Fort Worth Urogynecology — Bladder Diary
1250 8th Avenue, Suite 330, Fort Worth, TX 76104 · (817) 923‑5559 · Fax (817) 924‑3222
What you'll need
- A measuring container. A plastic measuring cup from the kitchen works perfectly. You'll use it to catch and measure your urine, so keep it in the bathroom.
- This chart and a pen, kept somewhere you'll actually see them — next to the toilet is best.
- Three days. They don't have to be in a row. Pick days that are typical for you rather than unusually busy or unusually quiet ones. Many women find a weekend easiest.
Record around the clock, including overnight. If you get up at night, write it down. Nighttime trips are one of the most useful things the diary tells us.
How to fill it in
- 1Every time you drink something, write down the time, what it was, and roughly how much. Coffee, water, soda, wine — all of it counts, and the type matters as much as the amount.
- 2Every time you pass urine, measure it in your container and write down the amount. Ounces or milliliters are both fine, whichever your cup shows — just stay consistent.
- 3Rate how urgent it felt using the 0 to 3 scale below. This is the part people skip, and it's often the most revealing column on the page.
- 4If you leaked, mark which kind it was — leaking that came with a sudden urge, or leaking that happened with coughing, laughing, lifting, or exercise. These are different problems, and telling them apart is one of the main things we're looking for.
- 5Note any pad changes, so we can see how much protection you're using in a normal day.
The urgency scale
0
No urge at all — you went because it seemed like a good time
1
A mild urge, easy to put off
2
A strong urge, but you could hold it
3
Had to rush — couldn't put it off at all
Don't change your habits for the diary. It's tempting to drink less or go less often so the numbers look better. Please don't — an ordinary day is exactly what we need to see. There are no wrong answers here.
Your three days
Day 1
Date:
| Time | What you dranktype and amount | Urine passedoz or mL | Urgency0–3 | Leak with urge | Leak with activity | Pad change |
|---|---|---|---|---|---|---|
Anything else worth noting:
Day 2
Date:
| Time | What you dranktype and amount | Urine passedoz or mL | Urgency0–3 | Leak with urge | Leak with activity | Pad change |
|---|---|---|---|---|---|---|
Anything else worth noting:
Day 3
Date:
| Time | What you dranktype and amount | Urine passedoz or mL | Urgency0–3 | Leak with urge | Leak with activity | Pad change |
|---|---|---|---|---|---|---|
Anything else worth noting:
Bring it with you. Don't worry if a day is incomplete or a little messy — a partly filled diary is far more useful than none at all.