Healthwise

Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein.

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: November 15, 2023

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

Due to the threat of the COVID-19 (Coronavirus), we are taking precautionary measures to protect our staff and patients. We are implementing a temporary NO VISITOR policy at this time. Only patients or patients and their guardians will be allowed into the office. Please note, this is not to inconvenience anyone! The virus is a very real threat and it is essential that we stay healthy in order to provide needed care for our patients. If you are sick, we ask that you CALL the office to speak with a nurse before you come in. The nurse will provide specific instructions for you. Please DO NOT enter the office if you are sick (upper respiratory symptoms, fever, cough, or flu like symptoms). We are closely monitoring the situation and will update you as circumstances change. Thank you for your understanding!!