the bathroom. Three circles appear side by side in each cell in this column.  The circles are labeled, from left to right, Three circles appear side by side in each cell in this column.  The circles are labeled, from left to right, The words Running
 7–8 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 8–9 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 9–10 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 10–11 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 11–12 midnight       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 12–1 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 1–2 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 2–3 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 3–4 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 4–5 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 5–6 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  

I used _______ pads today. I used ________ diapers today (write number).

Questions to ask my health care team: _________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

Let's Talk About Bladder Control for Women is a public health awareness campaign conducted by the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health.


National Kidney and Urologic Diseases Information Clearinghouse

3 Information Way
Bethesda, MD 20892-3580
Phone: 1-800-891-5390
TTY: 1-866-569-1162
Fax: 703-738-4929
Email: nkudic@info.niddk.nih.gov
Internet: www.kidney.niddk.nih.gov

The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your health care provider for more information.


NIH Publication No. 07–4195
August 2007

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Page last updated April 2, 2014


 

The National Kidney and Urologic Diseases Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892–3580
Phone: 1–800–891–5390
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nkudic@info.niddk.nih.gov
Internet: www.kidney.niddk.nih.gov

Department of Health and Human Services The National Institute of Diabetes and Digestive and Kidney Diseases USA.gov is the U.S. government's official web portal to all federal, state, and local government web resources and services. This website is certified by Health On the Net Foundation. Click to verify.

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