• In the ​Time ​column, write the time you drink, pee, have a bowel movement, or leak. Include night hours.
• In the Amount and Type of Drink column, write the type and amount of fluid you drink. Use the measurements mL, ounces, or cups.​
• Each time you empty your bladder, measure the urine in a container and write the amount in the Bladder ​column. If you can’t measure, estimate the amount as small (150 mL), medium (150 to 250 mL), or large (250 mL or more).
• Each time your bladder leaks, write in the ​Leaking and Urge column under Urine if it was a small (few drops), medium (wet underwear or pad), or large amount (soaked clothes or pad).​
  • ​​​​​Include what you think caused the leak—for example, cough, sudden movement, or strong urge. For an urge, write how strong the urge was from 1 (weak) to 5 (strong).​​
    
• In the Bowel Movement column, write down the type of stool: 1 = liquid, 2 = toothpaste-like, 3 = formed but soft, 4 = hard, 5 = pebble-like.
• ​Each time you leak stool, write the type (1 to 5) and amount (small, medium, large) in the Leaking and Urge column under Stool.
  • ​Include what you think caused the leak—for example, a cough, sudden movement, or strong urge. For an urge, write how strong the urge​ was from 0 (no​ urge) to 5 (very ​strong urge).​
    
• In the ​ Pelvic Pain column, note if you have pelvic pain and how bad it is from 0 (no pain) to 10 ( worst pain).
• ​Add any comments that you think will be helpful for your healthcare provider.
  

​Example: