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Kidney and Urologic Disease Organizations

Many organizations provide support to patients and medical professionals. View the full list of Kidney and Urologic Disease Organizations​​. (PDF, 345 KB)

What Your Doctor Needs to Know

To prepare for your doctor's appointment, check all the boxes below that apply to you. This information will help your doctor understand your bladder control problem.

checkbox  I take these prescription medicines:​
medicine: ________________________ dose: _________________
medicine: ________________________ dose: _________________
medicine: ________________________ dose: _________________

checkbox  I take these over-the-counter drugs (such as Tylenol, aspirin, or Maalox):
medicine: ________________________ dose: _________________
medicine: ________________________ dose: _________________
medicine: ________________________ dose: _________________

If you take more medicines, please list them on a separate paper.

I started having bladder trouble

checkbox  within the past few months
checkbox  1 to 2 years ago
checkbox  ________ years ago

checkbox  Number of babies I have had:_____________________

checkbox  My periods stopped-menopause.

checkbox  I had an operation.
Type of operation:________________________________

checkbox  I recently hurt myself or have been sick.
Date: _________________________________________
Type of injury or illness:____________________________

checkbox  I recently had a bladder—urinary tract—infection.
Date: _________________________________________

checkbox  I smoke cigarettes.

checkbox  I have pain or a burning feeling when I urinate.

checkbox  I often have a really strong urge to urinate right away.

checkbox  Sometimes my bladder feels full, even after I finish urinating.

checkbox  I go to the bathroom often, but very little urine comes out.

checkbox  I don't go out with friends or family because I worry about leaking urine.

checkbox  The first thing I do at new places is check the bathroom location.

checkbox  I worry about being put in a nursing home because of bladder control problems.

I have, or had, these medical problems:

checkbox  cancer checkbox  depression
checkbox  crippling arthritis check  diverticulitis
checkbox  diabetes checkbox  multiple sclerosis
checkbox  interstitial cystitis checkbox  stroke
checkbox  spinal cord injury checkbox  other_____________________
checkbox  urinary infection  

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

This information is not copyrighted. The NIDDK encourages people to share this content freely.


April 2014