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Healthy Bladder and Bowel

Bladder and Bowel Diary

​​​​Printable Version

A bladder and bowel diary helps give you information about what and when you drink, how often, how much you urinate (pee), and when and why your bladder leaks. It also gives the same information about your bowels. This information helps us to learn more about your problem and plan your treatment.

How to Use the Bladder and Bowel Diary

  • Write down the time that you drink, pee, or leak in the "time" column, including night hours.
  • List the type and amount of fluid you drink in the "drink" column. Use the measurements: mL, ounces, or cups.
  • Each time you empty your bladder, measure the urine in a container and write down the amount in the "void" column.  If you can’t measure it, estimate the amount as small, medium, or large (small = 150 mL or less, medium = 150 to 250 mL, large = 250 mL or more).
  • Each time your bladder leaks, write in the "leak" column if it was a small, medium, or large amount (small = few drops, medium = wet underwear or pad, large = soaked clothes or pad).
  • Write down what you think caused you to leak (for example: a cough, strong urge, or sudden movement). If it was because of an urge, write down how strong the urge was (1 = weak to 5 = strong).
  • Write down each bowel movement and the type of stool (see the legend on the next page).
  • Write down if you leak stool. Write down the type, amount, possible cause/trigger, and if you had the urge to go (0 = no urge to 5 = very strong urge).
  • Write down if you had pelvic pain, and grade your pain.

Example:

Time Amount and Type of Drink​
Bladder:
 
 Amount in Container​
Bowel Movement:
 Type
 (1 to 5)​

​ ​Leaking and Urge?

 (0=none, 5=very bad)

 Amount and reason for loss

Pelvic Pain

(0=no pain

10=very bad)​
Urine Stool
7:00 am​ 350 mL​ Sm – cough, 2/5​
8:15 am​ 1 cup milk​ 0​
9:30 am​
10:00 am​ 200 mL​
10:30 am​ 1 cup tea​ 3​ 2​

Comments:My allergies are acting up.
Number and style of pads used today: 2 panty liners

  • Your nurse or doctor will tell you the number of days to fill out this diary. Please bring it to your next appointment.

Click for a blank diary you can print.

Current as of: March 19, 2018

Author: Pelvic Floor Group, Alberta Health Services