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 Home : Kidney & Urologic Diseases A-Z List of Topics and Titles : Bladder Control for Women : What I need to know about Bladder Control for Women

 

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, “small,” “medium,” and “large.” The bottom quarter of the “small” circle is shaded gray. The bottom half of the “medium” circle is shaded gray. All but the very top of the “large” circle is shaded gray. The circles are to be used to record how much urine was released in a trip to the bathroom. In the sample row, a circle has been drawn around the “small” circle. Three circles appear side by side in each cell in this column. The circles are labeled, from left to right, “small,” “medium,” and “large.” The bottom quarter of the “small” circle is shaded gray. The bottom half of the “medium” circle is shaded gray. All but the very top of the “large” circle is shaded gray. The circles are to be used to record how much urine was accidentally leaked. In the sample row, a circle has been drawn around the “medium” circle. The words “yes” and “no” appear in this cell side by side. The word “no” is circled. 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  

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, “small,” “medium,” and “large.” The bottom quarter of the “small” circle is shaded gray. The bottom half of the “medium” circle is shaded gray. All but the very top of the “large” circle is shaded gray. The circles are to be used to record how much urine was released in a trip to the bathroom. In the sample row, a circle has been drawn around the “small” circle. Three circles appear side by side in each cell in this column. The circles are labeled, from left to right, “small,” “medium,” and “large.” The bottom quarter of the “small” circle is shaded gray. The bottom half of the “medium” circle is shaded gray. All but the very top of the “large” circle is shaded gray. The circles are to be used to record how much urine was accidentally leaked. In the sample row, a circle has been drawn around the “medium” circle. The words “yes” and “no” appear in this cell side by side. The word “no” is circled. 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  
 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 “yes” and “no” appear in this cell side by side.  

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.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.

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

NIH Publication No. 07–4195
August 2007

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The NKUDIC 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
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