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), and when you drink it.
  • Use a jug to measure the amount of urine you pass in mls and record this on the chart next to the most recent intake time.

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:

  • 1– I felt no need to empty my bladder, but did so for other reasons
  • 2 – I could postpone voiding (emptying my bladder) as long as necessary without fear of wetting myself.
  • 3 – I could postpone voiding for a short while, without fear of wetting myself.
  • 4 – I could postpone voiding, but had to rush to the toilet in order not to wet myself.
  • 5 – I leaked before arriving to the toilet
Bladder Diary

Bladder Diary

Please use format DD/MM/YYYY
All responses will go to this email address.

Day 1

Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock
Please use 24 hour clock