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Voiding Log (Bladder Record)

Overview

Complete one of these records each day for several days, then take the completed records to your doctor. This information will help you and your doctor see how often you leak urine and what seems to cause the leakage.

Name:

Date:

Instructions: Place a check mark in the appropriate column next to the time you urinated in the toilet or when an incontinence episode occurred. Note the reason for the incontinence, and describe your liquid intake (for example, coffee or water) and estimate the amount (for example, 1 cup).

Time interval

Urinated in toilet

Had a small incontinence episode

Had a large incontinence episode

Reason for incontinence episode

Type/amount of liquid intake

6–8 a.m.




8–10 a.m.




10 a.m.–noon




Noon–2 p.m.




2–4 p.m.




4–6 p.m.




6–8 p.m.




8–10 p.m.




10 p.m.–midnight




Overnight




Number of times urine leaked today:

Number of absorbent pads used today:

Comments:

Source: Fantl JA, et al. (1996). Urinary Incontinence in Adults: Acute and Chronic Management: 1996 Update. AHCPR Clinical Practice Guidelines, No. 2. Rockville, MD: Agency for Health Care Policy and Research (AHCPR).

Credits

Current as of: April 30, 2024

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Current as of: April 30, 2024

Author: Ignite Healthwise, LLC Staff

Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.