Bladder Diary

If you have been advised to complete a Bladder Dairy, please complete this form.

Bladder Diary

Keeping a bladder diary helps us to make an assessment of how your bladder is working and gives us an idea of the amount you drink, the amount of urine your bladder can hold, and how often you pass urine.

How to complete your bladder diary

  • Fill in the bladder diary as carefully as possible for two days in the week.
  • For each day record what and how much you drink (in mls or cups), and when you drink it.
  • Use a jug to measure the amount of urine you pass. Record the amount on the chart.
  • If you leak urine, tick the column marked ‘wet’.

Every time you pass urine, please put a letter on the chart from the list below that describes
how urgently you had to get to the toilet:

A. I felt no need to empty my bladder, but did so for other reasons.
B. I could postpone voiding (emptying my bladder) as long as necessary without fear of
wetting myself.
C. I could postpone voiding for a short while, without fear of wetting myself.
D. I could not postpone voiding, but had to rush to the toilet in order not to wet myself.
E. I leaked before arriving to the toilet.

Please use this date format: DD/MM/YYYY.
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