Bladder Diary

There is such a stigma attached to loss of bladder control and the shame of it is that there is almost always something that can be done.

The urine bladder diary gives your doctor a picture of your incontinence. Keeping an accurate and thorough diary will allow your doctor to see a clearer picture of your individual situation. Try to keep your diary for at least a week before you see your doctor, then take it with you to your appointment.

Click here to download your Bladder Diary.

Instructions for Bladder Diary:

  • Make at least seven copies of the blank bladder diary form so that you can keep the diary for a week.
  • Record the time of day when you void in the toilet or have leakage.
  • Record (yes/no) that you voided in the toilet in the “Toilet” column.
  • Indicate the degree of leakage (none/damp/wet) in the “Leakage” column.
  • Indicate if you changed your absorbent product or had to change your clothing.
  • Note your activity at the time of any leakage.
  • Measuring the amount you drank or voided may help the doctor or nurse assess your condition. If possible, record these measurements in the “Fluid Intake” and “Fluid Output” columns.

Download Bladder Diary (PDF)