Dear Diary -

When someone calls my office to set up an appointment for any condition remotely related to pelvic floor problems, I ask them to track behavior in a bladder diary for at least 3 days before the initial consult. I require this of patients with incontinence, pelvic pain, interstitial cystitis, vulvodynia, and urinary frequency. Often the response I get is, “Oh – I don’t need to do that, I don’t leak, and I know how often I go to the bathroom.” This is really good information – but; a bladder diary can tell me so much more.

Different diaries allow for recording of different data. My favorite is from the NIDDK (The National Institute of Diabetes and Digestive and Kidney Diseases). Click here to download a copy in pdf format: Bladder Diary. This diary breaks the day up hourly, with separate sheets for night and day. Each hour you are asked to record what you drank, and how much; how often you urinated, and how much; if you had an accidental leak; if you had a strong urge to urinate; and what activity you were involved in at the time. I know – you think you are going to spend your life filling out a ridiculous form, you already know you go too little, too often, and you don’t drink enough water. But now we have a pattern, and this information will tell me a lot about when you have the most frequency, and maybe some information about why.

For instance: some nights you only have to get up once or twice to urinate, some nights it’s five. Most people are aware that they occasionally have more nocturia (night-time urination), but with a bladder diary we may find out that it happens on nights that they have a glass of wine or soda with dinner. Sometimes the patterns aren’t as easy to see: once a bladder diary showed me that a patient went to the bathroom as often as 4 times in one hour on Monday afternoons – the day her mother-in-law came to visit the grand children. Do you think stress may have been a factor?

Usually the diary is a tool I use to further explore problem areas with the patient. Sometime, just the act of writing things down lets the patient see patterns that they were missing. I had someone schedule for an evaluation because she had severe urge incontinence. While doing her homework before the appointment, she realized that she lost control as she got to her front door after work everyday. She also realized that she worked an 8 hour day without urinating – not even once. She disciplined herself to take potty breaks during the day, and called me to cancel her appointments – complete resolution of the problem.

Even if your healthcare provider has not asked for a bladder diary, it might be a good idea to start one. I only ask for 3 days because I can usually expect some level of compliance in that amount of time; a week would be better, a month would be optimal. Some additional things that you may want to track, especially if this is a problem you have had for a long time, or if you are seeing a new doctor, or just looking for more comprehensive information to give your health care team:

• Bowell patterns. Are you frequently constipated? If so, when? And does it affect your urinary frequency, urgency, or incontinence?


• Menstrual patterns. Do you have more symptoms before, during, or after your period?


• Diet. Some foods irritate the bladder, and most diaries only consider fluids.


• Stress patterns. What is going on in your environment, and in your head? Does any of this have a bearing on your symptoms?

Don’t just write down the bad things; track the simple pleasures in your life. You may find that when you have a really good day – your bladder has a good day, too!