U.S. Department of Health and Human Services
 

 Alternate Versions

 

You can also order print versions from our online catalog.

Contact Us

Health Information Center

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)

Your Daily Bladder Diary

This diary will help you and your health care team figure out the causes of your bladder control trouble. The "sample" line shows you how to use the diary.

Your name: ________________________________________________
Date: _____________________

 Time  Drinks  Trips to the
 Bathroom
 Accidental
 Leaks
 Did you feel
 a strong
 urge to go?
 What were you
 doing at the
 time?
  What kind? How much? How many times? How much urine? (circle one) How much? (circle one) Circle one Sneezing, exercising
having sex, lifting, etc.
 Sample Coffee 2 cups A cell with two checkmarks demonstrates how the user is to record two trips to the bathroom. Three circles appear side by side in each cell in this column.  The circles are labeled, from left to right, Three circles appear side by side in each cell in this column.  The circles are labeled, from left to right, The words Running
 6–7 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 7–8 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 8–9 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 9–10 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 10–11 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 11–12 noon       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 12–1 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 1–2 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 2–3 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 3–4 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 4–5 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 5–6 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 6–7 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  

Use this sheet as a master for making copies that you can use as a bladder diary for as many days as you need.

 Time  Drinks  Trips to the
 Bathroom
 Accidental
 Leaks
 Did you feel
 a strong
 urge to go?
 What were you
 doing at the
 time?
  What kind? How much? How many times? How much urine? (circle one) How much? (circle one) Circle one Sneezing, exercising
having sex, lifting, etc.
 Sample  soda 2 cans A cell with two checkmarks demonstrates how the user is to record two trips to the bathroom. Three circles appear side by side in each cell in this column.  The circles are labeled, from left to right, Three circles appear side by side in each cell in this column.  The circles are labeled, from left to right, The words Running
 7–8 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 8–9 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 9–10 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 10–11 p.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 11–12 midnight       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 12–1 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 1–2 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 2–3 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 3–4 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 4–5 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  
 5–6 a.m.       Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. Three circles appear side by side.  The bottom quarter of the circle on the left is shaded gray.  The bottom half of the circle in the middle is shaded gray.  All but the very top of the circle on the right is shaded gray. The words  

I used _______ pads today. I used ________ diapers today (write number).

Questions to ask my health care team: _________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

Let's Talk About Bladder Control for Women is a public health awareness campaign conducted by the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health.


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.


[Top]

April 2014